Elbow Joint Conditions

Elbow Arthritis

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For many people, arthritis in elbow can cause pain not only when they bend their elbow, but also when they straighten it, such as to carry a briefcase.

The most common cause of elbow arthritis is rheumatoid arthritis. Osteoarthritis and injuries can also cause arthritis in the elbow joint.
Rheumatoid arthritis is a disease of the joint linings, or synovia. As the joint lining swells, the joint space narrows. The disease gradually destroys the bones and soft tissues. Usually, rheumatoid arthritis affects both elbows, as well other joints such as the hand, wrist and shoulder.

Osteoarthritis affects the cushioning cartilage on the ends of the bones that enables them to move smoothly in the joint. As the cartilage is destroyed, the bones begin to rub against each other. Loose fragments within the joint may accelerate degeneration.

Trauma or injury to the elbow can also damage the cartilage of the joint. This can lead to the development of arthritis in the injured joint.

Elbow arthritis symptoms vary and can include:

Pain: in the early stages of rheumatoid arthritis, pain may be primarily on the outer side of the joint. Forearm pain generally gets worse as you turn (rotate) your forearm. The pain of osteoarthritis may get worse as you extend your arm. Pain that continues during the night or when you are at rest indicates a more advanced stage of osteoarthritis.
Swelling: this is more common with rheumatoid arthritis
Stiffness: this happens particularly with arthritis that develops after an injury.
Locking: your elbow joint catches or locks. This can happen with Osteoarthritis.
Instability: the joint isn’t stable and gives way, making it difficult or impossible to do normal daily activities.
Lack of full movement: you are not able to straighten (extend) or bend (flex) the elbow.

Nonsurgical Treatment of Elbow Arthritis

The first elbow arthritis treatments used include:

Activity modification: Osteoarthritis may be caused by the repetitive overuse of the joint. Avoiding certain activities or sports may be helpful. Having periods of rest after exercise or activity involving your elbow can relieve stress on the joint.
Physiotherapy: applying heat or cold to the elbow and gentle exercises may be prescribed. A splint to protect the elbow from the stress of moving may be helpful. Devices that reduce stress on your joints such as handle extensions, to maintain daily activities.
Pain management: simple pain medications can provide short-term pain relief. More powerful drugs may be prescribed to treat rheumatoid arthritis. These include anti-malarial agents, gold, salts, drugs that suppress your immune system and corticosteroids. An injection of a corticosteroid into the joint can often help.

Surgical Treatment of Elbow Arthritis

If arthritis does not respond to other treatments, surgery may be discussed. The specific type of surgery may depend on the type of arthritis, the stage of the disease, your age, your expectations and your activity requirements. Surgical options include:

Arthroscopy: using pencil-sized instruments and two or three small incisions, the surgeon can remove bone spurs, loose fragments or a portion of the diseased synovium. This procedure can be used with both rheumatoid arthritis and osteoarthritis.
Synovectomy: we remove the diseased synovium. Sometimes, a portion of bone is also removed to provide a greater range of motion. This procedure is often used in the early stages of rheumatoid arthritis.
Osteotomy: we remove part of the bone to relieve pressure on the joint. This procedure is often used to treat osteoarthritis.
Joint replacement: we create an artificial joint using either an internal prosthesis or an external fixation device. A total joint replacement is usually reserved for patients over 60 years old or patients with RA in advanced stages.

ELBOW, WRIST AND HAND SPECIALIST

Matthan Mammen

MS, FRACS (Orth)

Matthan is an internationally qualified orthopaedic surgeon, who is a Fellow of the Royal Australasian College of Surgeons and the Australian Orthopaedic Association.