WHAT YOU SHOULD KNOW
The purpose of the elbow is to position the hand in space. With arthritis, the joint becomes stiff and painful. Treatments for elbow arthritis are directed at these two main symptoms. There are three main types of arthritis that affect the elbow. Osteoarthritis is simply the basic arthritis that comes with aging as the cartilage of the joint wears away over time. Post-traumatic arthritis occurs in younger patients following fractures and ligament injuries to the elbow. Rheumatoid arthritis frequently affects the elbow joint as part of a body-wide special disease process.
MEDICAL HISTORY
The first step in evaluating elbow arthritis is to determine which of the three basic types of arthritis has occurred. Next is to determine how the elbow arthritis relates to any other abnormalities in that arm, the other arm, or elsewhere in the body. The lifestyle of the patient is important, since different activities place different demands on the elbow joint. Any history of prior infection in the elbow is critical.
EXAMINATION
The elbow is examined for range of motion, stability, and deformity. The quality of the surfaces during motion and at the limits of motion can be felt. The remainder of the arm and hand, as well as the opposite side, is examined to establish context.
ADDITIONAL TESTS
The main test needed to evaluate elbow arthritis is a basic x-ray. Very rarely do expensive imaging studies such as CT scan or MRI add anything to the evaluation process. If there has been a history of infection in the past, a special scan may be performed to assess for current infection activity.
TREATMENT OPTIONS
| NON-OPERATIVE | SURGICAL JOINT FUSION | SURGICAL JOINT REPLACEMENT | |
| CONSISTS OF | Cortisone injection; Oral anti-inflammatory medication; Activity modification | Surgical removal of bone spurs and inflamed tissue lining the joint | Surgical replacement of the joint with man-made prosthesis |
| FEATURES | Maximum of 3 injections into same joint | Open incision surgery on one or both sides of the joint, no implants used | Prosthetic components made of metal with polyethylene bearings on surface |
| ADVANTAGES | Non-surgical | Patient keeps his / her original joint; can improve motion | Provides new smooth surfaces for motion |
| DISADVANTAGES | Only effective for milder cases; Side effects limit oral medication use | Does not create new cartilage on joint surfaces that will continue to deteriorate further | Prosthesis can loosen or wear out over time especially with aggressive use |
RECOVERY
After capsulectomy, the patient must immediately pursue very aggressive motion in therapy to avoid post-surgical stiffness. The therapy is quite painful and requires a major commitment on the patient’s part to achieve a good result. Therapy continues as an outpatient for at least 2 months and as an ongoing home program for up to 6 months. Specialized splints (static progressive splints) are used to achieve and maintain better full extension and full flexion postures.
After implant arthroplasty using a prosthesis, the triceps tendon is initially protected (6 weeks) with controlled motion prior to using the elbow more vigorously. Daily motion exercises are still performed in outpatient and home therapy, but the nature of the therapy is not as intense as following capsulectomy. Permanent limits on lifting any carrying forces with the operated arm are set at 2 lbs.
