What is Elbow Osteoarthritis?
Osteoarthritis is a roughening of the bones of the joint. Over time, the cartilage wears away gradually, resulting in pain and inflammation. Osteoarthritis of the elbow is the gradual wearing away of the cartilage that covers the bones of the elbow joint.
The elbow joint is composed of three bones. The arm bone— the humerus— primarily moves with one of the forearm bones— the ulna. In addition, the humerus moves with the other forearm bone—the radius. Osteoarthritis may affect all three of these bones or only two of them.
Elbow osteoarthritis can be chronic, or it can be a result of a previous injury, such as a dislocation or elbow fracture. These injuries can cause damage to the bones and their overlying cartilage, or it can change how the elbow moves as in ligament and muscle injuries, causing it to slowly wear out prematurely.
Characteristics and Clinical Presentation of Elbow Osteoarthritis
Pain and stiffness are common with elbow osteoarthritis. It is possible for the elbow to be stiff with minimal pain. The stiffness can progress and result in a contracture of the elbow. Clicking of the elbow may be noticed as well.
Sometimes the little finger and ring finger in the hand may feel numb or tingly. This occurs because the ulnar nerve, which runs right along the inside part of the elbow (“the funny bone”), can become irritated and/or compressed by the arthritic elbow joint due to synovial thickening or osteophytes.
Osteoarthritis of the Elbow most commonly occurs when a prior traumatic accident has damaged the cartilage surfaces due to fracture or dislocation. Since cartilage does not heal normally once it has been damaged, the injured joint surfaces are no longer perfectly smooth and the path to osteoarthritis often begins. Prolonged heavy use of the elbow, such as decades of construction work, can cause gradual overloading of the cartilage.
Chronic overuse can also occur in baseball pitchers due to the stress continually placed on the elbow joint during the pitching motion. This stress can cause damage to the supporting elbow ligaments, which may lead to premature wear of the joint surfaces due to instability
Common symptoms of elbow osteoarthritis may include:
- A grating sensation
- Locking of the elbow joint
- Swelling at the elbow joint
- Pain in and around the elbow joint
- Tingling from the elbow to the fingers
Getting a Diagnosis for Elbow Osteoarthritis
The diagnosis of elbow osteoarthritis is typically based on the patient’s medical history, followed by a physical examination and imaging tests. Patients who have noticed chronic pain or pain following an injury to their elbow should seek prompt medical evaluation to receive a diagnosis. Your surgeon will speak with you and perform a careful physical exam to assess areas of tenderness, ligamentous instability, and limitations in motion are essential.
X-rays of the elbow will confirm the diagnosis and aid in evaluating the extent of the osteoarthritis. Sometimes, a CT scan is helpful if surgery is being considered and there are large osteophytes and significant joint deformity.
Additionally, an MRI may be necessary for visualizing ligamentous injury. If there is numbness in the little finger and ring finger, a nerve study (NCS) can be obtained to evaluate the extent of ulnar nerve injury in relation to the adjacent arthritic joint.
Treatment Options for Elbow Osteoarthritis
In patients presenting with early onset of Elbow Osteoarthritis, treatment is typically nonsurgical. Patients may be prescribed non-steroidal anti-inflammatory drugs and pain relievers. Physical therapy may be recommended to improve range of motion. Additionally, a corticosteroid injection may be beneficial for providing some immediate relief from pain and inflammation.
Anti-inflammatory medication, physical therapy, and minimizing stress on the elbow can help reduce pain and improve motion. Patients may be advised to wear a splint during resting periods, perhaps sleep, to immobilize the joint. Allowing the joint to rest in this way removes unnecessary stress and strain. Physical therapy may be recommended in cases where the joint begins to stiffen, prohibiting free range of movement, or to improve strength.
Arthritic elbows with large osteophytes and more significant joint contractures of the soft tissues may need an open surgical debridement, including an Osteocapsular Arthroplasty.
More advanced cases of osteoarthritis, especially when there is extensive osteophyte formation that creates a bony block to motion, may benefit from surgery. Arthroscopic debridement can be performed to remove some osteophytes and damaged tissue, while also smoothing irregular joint surfaces.
Cases involving ligamentous instability with only mild arthritis can benefit from ligament reconstruction (like Tommy John Surgery) to reduce the arthritic process. Total Elbow Replacement is reserved for severely damaged joints in older, low-demand patients.
Surgical procedures to treat elbow osteoarthritis include:
- Arthroscopic debridement: arthroscopy intended to smooth the joint surfaces having bone spurs.
- Interposition arthroplasty: placing a donor tendon between the ends of bones of the joint.
- Joint replacement: replacement of the joint to improve range of motion & pain.
- Ligamentous reconstruction: this procedure helps pain by improving the stability of the joint.
Preventing Elbow Osteoarthritis
Osteoarthritis generally develops with acute or chronic trauma, and age. However, patients can still mitigate their factors for this disease with changes to their lifestyle. Maintaining a healthy lifestyle with low-impact exercise may help reduce the development of osteoarthritis of the elbow. You ought to seek treatment immediately if you begin to notice a pattern of chronic pain in the elbow area.
Some modifiable factors include:
- Managing occupational risks that involve repetitive, forceful movements in the elbow.
- Utilize low-impact exercise with activities that include strength training and stretching.
- Maintain a healthy weight, know your resistance and reps limits, as excess stress via extra weight can speed up the deterioration of joint cartilage.
- Get adequate amounts of rest to allow joints to recover or to heal.
Prognosis for Elbow Osteoarthritis
For patients requiring surgical intervention, a significant healing period is required. This period may require a temporary immobilization splint to promote healing. While there is no complete cure for this condition, patients can mitigate its long-term effects by easing stress on the jointed areas of the hand, wrist, and elbow and receiving the best possible treatment.
Patients are typically recommended to attend physical therapy to improve motion and function to the elbow, depending on the severity of their condition.
If You Believe You Have Elbow Osteoarthritis, Contact HandSport Surgery Institute.
Please contact us to schedule an appointment with our talented team. People who have been hurt should be evaluated to try and prevent further injury and mobility issues.
If you have been injured, it’s important to be evaluated by a highly skilled professional. Call Drs. Mark and Jason Pruzansky at 212-249-8700 to schedule an appointment and obtain an accurate diagnosis.