What is elbow osteoarthritis?
Elbow osteoarthritis, like arthritis in other areas of the body, refers to wearing out or damage of the cartilage that coats the ends of the bones. In the elbow, there are three bones that come together (radius, ulna, humerus) to make up the elbow joint.
Osteoarthritis most commonly occurs as we age. Activities or athletes involved in repetitive elbow flexion and extension or weightbearing, such as weightlifters, manual laborers, baseball pitchers, boxers, and martial artists are specifically prone to elbow osteoarthritis. It can also occur as a result of trauma, most commonly a previous elbow fracture or dislocation. Even injury to the ligaments of the elbow can also lead to arthritis given the normal forces across the elbow are altered, leading to accelerated joint wear.
The most common symptoms associated with elbow arthritis are pain, swelling, and loss of range of motion. Because cartilage does not have any nerve endings, yet bone does, pain is usually experienced when cartilage is worn down enough to expose its underlying bone. Loss of range of motion is usually the result of large bony spurs (osteophytes) that occur within the joint and create a physical block to elbow motion, or because of pain restricting motion. Patients may also complain of locking or a grating sensation with the elbow. This is usually caused by severe cartilage wear and can be indicative of loose bodies (cartilage or bone) within the elbow joint. These loose bodies can also impede joint range of motion
X-rays are usually ordered to evaluate the joint space and look for any bony spurs and loose bodies within the joint. MRI and or CT scans may be ordered to further evaluate for loose pieces of bone or cartilage within the joint. It is important to note that the appearance of the joint does not necessarily correlate with symptom severity. Patients with an x-ray showing severe osteoarthritis may have minimal pain and vice versa.
Nonoperative treatment is first-line for elbow osteoarthritis. Activity modification, physical therapy, and lifestyle modifications are treatment staples. Heat (heating pad/warm towel) in the morning to help with stiffness and ice towards the end of the day or after significant activity can help. The occasional use of pain medicines such as Tylenol or NSAIDs (such as Aleve and Ibuprofen), if not contraindicated for other health reasons, can also alleviate pain. Different anti-inflammatory gels may temporarily help as well.
Injections may also be an option for some patients. Platelet-rich plasma (PRP) is commonly used. Find out more information about PRP by following the link. Cortisone injections are usually only recommended as a last resort given there is evidence suggesting cortisone can lead to cartilage damage, especially after being given multiple times. Dr. Steven Lee will discuss all of these options with you during your visit, and is one of the world’s leaders in the use of PRP for arthritis.
Surgery is usually recommended once all nonoperative treatment options have been exhausted and the pain and functional limitations can no longer be tolerated. The type of surgery performed depends on the patient’s age, activity level, and arthritis severity. A minimally invasive elbow arthroscopy (scope) is often performed. During this procedure, a small camera and other instruments are inserted into the elbow joint through tiny incisions. The elbow scope can be used to remove degenerative tissue (synovectomy), remove degenerative cartilage and smooth the joint surface (chondroplasty), remove loose pieces of bone, or remove large osteophytes restricting range of motion.
A total elbow replacement may be recommended for patients with significant arthritis and involves removing the diseased ends of bone and resurfacing those bones with special implants designed to recreate normal elbow anatomy. This creates a new prosthetic joint surface and facilitates smooth joint motion. The decision to have a total elbow replacement is a significant and personal decision. Dr. Steven Lee is one of the few surgeons in NYC who performs total elbow replacements, a notoriously complex surgery best performed in the hands of an experienced surgeon.
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The postoperative protocol and recovery depends on which surgical treatment is utilized. Those undergoing an elbow scope are usually started on physical therapy the day following surgery, as early range of motion is crucial towards preventing scar tissue build-up that may restrict range of motion. Patients can usually return to normal activity within a few weeks after surgery.
For total elbow replacements, patients are usually placed in a splint after surgery for at least two to three weeks to allow for adequate skin healing. After which an extensive rehabilitation process occurs with the use of a brace for at least 2-3 months. Patients may feel relatively well at the 3 month mark, but will be limited to carrying less than 15 pounds in that extremity.
Immediate Post-Operative Instructions
Please refer to the following pages for more information:
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.