OSTEOARTHRITIS OF THE ELBOW

Condition Overview

  • Symptomatic primary osteoarthritis of the elbow is relatively rare.

  • The average age of presentation is 50 years (with an age range of 20 to 70 years).
 
  • Men are affected more often than women.
 
  • There is tendency to affect the dominant elbow in a person involved in strenuous manual labour.
 
  • It can also be caused by trauma, osteochondritis dissecans, synovial osteochondromatosis, and prior elbow instability.
 
  • The features of osteoarthritis of the elbow include osteophytes (bone spurs), capsular contracture, and loose bodies (consisting of bone and cartilage fragments) within the elbow joint. In advanced disease, there is joint space narrowing due to the wearing down of cartilage.
 
  • Osteophytes and capsular contractures act as a mechanical block to movement. Loose bodies are responsible the catching/clicking or locking of the elbow with movement 
 
  • Patients typically present with loss of extension (the ability to straighten) and painful catching/clicking or locking of the elbow.
 
  • Pain is typically noted at the extremes of motion (at maximum straightening and at maximum bend) and not through the midrange.
 
  • Pain at night is not typical; if present, an inflammatory cause of the arthritis should be considered.
 
  • The ulnar nerve lies close to the elbow joint and ulna nerve neuropathy can be present in up to 50% of patients. This causes pins and needles or tingling in the little and ring finger. In more severe cases, weakness and muscle wasting in the hand can occur.
 
  • The degree of disability caused by osteoarthritis, can depend on the patient's type of work and lifestyle.
 

Imaging

  • Radiographs (X-Rays) of the elbow joint will typically show osteophyte formation at the margins of the bony structures. Joint spaces are usually preserved or mildly narrowed. Loose bodies may be evident.
 
  • CT—May be useful for surgical planning; a 3D model of the elbow allows a detailed assessment of osteophytes and the presence of loose bodies. 

Treatment

Non-Surgical Treatment

  • Nonsurgical treatment includes rest, anti-inflammatory medication (NSAIDS), and activity modification. This should be tried as a first line of treatment. 

Surgical Treatment

Reasons to consider surgery

  • Failure to respond to nonsurgical treatment
 
  • Loss of motion that interferes with activities of daily living
 
  • Painful locking or catching of the elbow
 

Surgical Procedures

  • Joint-sparing procedures such as débridement, removal of osteophytes, capsular release, and removal of loose bodies are preferred. These procedures can be performed arthroscopically and through a small incision and are generally very successful.

  • If the ulna nerve is involved, then this also needs to be addressed by freeing the nerve from within its tunnel
 
  • Total elbow arthroplasty is rarely suitable for this condition, and it is generally not performed in patients younger than 65 years or physically active patients because of concerns about implant longevity.

Rehabilitation

  • After surgery, pain control and reduction in swelling is very important to allow the elbow to move. Compression and cooling is very effective at reducing swelling.
 
  • Early movement of the elbow is very important to prevent stiffness. Physiotherapy with a prescribed regime is very helpful.
 
  • Nighttime extension splinting can be used to maximize the ability to straighten the elbow
 
  • A static, progressive splinting program may be implemented at approximately 6 to 8 weeks, when the elbow is less swollen.

INFLAMMATORY ARTHRITIS OF THE ELBOW

Condition Overview