Arthritis of the Elbow

How many times a day do you bend your elbow? Every time you eat or drink, sit at a desk to type or write, point the remote at the TV to change the channel—hundreds of times a day, you bend your elbow without even thinking about it. Now imagine if every time you bent your elbow, you felt the pain of arthritis.

For many Americans, this scenario is all too true. Arthritis of the elbow can cause pain not only when they bend their elbow, but when they straighten it, such as to carry a briefcase. The most common cause of arthritis of the elbow is rheumatoid arthritis (RA). Osteoarthritis (OA or "wear-and-tear" arthritis) and trauma can also cause arthritis in the elbow joint.

• RA 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, RA affects both elbows, as well other joints such as the hand, wrist and shoulder.
• OA 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 articular cartilage. This eventually leads to the development of posttraumatic arthritis. Usually, this form of arthritis is confined to the injured joint.

Signs and symptoms

• Pain. In the early stages of RA, pain may be primarily on the outer (lateral) side of the joint. Pain generally worsens as you turn (rotate) your forearm. The pain of OA may intensify as you extend your arm. Pain that continues during the night or when you are at rest indicates a more advanced stage of OA.
• Swelling, particularly with RA.
• An inability to perform daily activities because the elbow is unstable and gives way.
• Inability to straighten (extend) or bend (flex) the elbow.
• "Catching" or locking of the elbow, particularly with OA.
• Stiffness, particularly with posttraumatic arthritis.
• Involvement of both elbows, or pain at the wrists and/or shoulders as well as the elbows, indicates RA.

Diagnosis and tests

During the physical examination, your physician will look for signs of tenderness and swelling. He or she will also assess your range of motion. The physician may try to recreate the pain by moving the joint. X-rays will show the joint narrowing as well as the presence of any loose bodies. If your pain is due to posttraumatic arthritis, the X-rays may show a malunion or nonunion of bones.

Nonsurgical Treatments

The initial treatment is nonsurgical and depends on the type of arthritis. Your physician will discuss the options with you and develop an individualized program of medical and physical activities. Among the therapies that can be used are:

• Activity modification. OA may be linked to repetitive overuse of the joint, so modifying job or sports activities can be helpful. Intermittent periods of rest can relieve stress on the elbow
• Medical management. Acetaminophen or ibuprofen can provide short-term pain relief. More potent agents can be prescribed to treat RA. These include antimalarial agents, gold salts, immunosuppressive drugs, and corticosteroids. An injection of a corticosteroid into the joint can often help.
• Physical therapies. Heat or cold applications and gentle exercises may be prescribed. A splint worn at night, or one that permits movement as it protects the elbow from stresses, may also be helpful. Other assistive devices, such as handle extensions, can be used to maintain daily activities.

Surgical options

If your arthritis does not respond to the above treatments, you and your physician may discuss surgical options. Because several nerves are near the elbow, a skilled orthopaedic surgeon should be consulted. Surgery usually results in improved pain control and increased range of motion.

The exact procedure will depend on the type of arthritis you have, the stage of the disease, and your own age, expectations, and activity requirements. Some of the 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 RA and OA.
• Synovectomy. The surgeon removes 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 RA.
• Osteotomy. The surgeon removes part of the bone to relieve pressure on the joint. This procedure is often used to treat OA.
• Arthroplasty: The surgeon creates 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.
  

The information presented has been modified from the American Academy of Orthopaedic Surgeons.