The elbow is a hinged joint consists of three bones, the humerus, radius and ulna. Arthritis of the elbow can be classified into three different types, osteoarthritis, post-traumatic arthritis and inflammatory arthritis.
The most common symptomatic type of arthritis is inflammatory arthritis, specifically due to rheumatoid disease. In this condition there is chronic inflammation in the joint leading to progressive articular cartilage destruction, joint space narrowing, bone resorption,instability and ligamentous damage. While rheumatoid arthritis is the most common cause of elbow inflammatory arthritis, other conditions such as psoriatic arthritis, systemic lupus and pigmented villonodular synovitis can also lead to similar joint destruction of the elbow.
Osteoarthritis of the elbow is a degenerative condition in which the cartilage becomes worn causing elbow pain and stiffness.
Signs and symptoms
Symptoms of elbow arthritis include joint stiffness, pain and loss of motion. The most common presenting symptom is loss of end range extension of the elbow. Additionally, patients may note neurologic symptoms related to the ulnar nerve.
Physical examination and plain film x-rays can help in diagnosing elbow arthritis. Occasionally a CT may be indicated for pre-operative surgical planning.
First line treatment of elbow arthritis depends on the type of arthritis but generally consists of activity modification, physical therapy and oral or topical anti-inflammatory medications. Some patients may find bracing helpful. When patients fail to respond to conservative measures, surgical management may be indicated.
Surgical management for elbow arthritis may consist of arthroscopic debridement and capsular release in which the surgeon will insert a camera and small surgical tools into the elbow and debride any loose bodies and reshape the damaged cartilage.
Another surgical option that may be considered is a total elbow replacement in patients over 65 with severe arthritis or complex post traumatic arthritis.