Elbow Osteoarthritis (OA)
Fig 1: Osteoarthritis of the elbow
The elbow is a hinge type of joint. Osteoarthritis of the elbow is relatively rare. It is characterized by wear of the cartilage surface, progressive formation of osteopytes (bony expansion on the edge of the joint surface) and osteocartilagineous loose bodies inside the joint. The narrowing of the joint space is less frequent in the elbow probably because this is a non weight bearing joint and this has a good prognostic value in comparison with other areas of our body.
Who is affected?
Arthritis of the elbow is more common in middle aged men involved in strenuous manual activity and is particularly frequent in laborours using pneumatic tools. It may also occur following previous elbow injury or fracture, or damage to the elbow from another types of arthritis such as rheumatoid arthritis or gout.
The Condition and its Presentation
Osteoarthritis usually develop in the elbow gradually (over years).It may remain completely asymptomatic or present with pain, stiffness, deformity and swelling of the affected joint. When the elbow is moved a grating sound or a clicking sensation may be appreciated. The symptoms may only be present in certain postitions of the elbow, or occur through out the arc of elbow movement.
Plain X-Rays are the cornerstone in diagnosis and provide us information about the degree of joint wear. Laboratory tests, Ct Scan or MRI are indicated very occassionally in case of any doubt and may provide useful information about the extension of the ostheoarthitic process.
Every osteoarthritic elbow is different. Treatment of this condition should be adapted to individual needs as well as to the degree of the cartilage wear and of the clinical symptoms.
In cases with mild to moderate inconstant pain, or moderate stiffness sometimes associated with locking sensation, treatment includes simple pain killers, modification of the activity avoiding heavy lifting and repetitive strenuous exercises with upper limbs. A physical therapy program aimed to stretch the capsule and decrease the deformity due to muscular contracture is indicated.
In a moderate arthritis with loss of the range of motion, or constant moderate pain with flare up phases and repeated locking of the joint, keyhole surgery with a surgical washout of the debris from the joint is often the treatment of choice. Results are very rewarding and often give medium to long term pain relief. Occassionally, open exploration of the joint is indicated.
In severe elbow arthritis with loss of joint space, constant and severe pain, severe loss of range of motion and often associated peripheral nerve involvement, the treatment of choice is joint replacement (total elbow replacement) or resurfacing surgery.