Arthritis In Elbow

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Old woman hand holding her elbow suffering from elbow pain, possibly due to arthritis.

Elbow arthritis is a condition characterized by pain, swelling and stiffness at or near the elbow. The term arthritis is actually an umbrella term for several different conditions that can attack the elbow joint. They all make it difficult to use or bend the elbow and can have a significant adverse impact on your quality of life. The most common types of elbow arthritis are osteoarthritis and rheumatoid arthritis.

As with other types of arthritis, there is no actual cure for elbow arthritis. Instead, in the early stages of the disease, doctors will focus on pain management and reducing your joint pain and stiffness. Their goal will be helping you to regain as much of the joint range of motion as possible. They will also try to slow down the rate of progression of the disease.

In the later stages of elbow arthritis, doctors can use various surgical procedures to reduce the joint pain and stiffness. These can range from surgery to alter the shape of bones in the joint to a complete joint replacement.

Both surgical and non surgical treatment options are usually augmented by physical therapy to try to reduce joint stiffness and preserve range of motion.

Causes Of Elbow Arthritis

As mentioned above, the two main causes of elbow arthritis are osteoarthritis and rheumatoid arthritis. Another cause is post-traumatic arthritis. Although these sub types all attack the elbow joint and cause pain and stiffness, they differ in their precise causes:

Osteoarthritis

The three bones of the elbow are the humerus (upper arm bone), the ulnar (the medial or inner lower arm bone) and the radius (the lateral and longer lower arm bone). The ends of these bones in the elbow joint are covered with a tough but slick coat (cartilage) that help them to glide smoothly over each other as you move your elbow.

However, if you suffer from osteoathritis, the cartilage begins to wear down so that the bone ends start to make direct contact with each other. This bone on bone contact results in the formation of bone spurs but also cause elbow pain and joint stiffness.Moreover, the bone on bone contact also contributes to cartilage deterioration through “wear and tear”.

Rheumatoid Arthritis.

This is a type of arthritis in which your body’s immune system actually starts to attack the synovial lining of the elbow joint. In a healthy elbow, this lining “lubricates” the joint and helps to keep it moving smoothly. Hence, the impact of rheumatoid arthritis is to cause the joint pain and stiffness characteristic of all types of elbow arthritis.

Unlike osteoarthritis, rheumatoid arthritis tends to appear in both the left and right elbow. It is also more prevalent in women whereas osteoarthritis appears more often in men.

Post-traumatic Arthritis

This is another common cause of elbow arthritis. In this case, however, a previous elbow injury such as a dislocation or fracture damages the cartilage. From this point, the bone on bone contact within the joint causes further cartilage deterioration and increasing joint pain and stiffness.

It is important to understand that, in addition to the three types listed above, there are dozens of other types of arthritis. They include psoriatic arthritis and gout, just to take two examples. However, all forms of arthritis attack the elbow (or other) joint and result in pain, stiffness and reduced strength and range of motion.

Symptoms Of Elbow Arthritis

Regardless of the precise cause, the symptoms of elbow arthritis primarily concern the joint. In general, they include:

  • Pain and stiffness around the elbow. The pain tends to worsen when you try to bend or straighten the elbow or rotate your forearm;
  • Swelling in some cases;
  • A feeling that the elbow is “catching” or “locking” as you attempt to move the join;
  • Elbow instability;
  • A loss of elbow strength and range of motion, which worsens as the disease progresses;
  • As the condition advances,your elbow pain can appear at night and at other times while you are not using the elbow.

Diagnosis

To confirm whether your elbow pain is due to arthritis and to determine the type of arthritis you have, your doctor will conduct several tests:

  • A detailed physical examination of the affected joint. This will include applying pressure to various parts and asking you when the pain is most severe;
  • A review of your medical history. Your doctor may be particularly interested in any previous elbow injuries. As we have mentioned above, certain prior injuries like dislocations and fractures can lead to arthritis later in life;
  • Tests of your elbow strength and range of motion;
  • X Ray scans to reveal bone spurs or loose bone fragments in the joint. In addition, an X-Ray can also reveal whether the space within the joint is narrowing due to swelling of the synovial lining. This is a potential sign of rheumatoid arthritis.

Treatment Of Elbow Arthritis

In the early stages of the disease, doctors will likely focus on conservative treatment options for your elbow arthritis:

  • Heat therapy to help loosen the joint. This is usually most beneficial early in the morning, when joint stiffness is usually at its worst. Alternatively, warm showers or baths can have a similar effect;
  • For additional elbow warmth throughout the day, you can try wearing an elbow sleeve, particularly one made from neoprene;
  • Taking over the counter pain relief medications such as Tylenol;
  • Moist heat therapy has been reported as being particularly effective in reducing arthritic pain;
  • For control of inflammation and swelling in addition to pain, you may be advised to try a non steroidal anti inflammatory drug (NSAID) such as Advil. Be careful to understand any potential long term side effects before you try these options;
  • If your doctor determines that you have rheumatoid arthritis, he can prescribe a range of newly developed medications. These include antirheumatic drugs and biologic response modifiers;
  • Cortisone injections  can act as powerful anti inflammatory agents once the NSAIDS are no longer effective.

Unfortunately, the treatment options outlined above will not eliminate the underlying cause of your elbow arthritis. They will only slow the rate of advance of the disease, reduce your pain and help you preserve more of your strength and range of motion.

Surgical Options

As your elbow arthritis reaches its advanced stage, your doctor may discuss surgical options for its treatment:

Elbow Arthroscopic Surgery

The surgeon will make 3 or 4 small incisions near your elbow. He or she can then use tiny instruments and cameras to remove loose bodies from the joint as well as damaged synovial lining. In addition, this type of surgery can be used to shave down bone spurs and remove scar tissue.

Synovectomy And Osteophyte Removal

Under this surgical procedure, the elbow joint is opened to provide access for the surgeon. The damaged synovial joint lining is then completely removed from the elbow. Osteophytes (bone spurs) can also be removed.

Although this procedure has a longer recovery time than arthroscopy, it usually provides significant pain relief. Patients also usually report a significant increase in elbow range of motion.

Elbow Fusion

The surgeon removes damaged cartilage from the bone end. The bone ends are then fused together to prevent them rubbing together and causing pain.

Although this is effective in reducing pain, it usually results in a loss of elbow range of motion. You will then need to learn to compensate for this loss with shoulder movements.

Elbow Replacement

This procedure involves the removal of bone cartilage from your elbow.The surgeon will then implant an artificial humeroulnar joint made from metal and equipped with a plastic bearing.

After your surgery, you will need to wear an elbow brace for several weeks to aid joint healing.

Once this stage is over, you will then have to work with a physical therapist to regain elbow joint functionality and range of motion. A later stage of the therapy will focus on joint strengthening. Expect to spend 6 months or more in immobilization and then therapy before you can return to normal activities.

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