Elbow Arthritis

a. What is Elbow Arthritis?

Arthritis is inflammation of the elbow joint. Arthritis leads to the loss of articular cartilage, which covers the ends of the bones, and allows the bones to move smoothly against each other. When the cartilage is damaged, the bones rub together during joint motion, and the patient is said to have ‘bone-on-bone’ in the joint. This can lead to pain with motion, or at rest, clicking or grinding with motion, and a loss of strength. When arthritis becomes severe, the body attempts to stabilize the joint and limit motion by forming bone spurs, or extra bone around the edges of a joint.

What causes Elbow Arthritis?
There are two main types of arthritis: rheumatoid and osteoarthritis. Rheumatoid arthritis occurs when the body’s immune system causes the inflammation; osteoarthritis occurs when the joint wears out as a result of overuse, age, or injury. When an infection in the joint leads to loss of cartilage, it is called septic arthritis.

What are the symptoms?
Patients suffering from elbow arthritis will experience pain, stiffness and loss of strength. A ‘grinding’, ‘clicking’ or ‘locking’ sensation may be felt in the affected joint. Loss of motion can become severe, and the patient may have trouble performing everyday tasks, such as combing their hair.

How is Elbow Arthritis diagnosed?
Arthritis is diagnosed on physical exam and on x-ray. Your orthopaedic surgeon will examine your elbow, noting range of motion, strength and pain with motion. Your surgeon will obtain x-rays, and sometimes a CAT scan or MRI to evaluate the arthritis.

How is it treated?

Non-operative
Elbow arthritis can be treated with physical therapy, to strengthen the muscles that support the joint. The stronger the supporting muscle, the less the body will need to rely on bony architecture to stabilize the joint. This will lead to less stress across the arthritic area. Because arthritis is inflammation, your surgeon may prescribe anti-inflammatory medication or offer an injection to reduce the inflammation. For arthritis in its beginning stages, nutritional supplements are available to slow progression of the arthritis. An injection of the patient’s own blood, which is processed to enhance its healing properties, has shown promise for treating arthritic conditions.

Operative
When non-operative treatment has failed, your surgeon may suggest surgery. Two surgical options are available for elbow arthritis. Arthroscopy of the elbow, or an ‘elbow scope’, involves placing a tiny camera in the joint to remove injured cartilage. Although not a cure, this procedure may provide long lasting relief.  For more severe cases, a total, or partial elbow replacement may be offered. This involves removing the joint and replacing the injured cartilage with a smooth metal or plastic implant. This allows the elbow to move smoothly, reducing pain and, in many cases, improving motion.

b. Osteohondritis Dissecans (OCD) of the Elbow

What is OCD of the Elbow?
Osteochondritis Dissecans is a condition in which fragments of bone and cartilage become separated from the joint surface and form loose bodies in the joint. These fragments usually originate from the humeral side of the joint.

What causes OCD?
It is currently thought that most OCD lesions occur as a result of a traumatic injury that occurred in the patient’s past. They can also occur in throwing athlete as a result of overuse. Some lesions do not have an identifiable cause.

What are the symptoms?
Patients will complain of clicking and locking in the elbow. Patients complain of pain, and are often unable to fully extend their elbow.

How is an OCD lesion diagnosed?
Physical exam reveals loss of motion or clicking in the elbow. The area the bone chips came from may be tender to the touch. X-rays will confirm the diagnosis. An MRI may be obtained to help determine stability of the fragment. Fluid seen behind the fragment on MRI is an indicator of instability, and an indication for surgery.

How is it treated?

Non-operative
Stable lesions, those not likely to displace, are treated with rest, anti-inflammatory medications and observation.

Operative
Unstable lesions, or those that have become loose bodies, are removed arthroscopically. Depending on the patient’s age and activity level, a microfracture may be performed at the time of arthroscopy. A microfracture is a procedure used to repair damaged cartilage. The surgeon drills into the bone where the lesion is located. The drill hole allows bone marrow to leak into the lesion bringing with it blood cells that are capable of forming new cartilage.

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