What is elbow arthritis?
Elbow joint is the second most mobile joint of the body after shoulder joint. It is a hinge joint and comprises of three bones, humerus (arm bone), radius and ulna (forearm bones). It is supported by ligaments which keep the bones of the elbow in proper alignment. Elbow arthritis is a degenerative condition of the elbow joint that damages the lining (cartilage) of the joint. It can be caused by degenerative wear and tear due to ageing (osteoarthritis), rheumatoid arthritis (inflammatory) and after an injury (post-traumatic) like a broken elbow or a torn ligament/tendon and dislocation.
Osteoarthritis mostly affects adults above 60 years. Rheumatoid arthritis commonly affects women in the age between 20-40 years. Osteoarthritis accounts for 2% cases in general population mostly occur in people who use the arm for heavy labour and also those involved in weightlifting or baseball pitchers (throwing). Rheumatoid arthritis accounts for 20-65% of patients with elbow ailments. It mostly affects women of middle age. Post-traumatic arthritis can affect any person commonly younger patients after an injury.
What are the symptoms of elbow arthritis?
You will feel pain, swelling, deformity and stiffness in the affected elbow. The joint is warm when touched. Pain is felt most when you bend or extend your elbow or try to lift a thing. Catching or locking of the joint is also common. Numbness and tingling are felt in some cases. In later stages the elbow joint could become very stiff or sometimes unstable that you may feel great difficulty in performing activities of daily living. Night pain is present in most patients.
How is it diagnosed?
Your orthopaedic surgeon will confirm its diagnosis by evaluating your complete medical history, physical examination, and X-ray. Your surgeon will also ask for scans (USS, CT, MRI) and blood tests.
What happens if nothing is done?
If elbow arthritis is left untreated, the range of motion becomes more limited with progressing arthritis. Marked disability with constant pain and stiffness develops, hindering the normal activities of daily life. It becomes very difficult to manage pain with painkillers in such cases.
How is it treated?
Arthritis is not curable. However, its symptoms can be reduced by a number of treatments. It can be managed surgically and non-surgically. Non-surgical treatment options involve activity modification, rest, painkillers, anti-inflammatory medicines, warm or cold therapy, steroid injection and physiotherapy.
Surgery is indicated in-
- Failure of conservative treatment
- Advanced arthritis
- Severe pain
- Persistent stiffness
- Unstable joint
- Joint subluxation/dislocation
- Patient preference
- Prolonged disability
- Persistent pain
- Complex distal humerus fracture
- Non-union or malunion of fractures
What are the non-operative treatments?
Non-operative treatment is the first line of treatment for elbow arthritis. It includes the following –
- Activity modification- you may have to modify your activities like repetitive overuse of elbow, avoiding sports and other activities that can render stress on your elbows.
- Icepacks or moist heat- ice-packs or moist heat is applied to the affected joint in order to relieve pain and swelling of the joint for 20-30 minutes twice or thrice a day.
- Physiotherapy- it is recommended to prevent the stiffness and restore the lost range of motion.
- Medicines- painkillers like paracetamol or codeine and anti-inflammatory medicines like aspirin or ibuprofen are given to the patient to manage pain and inflammation. However, they can just relieve the symptoms but cannot cure the condition completely.
- Steroid injection– steroid injection (cortisone) in the affected joint relieves pain. However, it usually provides temporary relief of pain and inflammation of the elbow.
- Dietary supplements – glucosamine and chondroitin sulfate can be taken to reduce pain but there is less evidence to support their efficacy in arthritis. However, it should be taken after the consultation with your physician as it may interact negatively with medicines.
What does the operation involve?
The main purpose of surgery is to restore range of motion and full function of the elbow. Choice of surgery depends on the type of arthritis, stage of your disease, your age and health and your activity needs. The surgical options ranges from arthroscopy (keyhole surgery) in mild to moderate arthritis to arthroplasty (implantation of artificial joint) in severe cases.
- The operation is performed as day case; the skin is incised over the affected areas. The number of incisions made on the skin depends on the type of surgery selected.
- In mild and moderate arthritis, the joint is debrided, capsule released, extra bone removed, joint manipulation done by either open or key hole surgery. However, in severe cases total elbow replacement is a good option.
- The skin is then closed by absorbable sutures. The whole operation ends in 1-2 hours and most patients are discharged on the same day.
What happens after surgery?
- The local anaesthetic wears off in 4 to 12 hours after surgery. Patients are given painkillers before the pain starts i.e. on return to home. It is continued for at least 48 hours after the first dose. Thus, most of our patients report little pain.
- You may be discharged from the hospital same day if you had arthroscopy vs 2 to 3 days as elbow replacement surgery is a major surgery.
- Before discharge, your physiotherapist will teach you gentle exercises of fingers, wrist, elbow and the shoulder. This is necessary to prevent stiffness and pain and to maintain the strength of the muscles near your shoulder after healing.
- A polysling is applied on your operated side to provide support and avoid new injury to this area.
- You are reviewed after two weeks of surgery to check the status of the wound and physiotherapy.
- The wound should be massaged (typically after 2 weeks) using the moisturizing cream by the patient 3 times a day for 3 months once the wound is well healed. This reduces the scar sensitivity and scar-related complications (tenderness; helps scar to mature).
- Physical therapy is advised to facilitate rehabilitation. The physical therapy begins with gentle exercises and progressed to more aggressive exercises. This will be guided by your surgeon and is based on the complexity of the primary problem and the procedure performed.
Are there any risks?
- Elbow stiffness
- Ulnar or Median or Radial nerve injury
- Vascular injury (uncommon, brachial artery)
- Myositis ossificans
- Anaesthetic complications
- Instability of the joint
- Improper wound healing
- Loosening of the joint
- Implant failure
- Triceps avulsion
- Recurrence of stiffness
- Need for further procedures
What are the results of the operation?
The outcome of the surgery is good with minimal serious complications (<5%). The outcome following this surgery depends on grade of arthritis, associated pathologies, chronicity of the problem, treatment involved and adherence to physiotherapy.
When can I return to driving and work?
You can get back to work in 2-4 weeks if you have a desk job, however might take a little bit longer if your job involves physical work. You should be able to resume driving in 4-6 weeks. The above time line could vary based on the severity of injury and the treatment modality. Your physician will be able to advise you.
- An 80 year old lady with severe arthritis affecting her elbow joint presented with severe pain, stiffness and loss of function
- She had a total elbow replacement that relieved pain, restored range of movement and function.