Elbow Osteoarthritis: Causes, Symptoms, Signs, Treatment, Surgery, Diagnosis

Elbow osteoarthritis is a degenerative condition, affecting the elbow joint. The elbow joint forms a joint, which connects the upper arm to the hands and enables free movements of hands. Elbow osteoarthritis is a condition that results due to wear and tear of the elbow joint, more commonly with aging or in previously injured elbow joints. While elbow injuries are less common than other joints, they are commonly encountered due to falls, direct blows or as sports injuries.

Elbow osteoarthritis occurs when the cartilage in between two bones meeting at elbow joint gets degenerated or wears off causing further thinning of the cartilage. This results in rubbing of the bones on each other or increased friction, due to minimal cushioning present in between them. The destruction of cartilage affects normal movements of the elbow joint, making it painful and restricted. In elbow osteoarthritis, the joint space too gets narrowed due to the thinning cartilage, causing more pain and restriction of activities of the elbow joint.

Elbow osteoarthritis is the inflammation at the elbow joint, which can be precipitated by certain causative factors.

Elbow joint injuries are commonest among sports persons, especially sports involving the use of hands like cricket, hockey and racquet sports. Injuries to the elbow can also occur when the elbow is directly hit due to a fall, blow or due to accidents. The common injuries to the elbow joint that can cause damage and lead to osteoarthritis in elbow include:

• Fractures or dislocations at the elbow joint can cause cartilage damage and lead to gradual loss of cartilage.
• Sprains causing injury to the ligaments, most commonly ulnar collateral ligament. An injured ligament makes the elbow joint unstable forcing altered movements of the elbow resulting in more damage to the elbow joint.
• Bursitis (inflammation of the bursa), swelling that appears after the elbow joint is hit and injured.
• Tennis elbow, medically termed as lateral epicondylitis that results from an overuse injury to the extensor muscles.
• Muscle strains of the muscles of the elbow, forearm, biceps, extensors, can cause varying degree of damage to the muscles around the elbow joint.

Certain factors can increase the risk of elbow osteoarthritis. People who may be at an increased risk generally include those middle-aged men involved in manual labor, activity or sports; older population, those with a history of elbow fracture, injury, joint related conditions or those with a family history of osteoarthritis.

Elbow osteoarthritis presents itself with common symptoms that are usually difficult to ignore.

Some of these symptoms include:

• Pain – Pain may be felt often in a previously injured elbow joint. However, with gradual degeneration and progression of elbow osteoarthritis, pain may grow slowly. Pain may be sharp, severe at times or may be experienced only when performing certain activities of the hands. It is usually aggravated by hand movements, lifting weights and is usually better with rest. Eventually, pain in elbow osteoarthritis can become constant and may last for longer periods and result in chronic pain.
• Stiffness – Elbow joint stiffness is a common symptom in elbow osteoarthritis. In this, the joint feels stiff as if rigid and there is difficulty in bending or fully extending the elbow. It may be related to performing certain type of activities for a long time or repeated hand movements, which can cause pain and stiffness in elbow joint later on. Symptoms of elbow joint stiffness is often a result of inflammation in the joint.
• Restricted Joint Movements – Pain and stiffness of elbow joint, along with symptoms of joint swelling, makes it difficult to move the elbow. Activities involving movements of elbow, pushing, pulling and lifting objects may be difficult and painful to perform.
• Muscle Spasm – When joint stiffness causes more problem, the surrounding muscles get tensed as a protective mechanism. Muscle spasms around the elbow joint are commonly experienced symptom in elbow osteoarthritis, often resulting from elbow joint inflammation and stiffness.
• Clicking Sounds – Clicking sounds or a grating sensation is felt due to rubbing of the bones over each other, due to the lost cartilage and eventual loss of the smooth surface in between the joint.
• Locking of Joint – Locking of joint is felt as if the joint suddenly gets locked and is unable to move for some period. Symptoms of joint locking in elbow osteoarthritis occurs due to loose pieces of cartilage or bone get dislodged from their original position and get stuck in the joint, making joint movement difficult.
• Numbness in Fingers – Persistent swelling at the elbow joint and limited range of motion can cause compression of a nerve (ulnar nerve) running through the hand. Pinching of the ulnar nerve can lead to numbness and tingling in fingers. It is more common in the later stages of elbow osteoarthritis with progressive degeneration.

Apart from the symptoms experienced by the patients, certain signs related to elbow osteoarthritis can be noticed. These include:

• Elbow Swelling – With continued inflammation and progression of elbow osteoarthritis, signs of swelling appears around the elbow joint. Elbow swelling can be more painful and cause further restriction of elbow movements.
• Muscle Weakness – Elbow osteoarthritis causes restriction in elbow movements, which further lead to weakness in elbow muscles.
• Muscle Atrophy – Osteoarthritis of elbow joint cause painful movements, often resulting in restriction of hand and elbow movements. This causes weakness in muscles, loss of muscle mass and muscle atrophy.
• Crepitus – The signs of grating or creaking sound in a worn out joint is medically termed as crepitus. In elbow osteoarthritis, crepitus is felt over the joint when performing active (performed by self) or passive movements (performed with assistance) of the elbow joint.
• Restricted ROM – Medical examination of the elbow affected with elbow osteoarthritis shows signs of restricted range of movements. Normal movements like flexion, extension, twisting of hands using elbow muscles is often restricted.
• Elbow Joint Instability – The elbow joint may lose its stability and give way, while performing activities using elbow joint.
• Bone Spurs – Bone spurs are small bony growths like extensions called osteophytes that may be painful and often restrict normal elbow joint movements.
• Loose bodies in elbow joint – Elbow osteoarthritis often results in loose bodies in elbow joint. These loose bodies are pieces of bone and torn cartilage that come in way of normal elbow joint movement. It can cause joint locking, make the elbow joint more unstable and restrict movements. The loose bodies in elbow joint are usually required to remove along with treatment and rehabilitation for osteoarthritis.

Elbow osteoarthritis needs evaluation and medical examination. The physician considers the history of the patient to understand factors like injury to the elbow joint and looks out for signs of damage or trauma to the elbow. Any history of fall, blow, presence of fever and other history details are taken. Family history and patient’s previous medical history is also take into consideration.

Clinical examination of the elbow joint includes assessment of the joint region to detect signs of inflammation, joint swelling, redness, warmth and tenderness of the elbow joint. Range of movement is evaluated and the degree of pain and its severity is assessed. Duration for which elbow pain is present is assessed along with stability of elbow joint, signs of muscles weakness, muscle atrophy and crepitus.

Investigations are ordered based on the clinical symptoms, history and possible medical conditions related to elbow pain. Some of the common investigations include

X-ray – These are done to rule out fractures and other problems with the bone. Arthritic changes can be seen on X-rays. Elbow osteoarthritis can reveal elbow joint space narrowing, bone spurs or osteophytes and loose bodies on X-rays. However, sometimes X-rays changes may not always appear in the initial stages, as they appear with progressive degeneration.

MRI – Elbow osteoarthritis may be seen as thickened synovial membrane of the elbow joint, thinning of articular cartilages, bony spurs and narrowing of joint space in elbow joint.

CT scan – CT scans of elbow osteoarthritis can reveal the osteophytes that may not be easily picked in X-rays. It also helps to identify the size and location of bony spurs or loose bodies, its distance from important nerves like ulnar nerve and help in planning treatment options and surgical removal of bone spurs.

Blood Investigations – Blood tests are ordered to rule out systemic diseases and find signs of inflammation.

• CBC – Complete blood count gives an understanding of the cell counts and to rule out signs of infection.
• ESR – ESR is raised in inflammatory conditions and is often the case in elbow osteoarthritis. However, it may also be raised in other joint inflammatory conditions of the joint.
• Other Tests – Rheumatoid Factor (RF), ANA profile, Anti-CCP and similar tests are done to rule out rheumatoid arthritis and other autoimmune disorders affecting the elbow joint.

Arthrocentesis or Joint Fluid Analysis – In case of swollen elbow joints, there is joint effusion. Arthrocentesis or joint fluid aspiration is a diagnostic and treatment modality performed to reduce the swelling and pain of the elbow joint. The joint fluid is aspirated with a needle in sterile conditions and the fluid is sent for further testing or fluid analysis. This is performed to rule out the presence of blood, white blood cells, bacteria, pus cells and signs of inflammation and to rule out other causes like septic arthritis, rheumatoid arthritis, etc.

Elbow Joint Arthroscopy – Arthroscopy is a procedure performed for diagnostic and therapeutic purposes. A thin tube with a camera is inserted into the elbow joint through small incisions made around the joint area. It enables visualizing of the elbow joint and its structures; cartilages, tendons, ligaments, muscles and synovial membrane can be viewed to assess the damage. It helps in diagnosing the condition and also guides in surgical treatment procedure.

Treatment of elbow osteoarthritis primarily includes non-surgical treatment and medical management along with rehabilitation.

Non-surgical Treatment of Elbow Osteoarthritis

• Activity Restriction – Patients with elbow osteoarthritis are advised to avoid activities that trigger elbow pain. Lifting heavy weights, repeated hand activities or sports may be restricted for some time. Adequate rest between periods of activities is important.
• Activity Modification – Patients may be advised to modify certain activities involving the use of elbow and hands to ensure less strain on the elbow joint.
• Medical Management – Medications to reduce elbow pain and swelling are given for managing elbow osteoarthritis. Non-steroidal anti-inflammatory medicines help to control joint inflammation, reduce pain and swelling, thus improving joint movements. Muscle relaxants may be given to reduce muscle spasms and pain. Oral steroid medications may be considered for chronic elbow pain in elbow osteoarthritis. Cortisone injection may be given in some cases of elbow osteoarthritis to reduce pain and inflammation. Nutritional and dietary supplements like vitamin D, calcium, Glucosamine and Chondroitin sulphate may be considered by the treating physician.
• Physical Therapy – Physical therapy for elbow osteoarthritis can help to reduce pain, improve joint functioning and range of movements. It also aims at strengthening muscles to maintain joint stability and effective elbow functioning, preventing further joint damage and injuries.

Cold compresses or ice packs can be applied to the elbow joint in case of acute inflammation, swelling, and pain in elbow osteoarthritis. Hot compresses may be applied to the area when muscles are tensed or alternate hot and cold compresses can also be applied.

Braces that help to support the elbow joint, compression bandages for limited periods and elbow joint supports can be worn as appropriate to ease activities while the joint remains supported.

• Exercises for Elbow Osteoarthritis

Elbow osteoarthritis is a degenerative condition, which can be managed by limiting activities that bother the elbow joint and preparing the supporting muscles to function optimally.

Exercises that focus on muscle strengthening, flexibility and weight training for elbow muscles are advised. For e.g. close the fist tightly and release, bend and straighten the elbow and repeat the same with weights. Therapeutic exercises that help to improve fine motor skills include pressing on stress ball, stringing beads or clay modeling.

When conservative treatment for osteoarthritis does not bring satisfactory results, surgical treatment may be considered. Some of the surgical options available for treatment of elbow osteoarthritis include

• Synovectomy – Removal of inflamed pieces of synovial membrane, which has caused inflammation of the elbow joint.
• Elbow Arthroscopy – Insertion of tiny instrument with camera to visualize and remove bony fragments, bone spurs and pieces of torn cartilage from the elbow joint.
• Elbow Osteotomy – Removal of sections of bone to allow free movement of elbow joint and alleviation of symptoms.
• Elbow Arthroplasty – Replacement of damaged joint with an artificial one.

Patient education plays an important role in prevention of elbow osteoarthritis. Occupations, hobbies, sports and activities that require repeated use of hands, bending elbow or making forceful movements of elbow joints can increase the risk of injuries and damage to the elbow joint. Increased wear and tear of the elbow with such activities or due to previous injuries can cause degeneration of the elbow joint and lead to elbow osteoarthritis. Being aware of this fact and preventing injuries, protecting the elbow joint during games and adventure sports, can help.

Early diagnosis and timely initiation of treatment can help to prevent further deterioration of elbow osteoarthritis. People with injured elbows or early elbow osteoarthritis need to protect their elbow with braces, strengthening exercises and activity modification.

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