Osteoarthritis occurs when the cartilage surface of the elbow is damaged or becomes worn. The elbow is one of the least affected joints due to its well matched joint surfaces and strong stabilizing ligaments. However, the cartilage can be damaged because of a previous injury such as elbow dislocation or fracture, or due to degeneration of the joint cartilage from age. It usually begins after age 50, although some patients can have symptoms earlier. Osteoarthritis usually affects the weightbearing joints, such as the hip and knee.

A doctor can usually diagnose elbow arthritis based upon a patient’s symptoms and standard X-rays. X-rays show the arthritic changes. Most of the time, advanced imaging studies such as CT (computed tomography) or MRI (magnetic resonance imaging) scans are not needed.

Risk Factors/Prevention

The best way to prevent elbow arthritis is to avoid injury to the joint. When injury does happen, it is important to recognize it right away and get treatment. Individuals involved in heavy work or sports activities should maintain muscular strength around the elbow. Always use proper conditioning and technique.

Most patients who are diagnosed with elbow osteoarthritis have a history of injury to the elbow, such as a fracture that involved the surface of the joint, or an elbow dislocation.

Sometimes there is no single injury. Work or outside activities may also lead to elbow arthritis if the patient places more demands on the joint than it can bear. For example, professional baseball pitchers place unusually high demands on their throwing elbows which can lead to failure of the stabilizing ligaments.High shear forces placed across the joint can lead to cartilage breakdown over a period of years.

Symptoms

The most common symptoms of elbow arthritis are:

• Pain
• Loss of range of motion
• Joint swelling may also occur. But this does not usually happen at first. Swelling occurs later, as the disease progresses.
• A “grating” or “locking” sensation in the elbow. The “grating” is due to loss of the normal smooth joint surface. This is caused by cartilage damage or wear. The “locking” is caused by loose pieces of cartilage or bone. These can dislodge from the joint and become trapped between the moving joint surfaces, blocking motion.
• Numbness in their ring finger and small finger can occur in later stages. Swelling in the elbow joint can put increased pressure on the ulnar nerve. See Ulnar Nerve Entrapment

Excerpted from the AAOS

Treatment Options for Osteoarthritis

Treatment options depend on the stage of the disease, prior history, what the patient desires, overall medical condition, and the results of X-rays.

Treatment Options: Non-Surgical

For the early stages, the most common treatment is non-surgical. This includes oral medications such as Tylenol® or Advil®, physical therapy, activity modification and joint injections.

Sometimes corticosteroid injections are used to treat arthritis symptoms. Steroid medication has typically been used with good results. The affects are temporary, but injections may give significant relief until symptoms progress enough to need additional treatment. An alternative to steroids has been the injection of hyaluronic acid in various forms. This attempts to increase the fluid in a joint, a process called viscosupplementation. It surrounds the diseased cartilage with a thicker and more “cushioned” environment.

When nonsurgical interventions are not enough to control symptoms, surgery may be needed.

Treatment Options: Surgical

By the time arthritis can be seen on X-rays, there has been significant wear or damage to the joint surfaces. If the wear or damage is limited, arthroscopy can offer a minimally invasive surgical treatment. Arthroscopy has been shown to provide symptom improvement at least in the short term. It involves removing any loose bodies or inflammatory/degenerative tissue in the joint. It also attempts to smooth out irregular surfaces. Multiple small incisions are used to complete the surgery, which can be performed as an outpatient procedure. The recovery is reasonably rapid.

If the joint surface has worn away completely it is unlikely that anything other than a joint replacement would bring about relief. There are several different types of joint replacement available. In appropriately selected patients, the improvement in pain and function can be dramatic. With an experienced surgeon, the results of elbow replacement are the same as the results of hip replacement and knee replacement.

For patients who are too young or who are too active to have prosthetic joint replacement, there are other reasonably good options. If loss of motion is the primary symptom, the surgeon can release the contracture and smooth out the joint surface. At times, a new surface made from the patient’s own body tissues can be made. These procedures can give years of symptom improvement.

Excerpted from the AAOS

About Total Elbow Replacement

A total elbow replacement is the replacement of the entire elbow joint with a metallic joint. This is done through a 4-6 inch incision along the posterior aspect (back) of the elbow. The incision is usually closed with staples. A elbow replacement is usually treatment for severe arthritis or a fracture.

Average Length of Surgery: 2 ½ hours

Average Length of Stay: 3 days in hospital

Blood donation: Generally not needed. It is possible that the patient may require a transfusion of one unit following surgery. Therefore, we ask the patient to donate one unit of blood pre-operatively.

Social Services: Home physical therapy, visiting nurses, nursing home/rehab center transfers and home health aides are arranged for the patient by the hospital social worker. They will also arrange for transportation to the patients home or rehab facility if family/friends are not available.

Post Op Visits:

1st Post-Op visit:

The patient must be seen in the office between the 10th and 14th post-operative day. This is for staple/suture removal and a wound check. At this visit outpatient physical therapy may also be discussed/arranged.

If a patient reports unusual redness, drainage, pus or irritation of the wound prior to this first visit, arrangements should be made to bring the patient in immediately.

If the patient is unable to make the 1st post-operative visit, arrangements for staple removal must be arranged with their inpatient facility, visiting nurse or family physician. Then, a post-op visit should be arranged for the next earliest possible date.

Recovering from Total Elbow Replacement

A total elbow replacement is the replacement of the entire elbow joint with a metallic joint. This is done through a 4-6 inch incision along the posterior aspect (back) of the elbow. The incision is usually closed with staples. A elbow replacement is usually treatment for severe arthritis or a fracture.

Post Op Visits

1st Post-Op visit:

The patient must be seen in the office between the 10th and 14th post-operative day. This is for staple/suture removal and a wound check. At this visit outpatient physical therapy may also be discussed/arranged.

If a patient reports unusual redness, drainage, pus or irritation of the wound prior to this first visit, arrangements should be made to bring the patient in immediately.

If the patient is unable to make the 1st post-operative visit, arrangements for staple removal must be arranged with their inpatient facility, visiting nurse or family physician. Then, a post-op visit should be arranged for the next earliest possible date.

2nd Post-Op visit:

Generally at 6 weeks following surgery date – needs x-rays

3rd Post-Op visit:

At 3 months post-op.

4th Post-Op visit

At 6 months or 1 year – dependent on progress

Rehabilitation

In Hospital: All patients begin therapy in the hospital immediately following surgery.

The patient utilize a continuous passive motion machine (CPM) post-operatively for range of motion. This will be continued in the patient’s home for 2-4 weeks post-operatively.

Inpatient: Reserved for the following types of individuals:

• Lives alone
• No family/friend support
• Elderly

Home physical therapy: Available to all patients immediately following discharge. Home therapy lasts approximately 2-3 weeks

Outpatient PT: All patients will enter an outpatient PT program for 6-8 weeks to work on range of motion and strength.

Driving: Patient should not drive for 4-6 weeks unless told otherwise by the physician