Elbow Arthritis (& Stiff Elbow)

What is Elbow Arthritis?

Arthritis, denoting joint inflammation, results in progressive damage and loss of articular cartilage. This exposes bare bones, leading to a loss of the smooth frictionless surface in the joint. Elbow arthritis can affect any of the three bony articulations: ulno-humeral, radio-capitellar, or proximal radio-ulnar.

Symptoms of Elbow Arthritis:

Common symptoms include pain, reduced range of motion, stiffness, swelling, and, in some cases, tingling or numbness in the ring and little fingers.

Is a Stiff Elbow Equal to Elbow Arthritis?

No, while arthritis is a common cause of a stiff elbow, various conditions like trauma, burns, prolonged immobilization, and congenital factors can also contribute to elbow stiffness.

Implications of a Stiff Elbow:

A stiff elbow limits hand reach and can significantly impact daily activities such as feeding or grooming, particularly if there is a substantial reduction in elbow flexion.

Causes of Elbow Arthritis:

1. Osteoarthritis: Results from progressive wear and tear due to usage and aging. Primary osteoarthritis of the elbow is relatively rare.
2. Rheumatoid Arthritis: An autoimmune disease affecting the synovium, often involving multiple joints simultaneously.
3. Post-Traumatic Arthritis: Arises from previous elbow injuries, such as dislocations or fractures.
4. Other Causes: Conditions like OCD, hemophilia, gout, and infection can contribute to elbow arthritis.

Diagnosis of Elbow Arthritis:

Elbow arthritis can be diagnosed by a medial professional by assessing symptoms, conducting a physical examination, and X-ray imaging. Further tests like blood tests, CT scans, or MRI may be necessary for a comprehensive evaluation.

Treatments for Elbow Arthritis:

The treatments available include pain control, physiotherapy, activity modifications, injections, and surgery.

The treatment algorithm is often individualized depending on the severity of the condition and the disease’s impact on daily life. In most cases, the initial treatment often involves a combination of non-operative measures mentioned above.

Oral medications, locally applied medicated ointments/gel/patch, iced or heat packs are some of the methods available to control the pain from arthritis. Steroid injections can sometimes be considered to reduce inflammation (and pain). Different individuals might respond to and tolerate these methods differently.

Guided physiotherapy focuses on gentle stretching with low-impact exercise, with aims to maintain or improve the range of motion, muscle tone, and strength. Periodic splinting may be useful as a form of passive stretching to improve the range of motion.

When your symptoms persist despite non-operative measures, you might need surgery.

What Are the Surgical options for Elbow Arthritis?

The surgical options depend on factors such as age, activity level, arthritis type, and severity. Your doctor may recommend one of the following operations tailored to your specific needs:

1. Arthroscopic Release

This procedure is typically recommended for patients with mild arthritis. It employs minimally invasive keyhole incisions, allowing the surgeon to introduce a small camera (arthroscope) and specialized instruments into the elbow joint. The goal is to inspect and debride (clean up) any loose tissue, cartilage flaps, or floating bodies within the joint. Simultaneously, tight scar tissue and bone spurs may be released and smoothed away. While this procedure aims to alleviate pain and enhance range of motion, it does not reverse or eliminate arthritis, and it may not be suitable for patients with advanced arthritis.

2. Open Capsular Release, Bone Spur Resection, and Manipulation

Indicated to improve elbow range of motion, this procedure involves one or two incisions on the elbow. The surgeon releases and excises thickened scar tissues and bone spurs. Postoperatively, optimal outcomes require periodic splinting and guided active and passive stretching by a therapist.

3. Arthroplasty (Elbow Replacement)

Elbow replacement, or arthroplasty, is recommended for older patients dealing with advanced arthritis, providing a reliable solution for pain relief and enhanced range of motion. Additionally, it may be the preferred option in cases of complex elbow fractures in elderly patients with osteoporosis. This procedure involves replacing the damaged joint surfaces with artificial components to restore function and alleviate discomfort.