Elbow Osteoarthritis
The elbow joint has two joints: the ulnohumeral joint to allow the elbow to extend and flex and the radiocapitellar joint to allow the forearm to rotate. Osteoarthritis of the elbow joint is relatively uncommon Primary Elbow Osteoarthritis: Evaluation and Management – PMC, affecting 2-3% of the general population. It is either primary (due to degeneration) and is most commonly seen in the dominant elbow of male manual workers. It can also be associated with previous trauma, dislocation or poorly controlled autoimmune diseases such as rheumatoid arthritis (secondary).
If the elbow joint surfaces are damaged by fracture or injury, the cartilage lining of the joint will wear more quickly. Similarly, if the ligaments around the elbow are damaged, the normal kinematics of the joint are altered, and early arthritis can develop.
What are the signs and symptoms?
Pain is often poorly localised around the elbow joint and can be felt anteriorly, medially and laterally, with a combination of them all being common. The symptoms are progressive, with associated stiffness developing, which is demonstrated both actively (you moving it) and passively (someone else moving it) accompanied on occasions with mechanical symptoms of locking due to loose bodies and osteophyte formation.
Strength around the elbow is usually unaffected, but carrying heavy objects is often symptomatic due to the compressive forces through the joint, especially when working overhead. Sleep is commonly affected.
How is it diagnosed?
The diagnosis of elbow osteoarthritis will usually be made from a combination of your clinical history, examination findings and a plain film X-ray of your elbow. An MRI scan can also confirm the diagnosis with the additional benefit of assessing the soft tissue supporting structures of the elbow; however, this is not commonly needed in the initial workup. Ultrasound is not typically used in the workup of osteoarthritis.
How is it treated?
Treatment options are divided into conservative and surgical.
Conservative options:
- Oral analgesia in combination with modifications of daily activities may help alleviate some of the symptoms. Elbow supports can sometimes be helpful for patients as well.
- A local anaesthetic and steroid injection, typically under ultrasound guidance, into the elbow joint can be helpful at easing some of the inflammation associated with osteoarthritis. This can provide some temporary pain relief; how long this lasts and how beneficial it is will vary in patients depending on the severity of the arthrosis and how active the patient is with their elbow. They can be repeated if they are helpful, but it is typically advisable to have a 6-monthly interval between them.
- In less severe cases of arthrosis, hyaluronic acid injections into the elbow joint, typically under ultrasound guidance, can be helpful as a potential alternative to repeated steroid injections. They have a very safe injection profile without the potential risks that steroids can have on the articular cartilage. (Please visit our Hyaluronic acid page.)
Surgical options:
If conservative options mentioned previously do not provide adequate relief or if there is already substantial arthrosis on a plain film X-ray at the time of initial presentation, then there are surgical options.
- Arthroscopy (keyhole) may be appropriate for certain patients depending on the level of their symptoms and the changes seen on plain film X-ray. Loose bodies can be removed, and the capsule can be released in the early stages of arthrosis. If the arthrosis is isolated to the radiocapitellar joint, the radial head can be excised or replaced, allowing joint preservation, which is beneficial, especially for the young, high-demand patient.
Arthroplasty (elbow replacement). Ultimately, if the joint surfaces are completely worn and pain is not controlled with conservative options, then an elbow replacement may be offered. Patients will ideally be elderly and low demand, as elbow replacements need to be looked after to prevent the implant from becoming worn/loose. Outcomes are usually very good at the 10-year follow-up for carefully selected patients. Long-term outcomes of total elbow arthroplasty: a systematic review of studies at 10-year follow-up – PubMed
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