Most patients who are diagnosed with elbow osteoarthritis have a history of injury to the elbow, such as a fracture that involved the surface of the joint, or an elbow dislocation. The risk for elbow arthritis increases if:
In some patients, no single injury to the elbow occurs. Work or outside activities can lead to osteoarthritis of the elbow if the patient places more demands on the joint than it can bear. For example, professional baseball pitchers place unusually high demands on their throwing elbows, which can lead to failure of the stabilizing ligaments. When this occurs, surgical reconstruction is usually needed. High-shear forces placed across the joint can lead to cartilage breakdown over a period of years.
The best way to prevent elbow arthritis is to avoid injury to the joint.
When injury does occur, it is important to recognize it right away and get treatment. Individuals involved in heavy work or sports activities should maintain muscular strength around the elbow. Proper conditioning and technique should always be used.
Osteoarthritis of the elbow occurs when the cartilage surface of the elbow is damaged or becomes worn. This can happen because of a previous injury such as elbow dislocation or fracture. It may also be the result of degeneration of the joint cartilage from age.
Osteoarthritis usually affects the weight-bearing joints, such as the hip and knee. The elbow is one of the least affected joints because of its well matched joint surfaces and strong stabilizing ligaments. As a result, the elbow joint can tolerate large forces across it without becoming unstable.
The most common symptoms of elbow arthritis are:
Treatment options depend on the stage of the disease, prior history, what the patient desires, overall medical condition, and the results of diagnostic X-rays.
For the early stages of osteoarthritis of the elbow, the most common treatment is nonsurgical. This includes oral medications to reduce or alleviate pain, physical therapy, and activity modification.
Corticosteroid injections are sometimes used to treat osteoarthritis symptoms. Steroid medication has typically been used with good results. Although the effects of injections are temporary, they can provide significant pain relief until symptoms progress enough to need additional treatment.
An alternative to steroids has been the injection of hyaluronic acid in various forms, called viscosupplementation.
When nonsurgical interventions are not enough to control symptoms, surgery may be needed. By the time arthritis can be seen on X-rays, there has been significant wear or damage to the joint surfaces. If the wear or damage is limited, arthroscopy can offer a minimally invasive surgical treatment. It may be an option for patients with earlier stages of arthritis.
Arthroscopy has been shown to provide symptom improvement at least in the short term. It involves removing any loose bodies or inflammatory/degenerative tissue in the joint. It also attempts to smooth out irregular surfaces. Multiple small incisions are used to perform the surgery. It can be done as an outpatient procedure, and recovery is reasonably rapid.
If the joint surface has worn away completely, it is unlikely that anything other than a joint replacement would bring about relief.
There are several different types of elbow joint replacement available.
In appropriately selected patients, the improvement in pain and function can be dramatic. With an experienced surgeon, the results for elbow joint replacement are typically as good as those for hip replacement and knee replacement.
For patients who are too young or too active to have prosthetic joint replacement, there are other reasonably good surgical options. If loss of motion is the primary symptom, the surgeon can release the contracture and smooth out the joint surface. At times, a new surface made from the patient’s own body tissues can be made. These procedures can provide years of symptom improvement.