Arthritis is caused by damage or wearing away of the cartilage surface in a joint. Cartilage is a smooth substance that covers the ends of the bones and allows the bones to slide over each other with movement. Injury or trauma to the cartilage can cause arthritis; for example, a previous fracture or dislocation can lead to cartilage damage. Age-related wear, or overuse of a joint, can also cause the cartilage surface to thin out and eventually erode, causing the bones to rub directly against each other. The result of this bone-on-bone contact is a stiff and painful joint. Arthritis is commonly seen in the weight-bearing joints like the hip and the knee but can also occur in the elbow.
Anatomy of the Elbow
The elbow comprises three bones, the humerus, the ulna, and the radius. The humerus is the upper arm bone. The radius and the ulna are the bones that make up the forearm. Cartilage covers the parts of the bones in contact with each other in the elbow. The elbow is also covered by a thin, smooth layer of tissue called synovium, which helps lubricate the joint. Strong bands of tissue (ligaments) and muscles connect the three bones and keep the joint stable. These structures allow the elbow to bend, straighten, and rotate, like the motion you use to turn a car key in the ignition.
Since the elbow is not a weight-bearing joint, most instances of elbow arthritis are related to some injury to the elbow or heavy use/overuse of the elbow. A fracture that extends into the elbow joint and disrupts the cartilage increases the risk for arthritis. Other injuries like ligament tears can cause the joint to be more unstable and unevenly distribute weight and force across the joint, leading to the premature wearing of the cartilage. Heavy overuse of the elbow places increased stress on the joint, also leading to premature wear. For example, a professional baseball pitcher or lumberjack puts increased and repetitive strain on the elbow joint.
The most common symptoms of elbow arthritis are pain and stiffness of the elbow. As the condition worsens, some patients may experience a grinding or grating sensation with the movement of the joint. Swelling of the joint occurs in later disease. Locking can be caused by loose pieces of bone and cartilage caught in the joint.
X-ray is an effective way to diagnose arthritis. X-rays can detect loss of joint space, deforming bone due to ongoing inflammation, and loose pieces of bone or cartilage in the joint. Computed tomography (CT) or magnetic resonance imaging (MRI) scan is usually unnecessary to diagnose arthritis.
A physical examination will also be performed to evaluate how the joint moves, and the stability of the joint, and check for nerve involvement. Physical examination is also essential to detect other possible causes of pain.
Non-Operative or Conservative Management
Mild or early arthritis may be treated with anti-inflammatory medications to relieve pain and decrease inflammation. Physical therapy and exercises can help condition the elbow. Activity modification may be key if the cause of the arthritis is heavy or overuse of the joint. Steroid injections are usually effective in decreasing pain. Often the effects of steroid injections are temporary.
Patients with severe arthritis or who have tried and failed conservation forms of treatment may benefit from surgery.
Elbow arthroscopy can be performed in an outpatient setting with tiny incisions. This minimally invasive technique can remove bone spurs, remove loose pieces inside the joint causing blockages, remove inflamed tissue, and smooth out irregular joint surfaces. The majority of patients that undergo this procedure usually recover fairly quickly.
If the joint is completely worn away and less invasive treatments have not helped, elbow joint replacement may be the appropriate option for pain control. A replacement includes exposing the elbow joint and cutting away the diseased bone and all the cartilage. A prosthetic joint made of metal is placed, creating a new artificial joint. After this surgery, the elbow may not function as a natural elbow. There may be limitations to the range of motion and how much the elbow can bend, straighten, and rotate. There is also a long-term limitation on how much weight you can lift with an elbow replacement after the surgery is done. The choice to have an elbow replacement should be made very carefully.