What is it?
This is a degenerative condition of the elbow joint whereby the cartilage becomes damaged or is worn away over time. Arthritis is an unusual occurrence in the elbow due to its highly congruent joint surface and strong supportive ligaments.
Why does it occur?
The majority of patients with elbow arthritis have previously sustained damage to the joint either by fracture or dislocation. The joint surface becomes uneven and new bone can form irregularly (osteophytes) restricting movement. Alternatively some suffer as a result of activity involving overloading/use of the joint causing degenerative wear and tear.
What are the symptoms?
Elbow arthritis is most commonly associated with pain, stiffness and swelling particularly after periods of increased activity. Some experience a creaking sensation felt when moving the elbow or restricted movement. Where loose bodies can be present in the joint, patients may experience elbow ‘locking’, with symptoms resolving after shaking the affected arm and displacing the fragments within the joint.
How is it diagnosed?
Your treating doctor will ask you a series of questions to establish whether you have any risk factors for arthritis and the severity of your symptoms. They will also carry out a detailed examination of your joints. In most cases the diagnosis is confirmed with an x-ray but occasionally further tests or scans may be required.
How is it treated?
The best course of treatment for elbow arthritis depends the part of the joint affected, your general health, activity levels and symptom severity. Conservative options should be trialled and exhausted prior to consideration of surgical management. There are three articulations within the elbow joint and your clinician should identify exactly what aspect is affected prior to initiating treatment. Contributing factors are numerous and should be excluded appropriately.
1. Non-surgical treatment
Options include lifestyle modification in combination with analgesia. Physiotherapy in the early stages is known to delay the onset and stiffness severity, or failing this steroid injections can be beneficial in reducing inflammation. Alternatively a course of hyaluronic acid injections acts to lubricate and cushion the joint producing an analgesic effect.
2. Surgical treatment
If non-surgical measures fail surgery may be indicated to relieve pain and improve function. Arthroscopy, or keyhole surgery is often considered in those with less severe arthritis involving multiple small incisions around the elbow joint. This is often done as a day case, and involves the use of instruments to remove loose bodies and smooth joint surfaces. Burring away of new altered bony spurs, ‘osteophytes’ that may be impinging local soft tissues would also be possible via keyhole surgery.
Where the joint surface has worn away completely, options are more focused on joint replacement. Some patients may be deemed unsuitable due to being too young or active. In these cases alternative surgical options may include a release of the contracted joint capsule via keyhole surgery or replacement of the joint surface using the patient’s own body tissue.
The definitive plan will depend on a case by case basis, and all the options will be discussed including the risks and benefits during your consultation.