Elbow Arthritis

The causes of elbow arthritis are numerous, from osteoarthritis to post-traumatic arthritis to secondary to generalised inflammatory arthritis. Patterns of elbow arthritis are incompletely understood, and work is currently underway to see if the arthritis is secondary to an instability, or whether there are specific patterns of instability that develop secondary to specific pathology. As the causes are many, equally there are numerous different presentations from elbow pain, to locking, to stiffness, and each patient will present their experience differently.

The elbow consists of the ulno-humeral joint, the radio-capitellar joint and the proximal radio-ulnar joint. Each of these might be affected, but mostly it is a combination of varying involvement of all three. Some stiffness is quite well tolerated in flexion and extension, as the very mobile shoulder joint and the dexterous wrist and hand below can compensate well. The so-called ‘functional’ range of the elbow joint is 30°-130° (extension-flexion).

In early stages patients complain of exacerbations of pain, usually with some elbow swelling, stiffness and a history of catching, clicking or locking if there are some offending osteophytes or loose bodies inside the joint.



  • Management
Management

Non-operative

Non-operative management is directed at alleviating the exacerbations of pain through anti-inflammatories and paracetamol. Splinting or bracing is rarely used, but some patients find a light bandage or tubigrip to be of some use. If the pain is very severe, a steroid injection with local anaesthetic usually gives good relief for some weeks to months. These are however temporary measures, as the joint degeneration is established and slowly progressive.

Operative

Operative management is defined by the age of the patient, the stage of disease and the prevailing symptoms the patient has. If the main issue is clicking or locking, and there are demonstrable loose bodies in the joint, then an elbow arthroscopy and debridement would be indicated. Stiffness may also successfully be treated with an elbow arthroscopy and capsular release.

If the pain becomes intolerable then invariably the joint needs to be replaced. Replacement of the joint is an arthroplasty, and is either with an implant or sometimes in select cases an interposition arthroplasty might be performed in younger patients. The results of arthroplasty are great for pain relief, and they reliably return patients to a functional range of elbow motion between 30°-130°. They are also long lasting, with around 8 in 10 patients still having their original prosthesis 10 years from the surgery.

Conditions Managed



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