Elbow Arthritis

Elbow arthritis can limit function, cause pain, and lead to serious impairment of the arm. Initial treatment includes a steroid injection and decreasing any painful activities. Sometimes a rubber-like sleeve worn over the elbow can help decrease pain by providing some stability, warmth and compression. You can try some non-steroidal anti-inflammatory medications, like Ibuprofen or Naprosyn. If those don’t work, then surgery can be very effective. There are different surgical options, depending on how advanced the arthritis is and where it is.

Pain that occurs mainly at full flexion or full extension is usually due to arthritic bone spurs. These can often be removed by either arthroscopic or open surgery (if the bone spurs are really big), improving symptoms. The arthritis may continue to progress, but many years of increased comfort may be provided. Pain at rest is usually due to the inflammation of arthritis. This can be removed during the surgery. Any catching or locking due to pieces of bone spurs that have broken off and are floating around the joint can also be addressed.

If stiffness is a problem, this surgery may often improve motion by removing the joint capsule, which is the balloon around the joint. If increased motion is desired, then after surgery a fairly extensive physical therapy program will be required in order to maintain the motion that is gained at the time of surgery. If significant stiffness is present, an endoscopic cubital tunnel release will be required to release the ulnar nerve, which is often caught up in the scar, in order to avoid problems with this nerve following surgery.

Pain throughout the entire range of elbow motion is usually due to cartilage loss, causing the joint to be ‘bone on bone’. In cases of arthritis this advanced, simply removing loose bodies, bone spurs, inflammation and the joint capsule will not be enough. The placement of a new joint surface will be required.

In older patients, a total elbow replacement is an effective option. Total elbow replacement often requires a hospital stay of 1-2 nights. The elbow is splinted for 2 weeks and then motion is begun. Pain relief and function are very good, but elbow replacements can loosen over time. To protect against this, there is a lifetime lifting limit of 1-2 pounds repetitively and 5-10 pounds for a single time once in a while.

In young patients who cannot live with these restrictions, the best operation is often a fascial-interposition arthroplasty, where the Achilles tendon from a cadaver is used to resurface the elbow joint. The Achilles tendon is broad and slippery, and can provide a pain-free surface for an elbow. This surgery also usually requires a night in the hospital. In order to keep the joint surfaces apart to allow healing and motion, an “external fixator” is placed around the elbow. This external fixator consists of 2 metal screws placed into the humerus (the large bone above the elbow) and 2 metal screws placed into the ulna (one of the forearm bones), connected by a hinge to allow motion. This device remains in place for 4-5 weeks and is then removed under general anesthesia as a second procedure. While fascial-interposition arthroplasty is not as predictable as a total joint replacement, it does very well in patients without ligament or bone loss. And unlike a total elbow replacement, once the fascial-interposition arthroplasty is healed, the elbow can be used within the limits of pain, without lifting restrictions.

For the best advice, and often the best results, consult an elbow specialist to find out what the best treatment is for your arthritic elbow.

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