Anatomy & Background
The elbow joint is the point where the humerus, the radius, and the ulna come together and meet. In the elbow joint, the ends of the bones have a smooth shiny surface called joint articular cartilage. This allows them to slide freely over each other without grinding or causing friction. This articular cartilage can become damaged by arthritis. When it does, the individual will begin to experience pain and discomfort in the joint.
What is Arthritis?
Arthritis is the wearing, degeneration or loss of articular cartilage in a joint. The three most common types of joint arthritis are osteoarthritis, rheumatoid arthritis, and traumatic arthritis.
What is Osteoarthritis?
Osteoarthritis typically affects weight bearing joints like the hip and knee, however in some cases it does effect the elbow. Osteoarthritis is a gradual wearing away and degeneration of the joint surfaces. The articular cartilage begins to wear down causing the individual discomfort, stiffness, and pain. Osteoarthritis is most common in people who are middle aged and adults over the age of 50. Women are more likely to develop osteoarthritis than men.
Common causes of elbow osteoarthritis include:
- Genetics and your family history
- Ligament damage can affect the stability and integrity of the elbow joint, placing more stress on the joint or articular cartilage.
- Repetitive strain injuries to the elbow can damage and accelerate wear on articular cartilage
- Diseases of the joint cartilage
- Damage from previous traumatic injuries
- Excessive use of steroids or steroid medication may cause degeneration of the joint and cartilage.
Symptoms of Osteoarthritis
- Pain in the elbow
- Loss of motion and a feeling of stiffness
- Noticeable swelling surrounding the joint.
- Increased size or deformity of the joint
- Cracking, crunching or other noises when moving the elbow
- Weakness of the elbow
Treating Elbow Arthritis
Treatment of elbow arthritis will depend on the severity of the condition. Some important guidelines should be followed at the onset:
- Rest: avoid the activities that produce any pain.
- Ice or moist heat: apply ice to the joint or area of pain or inflammation. It is one of the fastest ways to reduce swelling, pain and inflammation. Individuals with Rheumatoid arthritis may not tolerate ice well. The application of moist heat (like a warm wash cloth) may be helpful with stiff joints. The application of ice or heat should be done at intervals for about twenty minutes at a time. Do not apply directly to the skin.
- Compression: when using ice, apply light pressure. This is especially helpful if swelling is present.
- Elevation: elevate the area to help reduce swelling.
- Movement: keep your joints moving whenever possible. When pain occurs the tendency is not to move, but this will only result in further loss of motion and lead to increased pain and loss of function.
In mild cases rest, ice and medication may be all that is needed to reduce the pain. Once the pain is reduced physical therapy is recommended to develop a series of stretching and strengthening exercises to prevent loss of motion, weakness and loss of functionality in the joint.
Moderate to Severe Cases
If the problem persists, consult with your pain management specialist. Your physician should perform a thorough evaluation to determine the severity of the condition and the plan of care.
Medicine Intervenes and Managing Your Pain
Avoiding the activities that produce the pain or stress in the involved joint is the first line of treatment.
- RICE: Rest, Ice, Compression, Elevation should be used to reduce the stress on the bursa.
- NSAIDS (Non-steroidal anti-inflammatory drugs) to reduce pain and inflammation.
- Immobilization, strapping or bracing may be beneficial to rest, to protect the joint and to promote healing.
- Injection of steroids may be indicated to reduce inflammation of the involved joint.
- Joint injections of hyaluronic acid preparations to facilitate joint cartilage repair and regeneration.
- In severe recurrent conditions surgery may be indicated. In less severe cases arthroscopic surgery to clean the joint surfaces (debridement) may be indicated.
Outcomes and prognosis for individuals with osteoarthritis will depend on the severity of the joint degeneration, motion loss, weakness and age of the individual.
Individuals with mild degeneration often respond well to conservative treatment including medication for pain and inflammation and a program of exercises for stretching and strengthening of the knee joint and surrounding muscles. Most patients show improvement in pain and function in 4-6 weeks.
Individuals with moderate degenerative changes usually experience greater loss of motion, pain, weakness and loss of function. In some cases, arthroscopic surgery may be required to clean the elbow joint. Recovery may take from 6-9 weeks following surgery with emphasis on reduction of swelling, restoration of range, strength and function.
Individuals with severe joint degeneration have significant pain, stiffness, and loss of motion and function. The cartilage on the joint surface has been eroded and X-rays often reveal a loss of joint space and “bone-on-bone” contact. Joint replacement is usually the treatment of choice. At this point quality of life becomes a concern. Following a joint replacement the artificial elbow will be different from the natural joint and there will be some limitations in motion and function. However, a patient’s quality of life is usually significantly improved following a total joint replacement. Recovery following joint replacement can take 3-4 months of intensive physical therapy and rehabilitation. Improvements and functional gains can continue to develop for up to a year following the procedure.