Elbow Arthritis

The most common type of elbow arthritis is rheumatoid arthritis, which causes joint lining, or synovium, swelling and joint space narrowing. Rheumatoid arthritis progressively destroys the bones and soft tissues of both elbows and other joints of the body, in particular hand and wrist joints.

Osteoarthritis is the second most common arthritis of the elbow joint. It affects the cushioning cartilage on the ends of elbow joint bones (humerus, radius and ulna) that enables them to move smoothly in the joint. Osteoarthritis  occurs when the elbow joint cartilage is damaged as a result of previous injury, or normal wear and tear process as we age. As the cartilage is destroyed, the bones begin to rub against each other and cause pain. 

Arthritis Symptoms

Pain in both elbows and other joints is a sign of rheumatoid arthritis . In the early stages of rheumatoid arthritis , pain may be primarily on the outer side of the elbow joint and it may get worse as you extend your arm. Pain at rest or that continues during the night is indicative of a more advanced stage of osteoarthritis. Swelling of the elbow joint is more common with rheumatoid arthritis. In cases of advanced elbow osteoarthritis, patients may experience numbness in their ring and small fingers due to increased pressure on the ulnar nerve by the swelling on the inner (medial) side of the elbow. Patients with osteoarthritis usually complain of “grating” or “locking” sensation in the elbow as well as joint instability, which makes it difficult to do normal daily activities. Limited range of motion where you are not able to straighten or bend the elbow may be experienced in both rheumatoid arthritis  and osteoarthritis. 

Arthritis Diagnosis

A detailed history including medical conditions, activities that aggravate elbow use, and any prior injuries is important. During a physical examination, your doctor will look for tenderness and swelling, limited range of motion as well as identify positions which cause pain to your elbow joint. X-ray will be taken to evaluate the extent of joint damage and to check for any evidence of fractures. By the time elbow arthritis can be seen on x-rays, there has been significant damage to the elbow joint surface. Some forms of rheumatoid arthritis can be confirmed by a blood test. 

Arthritis Treatment

Treatment options depend on the severity of elbow arthritis symptoms and patient’s overall medical health. 

Nonsurgical Treatment

Non-surgical treatment options include pain and swelling control, physical therapy, corticosteroid and hyaluronic acid injections. 

• Pain and swelling control: For the early stages of elbow osteoarthritis, over-the-counter pain medications help to reduce or alleviate pain. Anecdotal reports have been favorable in patients on glucosamine/chondroitin supplements. However, these supplements may be contraindicated with other medications and may cause excessive bleeding during surgery. Always consult your doctor before taking dietary supplements. Additional therapies for patients with rheumatoid arthritis include antimalarial drugs, antimetabolites, gold, and immunosuppressive drugs. 

• Physical Therapy: Physical therapy and activity modifications serve to strengthen the musculature around the elbow and reduce stress on the joint cartilage. Avoiding aggravating activities and having periods of rest after these activities may be helpful. Applying heat or cold, elbow splinting, and gentle exercises may be recommended. 

• Steroid Injections: Steroid injections typically provide significant pain relief although temporary. They can be used until symptoms progress enough to require surgical treatment. An alternative to corticosteroids is hyaluronic acid, which is used to increase joint fluid. Hyaluronic acid injections are significantly more expensive than steroid injections and the long term results of these injections in the elbow have not yet been investigated.

Surgical Treatment

Surgical treatment is recommended when the conservative, non-surgical intervention fails to adequately control patient’s symptoms.  

• Arthroscopy: If the cartilage damage or wear is limited, minimally invasive, outpatient surgical arthroscopy may be an option for patients with early stages of arthritis. Using pencil-sized instruments with two or three small incisions, surgeon can remove any loose bodies or inflammatory joint tissue, and smooth out irregular cartilage surface, which can markedly improve symptoms. 

• Synovectomy: The surgeon removes the diseased synovium and/or a portion of the bone to provide a greater range of motion. This procedure is often used in the early stages of rheumatoid arthritis. 

• Osteotomy: The surgeon removes part of the bone to relieve pressure on the joint. This procedure is often used to treat osteoarthritis. 

• Arthroplasty: The surgeon creates an artificial joint using an internal prosthesis or an external fixation device.
  

If the joint surface is completely worn out then joint replacement is the only solution. This is usually reserved for patients over 60 years old or those with advanced rheumatoid arthritis. Typically, the improvement in pain and elbow function after the elbow joint replacement is dramatic. 

+Dr. Kayvon Izadi