Elbow Arthritis.
The elbow is actually made up of two joints, the joint between the humerus and the ulna, which allows bending and straightening of the elbow, and the joint between the humerus and the radius, which allow rotation of the forearm. Normally these joints are lined with smooth cartilage that provides a pain free and fiction free surface for movement.
In arthritis the smooth cartilage is worn away to expose the rough bone underneath. As more cartilage is worn away the rubbing of the bone surfaces cause pain and stiffness. Arthritis can often progress to the extent where the elbow will barely move and be painful even at rest.
What causes elbow arthritis?
Various types of arthritis exist, the most common of which is osteoarthritis. This has been traditionally thought of as ‘wear and tear’ but more realistically it can be thought of as a combination of genetic and environmental factors. You are more likely to experience osteoarthritis if there is a family history of arthritis or if you have any contributing factors such as: previous trauma or elbow surgery, and elbow overuse.
Inflammatory arthritis (which includes rheumatoid arthritis) is a family of conditions in which your immune system starts attacking your own tissues, which can cause pain, stiffness and joint damage. Multiple joints are often affected and patients are usually aware of their condition before the shoulder becomes involved. If this is the cause of your arthritis it is vital that the condition is first treated with specific medication before surgical treatments are considered.
How is elbow arthritis diagnosed?
Usually Mr Moverley can diagnose arthritis with a combination of clinical examination and a careful assessment of the history of your symptoms. As elbow arthritis can be confused with other conditions, further diagnostic tests are used for confirmation and to plan treatment:
X-rays are usually obtained on the day of your consultation and may demonstrate irregular joint surfaces and bone loss.
CT scans are usually obtained as they demonstrate the joint in greater detail and allow accurate planning of surgery.
Treatment options
Often the severity of your symptoms and the impact of arthritis on your daily activities do not correlate with the severity of the arthritis observed on x-rays. It is therefore crucial that treatment is tailored specifically to your symptoms whilst taking into account your expectations and medical history.
Non-operative Management
Non-operative treatment should always be exhausted before considering any form of surgery. Possible non-operative options include:
A focused physiotherapy program to strengthen the muscles around the shoulder can prevent any further stiffness and help regain range of motion. This will prove beneficial even of surgery is eventually indicated
Rest, activity modification, and simple pain relief can provide good benefit, particularly in the early stages of the disease.
Steroid injections are often used to provide short-term relief, which can then allow you to participate in physiotherapy. Repeated injections should not be given as a long-term cure as they may cause further damage to the joint.
Hyaluranon injections have been shown to be beneficial for early arthritis and where surgery is contra indicated. They can (but not always) provide longer benefit than steroid injections with fewer side effects.
Surgical Management
Elbow Arthroscopy
Arthroscopic treatment of the elbow for arthritis is a therapy in which the joint is "tidied up". Mr Moverley will debride the elbow to remove roughened bone and loose bone fragments that can catch, lock and rub against each other resulting in pain. This treatment has been shown to work in the early stages of elbow arthritis.
Elbow replacement
In cases of severe pain or previous failed treatment options, arthroplasty (elbow replacement) can be considered but actually this is quite uncommon.