Osteoarthritis occurs when the cartilage surface of the elbow is damaged or becomes
worn. The elbow is one of the least affected joints due to its well matched joint
surfaces and strong stabilizing ligaments. However, the cartilage can be damaged
because of a previous injury such as elbow dislocation or fracture, or due to
degeneration of the joint cartilage from age. It usually begins after age 50,
although some patients can have symptoms earlier. Osteoarthritis usually affects
the weightbearing joints, such as the hip and knee.
A doctor can usually diagnose
elbow arthritis based upon a patient's symptoms and standard X-rays. X-rays show
the arthritic changes. Most of the time, advanced imaging studies such as CT (computed
tomography) or MRI (magnetic resonance imaging) scans are not needed.
The best way to prevent elbow arthritis is to avoid injury to the joint. When
injury does happen, it is important to recognize it right away and get treatment.
Individuals involved in heavy work or sports activities should maintain muscular
strength around the elbow. Always use proper conditioning and technique.
Most patients who are diagnosed with elbow osteoarthritis have a history of
injury to the elbow, such as a fracture that involved the surface of the joint,
or an elbow dislocation.
Sometimes there is no single injury. Work or outside activities may also lead
to elbow arthritis if the patient places more demands on the joint than it can
bear. For example, professional baseball pitchers place unusually high demands
on their throwing elbows which can lead to failure of the stabilizing ligaments.High
shear forces placed across the joint can lead to cartilage breakdown over a period
of years.
Symptoms
The most common symptoms of elbow arthritis are:
* Pain
* Loss of range of motion
* Joint swelling may also occur. But this does not usually happen at first. Swelling
occurs later, as the disease progresses.
* A "grating" or "locking" sensation in the elbow. The "grating"
is due to loss of the normal smooth joint surface. This is caused by cartilage
damage or wear. The "locking" is caused by loose pieces of cartilage
or bone. These can dislodge from the joint and become trapped between the moving
joint surfaces, blocking motion.
* Numbness in their ring finger and small finger can occur in later stages. Swelling
in the elbow joint can put increased pressure on the ulnar nerve. See Ulnar Nerve
Entrapment
Excerpted
from the AAOS
Treatment options depend on the stage of the disease, prior history, what the
patient desires, overall medical condition, and the results of X-rays.
For the early stages, the most common treatment is non-surgical. This includes
oral medications such as Tylenol® or Advil®, physical therapy, activity
modification and joint injections.
Sometimes corticosteroid injections are used to treat arthritis symptoms. Steroid
medication has typically been used with good results. The affects are temporary,
but injections may give significant relief until symptoms progress enough to need
additional treatment. An alternative to steroids has been the injection of hyaluronic
acid in various forms. This attempts to increase the fluid in a joint, a process
called viscosupplementation. It surrounds the diseased cartilage with a thicker
and more "cushioned" environment.
When nonsurgical interventions are not enough to control symptoms, surgery
may be needed.
By the time arthritis can be seen on X-rays, there has been significant wear
or damage to the joint surfaces. If the wear or damage is limited, arthroscopy
can offer a minimally invasive surgical treatment. Arthroscopy has been shown
to provide symptom improvement at least in the short term. It involves removing
any loose bodies or inflammatory/degenerative tissue in the joint. It also attempts
to smooth out irregular surfaces. Multiple small incisions are used to complete
the surgery, which can be performed as an outpatient procedure. The recovery is
reasonably rapid.
If the joint surface has worn away completely it is unlikely that anything
other than a joint replacement would bring about relief. There are several different
types of joint replacement available. In appropriately selected patients, the
improvement in pain and function can be dramatic. With an experienced surgeon,
the results of elbow replacement are the same as the results of hip replacement
and knee replacement.
For patients who are too young or who are too active to have prosthetic joint
replacement, there are other reasonably good options. If loss of motion is the
primary symptom, the surgeon can release the contracture and smooth out the joint
surface. At times, a new surface made from the patient's own body tissues can
be made. These procedures can give years of symptom improvement.
Excerpted
from the AAOS
A total elbow replacement is the replacement of the entire elbow joint with
a metallic joint. This is done through a 4-6 inch incision along the posterior
aspect (back) of the elbow. The incision is usually closed with staples. A elbow
replacement is usually treatment for severe arthritis or a fracture.
2 ½
hours
3 days in
hospital
Generally not needed.
It is possible that the patient may require a transfusion of one unit following
surgery. Therefore, we ask the patient to donate one unit of blood pre-operatively.
Home physical therapy,
visiting nurses, nursing home/rehab center transfers and home health aides are
arranged for the patient by the hospital social worker. They will also arrange
for transportation to the patients home or rehab facility if family/friends are
not available.
The patient must be seen in the office between the 10th and 14th post-operative
day. This is for staple/suture removal and a wound check. At this visit outpatient
physical therapy may also be discussed/arranged.
If a patient reports unusual redness, drainage, pus or irritation of the wound
prior to this first visit, arrangements should be made to bring the patient in
immediately.
If the patient is unable to make the 1st post-operative visit, arrangements
for staple removal must be arranged with their inpatient facility, visiting nurse
or family physician. Then, a post-op visit should be arranged for the next earliest
possible date.
A total elbow replacement is the replacement of the entire elbow joint with
a metallic joint. This is done through a 4-6 inch incision along the posterior
aspect (back) of the elbow. The incision is usually closed with staples. A elbow
replacement is usually treatment for severe arthritis or a fracture.
The patient must be seen in the office between the 10th and 14th post-operative
day. This is for staple/suture removal and a wound check. At this visit outpatient
physical therapy may also be discussed/arranged.
If a patient reports unusual redness, drainage, pus or irritation of the wound
prior to this first visit, arrangements should be made to bring the patient in
immediately.
If the patient is unable to make the 1st post-operative visit, arrangements
for staple removal must be arranged with their inpatient facility, visiting nurse
or family physician. Then, a post-op visit should be arranged for the next earliest
possible date.
Generally at 6 weeks following surgery date – needs x-rays
At 3 months post-op
At 6 months or 1 year – dependent on progress
All patients begin therapy
in the hospital immediately following surgery.
The patient utilize a continuous passive motion machine (CPM) post-operatively
for range of motion. This will be continued in the patient’s home for 2-4
weeks post-operatively.
Reserved for the following
types of individuals:
* Lives alone
* No family/friend support
* Elderly
Available to
all patients immediately following discharge. Home therapy lasts approximately
2-3 weeks
All patients will enter
an outpatient PT program for 6-8 weeks to work on range of motion and strength.
Patient should not drive
for 4-6 weeks unless told otherwise by the physician
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Shoulder Evaluation