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Overview
Elbow arthritis, or osteoarthritis of the elbow, typically occurs in the over 55’s who have been suffering elbow pain on and off for many years. The pain eventually becomes so great that it:
- Becomes a constant, hot, joint pain.
- Limits movement in the elbow joint.
- Affects the ability to sleep.
This type of arthritis, also known as degenerative joint disease, is a condition whereby wear and tear damage is caused to the shiny surface of the elbow joint. Since the body can’t repair damaged joint surfaces, instead, it reacts with an inflammatory response which leads to ongoing destruction of the joint and the muscles, tendons and ligaments around it. Early onset arthritis often begins after traumatic injury, disrupting the normal joint surface sooner than normal wear and tear. Rheumatoid arthritis or RA is an autoimmune condition suspected to be triggered by certain viruses or bacteria. RA affects joints by eating away the joint surface, disfiguring the shape of the joint and causing joint swelling, tenderness, warmth and loss of movement.
Symptoms
Depending on the length of time someone has suffered elbow arthritis, they may experience the following symptoms:
- Constant elbow pain during the day.
- Elbow pain at night causing disruption to sleep.
- Increased pain and tender with touch.
- Loss of elbow movement.
- Loss of elbow strength.
- Increased elbow stiffness.
- Depression.
Causes
Elbow arthritis is the body’s reaction to damage to the shiny smooth surface of the elbow joint. Arthritis itself causes further joint damage and the deterioration of surrounding structures. In osteoarthritis, excessive wear and tear cause damage to the joint surface, often by undertaking elbow activities that are repetitive or heavy load. Joints affected by this kind of condition are usually isolated to one side of the body.
Arthritis of the elbow may also get names like post-traumatic arthritis where disruption of the joint surface accelerates arthritis. Different to osteoarthritis, rheumatoid arthritis or RA, is an autoimmune disease that doctors believe is caused by trigger factors such as infection by viruses or bacteria. Once triggered, RA slowly attacks the lining of joint surfaces and leading to joint destruction and deterioration of surrounding structures.
Early onset of elbow arthritis may commence after sports injuries like:
- Dislocated elbow.
- Fractured elbow joint.
- Fractured radial head at the elbow.
The more the injury disrupts the joint surface, the higher the risk of developing elbow arthritis. Heavy sports like weightlifting, gymnastics and CrossFit risk elbow dislocation, while contact sports like rugby, AFL, NRL and skateboarding may cause fractures of the elbow and early onset of elbow arthritis.
Accidents at work may cause elbow joint injury. Once you suffer injury to the joint surface, you are at risk of early-onset arthritis of the elbow.
Diagnosis
When diagnosing elbow arthritis, the following will be taken into consideration:
- Taking a history of the patient’s condition.
- Determining if it was caused by traumatic injury, impact, collision or fall.
- Determining if it was a gradual onset injury made worse by repetitive movements.
- Understanding the injury in the context of the patient’s age and need to use their elbow again quickly.
A physical examination will then be performed whereby the location of pain, stability and function of the elbow will be ascertained. Elbow arthritis is often painful at rest with increasing pain through movement. Movement tests will determine if there is any undue clicking or cracking which may suggest the presence of arthritis. A comparison to the patient’s non-affected side is always useful to determine the patient’s sense of normal.
Imaging such as xray and MRIs are used to determine the severity of the condition.
Moderate Elbow Arthritis
Typically suffered by patients under the age of 55, who have had elbow pain on and off for many years, made worse by movement and leaning on the elbow. Some clicking and cracking may be associated with various movement tests. Xray and MRI will confirm the severity of the condition.
Severe Elbow Arthritis
A serious condition, suffered by patients over 65, who have had constant elbow pain for many years made worse by movement and leaning on the elbow. Grinding, clicking, and cracking are associated with elbow movement. Xray and MRI will confirm the severity of the condition.
Treatment
Treatment of elbow arthritis should always begin with a thorough diagnosis of your condition to understand the severity of the condition in the context of your age, your sport, your work and your life.
Non-Surgical Treatment
- Moderate elbow arthritis may be treated non-surgically using:
- Rest.
- Pain and anti-inflammatory medication.
- Modification of activities causing wear and tear.
- Physiotherapy treatment for improved strength, better posture and function.
However, depending on the functional requirement of your elbow, like social sporting activities like golf or tennis or work activities like painting, you may require treatment that delivers a greater effect and so surgery may be right for you.
Surgical Treatment
Surgical treatment for elbow arthritis should be considered in patients who have severe night pain that is affecting their sleep and loss of function affecting their activities of daily living and the quality of their life. There are different surgical operations available to suit your age and physiology:
Partial Elbow Replacement
The operation which restores part of the elbow complex (55-65 year olds).
Hemi (half) arthroplasty (joint replacement) is the least traumatic of elbow replacements, where only the joint surface of the ulnar is replaced with a small prosthesis. Bone quality of the upper arm is generally very good and removing only the worse surface of the joint spares additional trauma caused by surgery.
Total Elbow Replacement
This operation which replaces the total anatomy of the elbow (65+ year olds).
Requires the surgeon to take away all joint surfaces of the elbow, in preparation for the new prostheses. A total elbow is the preferred prosthesis of choice in older patients suffering severe elbow arthritis, or who have had major fracture damage of the elbow.
Elbow arthritis involves long-term damage to the shiny surface of the ball and socket of the elbow joint causing increasing pain and loss of movement. When pain becomes too much, it’s time for an elbow joint replacement. Similarly, major trauma like severe fracture may cause major elbow joint damage. The goal of elbow replacement surgery is to replace the damaged joint surfaces with prosthetic ones. The type of prosthesis selected will depend on the patient’s age and how much of the joint is affected.
Post Operative Rehabilitation
You will achieve the best surgical outcome if you follow up surgery with a matching course of rehabilitation. Following surgery, Dr Gupta will outline the most appropriate rehabilitation protocol for your physiotherapist to follow and communicate with your healthcare team to ensure that you receive the best post-operative treatment.
Please contact our friendly team on 02 9687 8344 or make an online enquiry here.
Dr Manish Gupta | MBBS FRACS FAOrthoA
Dr Manish Gupta is a renowned expert surgeon in the field of orthopaedic surgery specialising in upper limb including shoulder, elbow and wrist.
