What Is It?
Osteoarthritis of the elbow is a condition that occurs due to degeneration of the surfaces of the elbow joint which are normally lined by smooth cartilage. Damage to this cartilage can be progressive over time and may result from an injury to the elbow, overuse of the joint or from just normal wear and tear.
What Are The Symptoms?
The most common symptoms of arthritis in the elbow are pain and stiffness. The pain commonly occurs at the extremes of motion and people often complain of a reduction in their ability to flex and extend the elbow. These symptoms become worse as the condition progresses and people may also notice bony swelling around the elbow associated with ache, both using the elbow and at rest. Occasionally bony swellings around the elbow can push on the ulnar nerve which gives numbness and tingling in the little and ring fingers of the hand. This can also lead to weakness felt in the hand. Manual workers are prone to this condition and also those who work with vibrating tools. Occasionally, people describe loose bodies within the joint where a small piece of bone has broken off and is now mobile in the joint which can cause locking and clicking movements.
Common examination findings are reduction in range of motion compared to the contralateral side. Soft tissue and bony swellings may also be apparent. Dr Taylor will perform a careful examination of your range of motion and use this to assess whether surgery is required.
What Investigations Are Required?
The most common investigation is an x-ray of the elbow, a CT scan or possibly an MRI scan may be indicated if surgery is warranted, to plan the approach for surgery.
What Are The Treatment Options?
There are two main options for treatment of elbow arthritis.
1. Non Operative Treatment
Non-operative treatments of elbow arthritis are usually guided by physiotherapists. They rely on maintaining range of motion and reducing pain. Anti-inflammatory medications can be trialled and avoidance of activities which provoke the pain. An intra-articular steroid injection or injection into the joint may also relieve pain and improve function, although, this benefit may not be sustained in many patients.
2. Operative Treatment
Operative treatments for elbow arthritis include arthroscopic debridement which is keyhole surgery to debride bony growths around the elbow surface which can block flexion or extension of the elbow. If intra-articular loose bodies are noted on examination or investigations, an arthroscopic surgery is often recommended to remove these. More severe arthritis may require an open debridement where an open incision is made over the back of the elbow and the extra bone around the elbow is debrided using an open procedure. This is frequently done with an arm nerve block to allow physiotherapy after the procedure which is an important part of this procedure. Very severe elbow arthritis may require elbow joint replacement. The indications for this are limited to patients who have less demands on their elbow and this is rarely indicated for most patients with this condition. However, this can be discussed, if required.
Most people are happy with the results of this surgery, however, complications do occur sometimes. Some complications specifically related to elbow surgery include infection, which is a less than 1% chance, damage to surrounding nerves which is also a less than 1% chance but can be very debilitating if this occurs. Recurrence of elbow stiffness or loss of range of motion can also occur and, in rare occasions, the surgery may not completely resolve the symptoms of elbow arthritis.
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