Osteoarthritis of the elbow usually happens when the cartilage of the elbow is damaged or wears down. This can be the result of a previous injury, such as dislocating the elbow, or even a fracture. It may also result from age-related degeneration of the joint cartilage. Arthritis is an autoimmune disease in which the immune system attacks and degrades the connective tissue of joints. The elbow can be affected by different types of arthritis, like any other joint. Osteoarthritis is the most common form of arthritis; it doesn’t just affect just the elbow, but a number of joints. The causes are hard to pinpoint, but the onset is more likely if the elbow has been previously injured – for instance, a fractured joint. Rheumatoid arthritis is another form that typically affects the elbow.
The most common symptoms of elbow arthritis are:
A number of conservative measures are helpful to decrease pain and maintain function of the elbow.
Heat can be helpful in loosening joints and relaxing stiff muscles. As the elbow joint is often stiff in the morning, you could try morning showers or heat pads first thing in the morning. Ice is generally effective for flare-ups or swelling at the end of the day, especially after overdoing activities.
Tylenol and nonsteroidal anti-inflammatory drugs (NSAIDs) may be taken for pain relief. NSAIDs have the added benefit of decreasing inflammation and swelling. In an acute flare-up, it can be helpful to take scheduled doses of NSAIDs for 5-7 days. NSAIDs include ibuprofen (Motrin, Advil), naproxen (Aleve), and several others that are prescription strength. NSAIDs should always be taken with food. Long-term usage in high doses can lead to serious side effects including gastric ulcers, gastrointestinal bleeding, and kidney damage.
Patients with rheumatoid arthritis should consult their rheumatologist about some of the newer disease modifying antirheumatic drugs (DMARDs) and biologic response modifiers (BRMs) such as Enbrel and Remicaid.
There are a number of different elbow braces made of neoprene that may help reduce swelling and provide support to the elbow. You could also consult your physician about the use of custom resting splints for the elbow to be worn at night and with activities.
After a trial of bracing, activity modification, and use of NSAIDs is no longer effective and the pain becomes disabling, your doctor may recommend a cortisone injection. Injection of a long-acting corticosteroid into the elbow joint may provide pain relief for a few months. However, the relief is temporary and the arthritis in the joint will continue to progress.
If conservative management is no longer effective and you have persistent severe pain and weakness, there are a number of surgical options that would provide pain relief and improved function. Consult with your hand and upper extremity surgeon to discuss the best surgical options for you.
Elbow arthroscopy can be performed in early rheumatoid and osteoarthritis to improve motion and provide pain relief. Similar to shoulder and knee arthroscopy, elbow arthroscopy is performed with several (3 or 4) small 1 cm incisions over the elbow joint. Through these small incisions or portals, the surgeon can remove loose bodies from the elbow joint, remove the inflamed synovium, shave off bone spurs, as well as remove scar tissue in the elbow joint. Elbow arthroscopy is also very effective in treatment of catching and clicking from loose bodies. This is a minimally invasive procedure with quicker recovery time due to the small incisions.
In less advanced cases of osteoarthritis and rheumatoid arthritis, the surgeon can open the joint to remove the diseased and inflamed synovium as well as bone spurs or osteophytes from the joint. Patients often experience significant pain relief from this procedure as well as increased range of motion.
In this procedure, your surgeon removes the diseased cartilage and fuses the bones in the affected joint. This provides stability and decreases pain. This is sometimes the only option for young patients with high demand jobs who have severe arthritis in the elbow. After the surgery, you lose the ability to bend the elbow and compensate with movement of your shoulder.
Elbow arthroplasty or replacement involves removal of the diseased cartilage from the elbow joint and the implantation of an artificial joint. The joint is a metallic implant that is cemented into your humerus and ulna bones with a plastic bearing. Elbow replacement is usually reserved for low demand patients over the age of 70 or patients with advanced stages of rheumatoid arthritis.
In all 3 surgical procedures, you will be in a thumb splint or brace for the first 6 weeks. Following the 6 weeks of immobilization, you will be working with a hand therapist on range of motion and flexibility of the thumb. At the 3-month time point, most patients have little or no pain. Strengthening exercises are initiated at this time, both with hand therapy and in a home exercise program. Most patients regain their strength and return to normal activities at the 6-month time point.