Arthritis of the Elbow

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For many people, arthritis of the elbow can cause pain not only when they bend their elbow, but also when they
straighten it, such as to carry a briefcase. The most common cause of arthritis of the elbow is rheumatoid arthritis.
Osteoarthritis and injuries can also cause arthritis in the elbow joint.
Rheumatoid arthritis is a disease of the joint linings, or synovia. As the joint lining swells, the joint space narrows. The
disease gradually destroys the bones and soft tissues. Usually, RA affects both elbows, as well other joints such as
the hand, wrist and shoulder.
Osteoarthritis affects the cushioning cartilage on the ends of the bones that enables them to move smoothly in the joint.
As the cartilage is destroyed, the bones begin to rub against each other. Loose fragments within the joint may
accelerate degeneration.
Trauma or injury to the elbow can also damage the cartilage of the joint. This can lead to the development of arthritis
in the injured joint.

Symptoms
Symptoms of elbow arthritis vary and can include:
Pain. In the early stages of rheumatoid arthritis, pain may be primarily on the outer side of the joint.
Pain generally gets worse as you turn (rotate) your forearm. The pain of osteoarthritis may get worse
as you extend your arm. Pain that continues during the night or when you are at rest indicates a more
advanced stage of osteoarthritis.
Swelling. This is more common with rheumatoid arthritis.
Instability. The joint isn't stable and gives way, making it difficult or impossible to do normal daily
activities.
Lack of full movement. You are not able to straighten (extend) or bend (flex) the elbow.
Locking. Your elbow joint catches or locks. This can happen with osteoarthritis.
Stiffness. This happens particularly with arthritis that develops after an injury.
Pain in both elbows. Having pain in both elbows or pain at the wrists or shoulders (or both) as well as
pain in the elbows is a sign of rheumatoid arthritis.

Diagnosis
During a physical examination, your doctor will first look for tenderness and swelling. He or she will also look at the
range of motion you have as well as identifying what positions cause pain to your elbow joint. X-rays often show the
joint narrowing as well as any loose bodies (e.g., bony pieces). If your pain is due to arthritis following an injury, the X-
ray may show an improper joining or a failure to join of the elbow bones.

Treatments
Nonsurgical Treatment
The first treatments used for elbow arthritis include:
Cut back on activity. Osteoarthritis may be caused by the repetitive overuse of the joint. Avoiding
certain activities or sports may be helpful. Having periods of rest after exercise or activity involving your
elbow can relieve stress on the joint
Pain management. Acetaminophen or ibuprofen can provide short-term pain relief. More powerful drugs
may be prescribed to treat rheumatoid arthritis. These include anti-malarial agents, gold salts, drugs
that suppress your immune system and corticosteroids. An injection of a corticosteroid into the joint
can often help.
Physical Therapy. Applying heat or cold to the elbow and gentle exercises may be prescribed. A splint to
protect the elbow from the stress of moving may be helpful. Devices that reduce stress on your joints
such as handle extensions, to maintain daily activities.
Surgical Treatment
If arthritis does not respond to other treatments, surgery may be discussed. The specific type of surgery may depend
on the type of arthritis, the stage of the disease, your age, your expectations and your activity requirements. Surgical
options include:
Arthroscopy. Using pencil-sized instruments and two or three small incisions, the surgeon can remove
bone spurs, loose fragments or a portion of the diseased synovium. This procedure can be used with
both rheumatoid arthritis and osteoarthritis.
Synovectomy. The surgeon removes the diseased synovium. Sometimes, a portion of bone is also
removed to provide a greater range of motion. This procedure is often used in the early stages of
rheumatoid arthritis.
Osteotomy. The surgeon removes part of the bone to relieve pressure on the joint. This procedure is
often used to treat osteoarthritis.
Arthroplasty. The surgeon creates an artificial joint using either an internal prosthesis or an external
fixation device. A total joint replacement is usually reserved for patients over 60 years old or patients
with RA in advanced stages.





Elbow Arthritis
ELBOW ARTHRITIS - Jerry Huang, MD.
The elbow joint is complex, consisting of three different bones (the humerus, the radius, and the ulna) with different
articulations (the ulnohumeral joint, the radiocapitellar joint, and the proximal radioulnar joint). The combination of
elbow flexion and extension as well as forearm rotation allows for placement of the hand in place for activities of daily
living. In addition to severe pain, the stiffness from elbow arthritic can become disabling, making it difficult to perform
simple activities.
Signs and Symptoms
Initial symptoms include pain and stiffness around the elbow, as well as swelling. Patients find that it becomes
increasingly difficult to bend or straighten the elbow as well as pain with forearm rotation. Other symptoms include
locking of the elbow or catching sensation from loose bodies in the elbow. Initially, most patients have pain with lifting
or with extremes of motion. In advanced stages, pain can be severe at night or at rest during the daytime. In some
cases, patients can also have feelings of instability and weakness in the elbow.
Causes and Risk Factors
Rheumatoid arthritis: Rheumatoid arthritis is an autoimmune disease where your bodys immune system attacks the
synovium, or the tissue lining the joints. There is progressive erosion and destruction of the cartilage and bone,
leading to severe pain, stiffness, and deformity.
Osteoarthritis: Normal cartilage provides a smooth gliding surface for joint motion as well as cushioning. As the
cartilage becomes thin over time, the bones begin to grind against each other on rough surfaces (bone on bone).
Bone spurs or osteophytes form inside the joint. In addition, loose bodies in the joint may cause catching symptoms
as well as accelerate degeneration from mechanical wear.
Post-traumatic arthritis: One of the most common causes of arthritis in the elbow is post-traumatic arthritis. Patients
with a prior fracture or dislocation of the elbow can have cartilage injury, leading to progressive deterioration of the
joint. These include fractures of the distal humerus, radial head fractures, and olecranon fractures. In complex injuries,
there are often large cartilage defects and deformities of the elbow, leading to abnormal mechanics and rapid wear of
the joint.
Initial Treatment
A number of conservative measures are helpful to decrease pain and maintain function of the elbow.
Heat and Ice- Heat can be helpful in loosening joints and relaxing stiff muscles. As the elbow joint is often stiff in the
morning, you could try morning showers or heat pads first thing in the morning. Ice is generally effective for flare-ups
or swelling at the end of the day, especially after overdoing activities.
Over the counter medications- Tylenol and nonsteroidal anti-inflammatory drugs (NSAIDs) may be taken for pain
relief. NSAIDs have the added benefit of decreasing inflammation and swelling. In an acute flare-up, it can be helpful
to take scheduled doses of NSAIDs for 5-7 days. NSAIDs include ibuprofen (Motrin, Advil), naproxen (Aleve), and
several others that are prescription strength. NSAIDs should always be taken with food. Long-term usage in high
doses can lead to serious side effects including gastric ulcers, gastrointestinal bleeding, and kidney damage.
Patients with rheumatoid arthritis should consult their rheumatologist about some of the newer disease modifying
antirheumatic drugs (DMARDs) and biologic response modifiers (BRMs) such as Enbrel and Remicaid.
Splints and Braces
There are a number of different elbow braces made of neoprene that may help reduce swelling and provide support to
the elbow. You could also consult your physician about the use of custom resting splints for the elbow to be worn at
night and with activities.
Cortisone injections
After a trial of bracing, activity modification, and use of NSAIDs is no longer effective and the pain becomes disabling,
your doctor may recommend a cortisone injection. Injection of a long-acting corticosteroid into the elbow joint may
provide pain relief for a few months. However, the relief is temporary and the arthritis in the joint will continue to
progress.
Surgery
If conservative management is no longer effective and you have persistent severe pain and weakness, there are a
number of surgical options that would provide pain relief and improved function. Consult with your hand and upper
extremity surgeon to discuss the best surgical options for you.
Elbow arthroscopy
Elbow arthroscopy can be performed in early rheumatoid and osteoarthritis to improve motion and provide pain relief.
Similar to shoulder and knee arthroscopy, elbow arthroscopy is performed with several (3 or 4) small 1 cm incisions
over the elbow joint. Through these small incisions or portals, the surgeon can remove loose bodies from the elbow
joint, remove the inflamed synovium, shave off bone spurs, as well as remove scar tissue in the elbow joint. Elbow
arthroscopy is also very effective in treatment of catching and clicking from loose bodies. This is a minimally invasive
procedure with quicker recovery time due to the small incisions.
Synovectomy and removal of osteophytes
In less advanced cases of osteoarthritis and rheumatoid arthritis, the surgeon can open the joint to remove the
diseased and inflamed synovium as well as bone spurs or osteophytes from the joint. Patients often experience
significant pain relief from this procedure as well as increased range of motion.
Elbow arthrodesis (fusion)
In this procedure, your surgeon removes the diseased cartilage and fuses the bones in the affected joint. This
provides stability and decreases pain. This is sometimes the only option for young patients with high demand jobs
who have severe arthritis in the elbow. After the surgery, you lose the ability to bend the elbow and compensate with
movement of your shoulder.
Elbow arthroplasty (replacement)
Elbow arthroplasty or replacement involves removing the diseased cartilage and implantation of an artificial joint. The
joint is a metallic implant that is cemented into your humerus and ulna bones with a plastic bearing. Elbow
replacement is usually reserved for low demand patients over the age of 70 or patients with advanced stages of
rheumatoid arthritis.
Recovery after surgery
In all 3 surgical procedures, you will be in a thumb splint or brace for the first 6 weeks. Following the 6 weeks of
immobilization, you will be working with a hand therapist on range of motion and flexibility of the thumb. At the 3-
month time point, most patients have little or no pain. Strengthening exercises are initiated at this time, both with hand
therapy and in a home exercise program. Most patients regain their strength and return to normal activities at the 6-
month time point.

Preop X-ray AP

Preop X-ray Lateral

Postop X-ray AP

Postop X-ray Lateral

Postop Flexion

Postop Extension