Osteoarthritis of the elbow occurs when the cartilage surface of the elbow is worn out or damaged. This can happen because of a previous injury such as elbow dislocation or fracture. Most commonly, however, it is the result of a normal wearing away of the joint cartilage from age and activity.
There are several different methods of cartilage repair performed which may include multiplying samples of healthy cartilage outside the body before implanting it back into the damaged area or transplanting grafts of healthy cartilage to the damaged area to relieve pain and restore the range of motion.
Other Names
- Elbow Osteoarthritis
- Elbow Arthritis
- Post Traumatic Elbow Arthritis
Background
- This page refers to all causes of elbow arthritis, which is often used interchangeably with the term elbow osteoarthritis, although causes can vary
- Osteoarthritis
- Rare, 2% prevalence (need source)
- Male predominance 4:1 (need source)
- Average age 50 (range 20-70)
- Post-traumatic
- #2 cause of elbow arthritis (need citation)
- Inflammatory
- Rheumatoid Arthritis most common cause (need citation)
Pathophysiology
- General
- Typically dominant arm
Osteoarthritis
- See: Osteoarthritis (Main)
- Primary (No other cause)
- Most cases
- Secondary (Secondary to other pathology)
- Osteochondral Defect
- Synovial Osteochondromatosis
- Ulnar Collateral Ligament Injury
- Valgus Extension Overload
- Pathoanatomy
- Joint degradation: osteophyte formation, capsular contracture, loose bodies
- Osteophytes reduce motion
- Radiocapitallar Joint most commonly affected, more so than the Humeroulnar Joint
Post-traumatic
- Commonly seen post-operatively after fractures or dislocations involving the elbow
- Pathoanatomy
- Direct articular cartilage damage from traumatic event
- Asymmetric load bearing
- Degenerative changes accelerated
Inflammatory
- Pathophysiology
- Chronic inflammation and synovitis
- Subsequent ligament attenuation, periarticular osteopenia, and capsular contracture
- Pathoanatomy
- Flexion contracture with the erosion of articular cartilage, joint space loss
- Cyst formation, joint deformities
- Ulnar Neuropathy
- Progressive instability
Risk Factors
- Systemic disease
- Rheumatoid Arthritis
- Septic Arthritis
- Gout
- Pseudogout
- Hemophilia
- Pigmented Villonodular Synovitis
- Activities
- Manual laborers
- Weight lifters
- Throwing athletes
Differential Diagnosis
- Fractures
- Adult
- Radial Head Fracture
- Olecranon Fracture
- Capitellum Fracture
- Coronoid Fracture
- Terrible Triad of Elbow
- Pediatric
- Nursemaids Elbow
- Supracondylar Fracture
- Lateral Condyle Fracture (Peds)
- Medial Condyle Fracture (Peds)
- Olecranon Fracture (Peds)
- Radial Head Fracture (Peds)
- Medial Epicondyle Fracture (Peds)
- Salter-Harris Fracture
- Adult
- Dislocations & Instability
- Elbow Dislocation
- Proximal Radioulnar Joint Instability
- Tendinopathies
- Lateral Epicondylitis
- Medial Epicondylitis
- Distal Biceps Tendon Injury
- Triceps Tendon Injury
- Bursopathies
- Olecranon Bursitis
- Ligament Injuries
- Lateral Collateral Ligament Injury (Elbow)
- Ulnar Collateral Ligament Injury
- Neuropathies
- Cubital Tunnel Syndrome
- Radial Tunnel Syndrome
- Arthropathies
- Elbow Arthritis
- Other
- Valgus Extension Overload
- Posteromedial Rotatory Instability
- Posterolateral Rotatory Instability
- Osteochondral Defect
- Pediatric Considerations
- Little League Elbow
- Panners Disease (Avascular Necrosis of the Capitellum)
- Nursemaids Elbow (Radial Head Subluxation)
Diagnosis
- General: Physical Exam Forearm
- History
- Patients report pain with range of motion, stiffness, weakness
- Progressive pain, most consistently at end of range of motion
- Loss of complete extension
- Locking, catching, clicking
- Physical
- Painful range of motion, including supination and pronation and typically worse at extremes of motion
- Some patients may have tenderness along the joint
- OA: 50% have symptoms of ulnar neuropathy
- Inflammatory: May have flexion contracture,
Radiographs
- Initial 3 views
- Findings in Rheumatoid Arthritis
- Symmetric joint space narrowing
- Periarticular erosions, cystic changes
- Disuse osteopenia
- Primary osteoarthritis
- Osteophyte and loose body formation on the olecranon and coronoid processes, extending into the fossae
- Typically sufficient for surgical planning
CT/MRI
- Typically unnecessary
- Consider in patients with heterotopic ossification, substantial bony deformities or intra-articular loose bodies
- Useful for surgical planning
Rettig classification
- Based upon radiograph findings[1]
- Class I: marginal arthritic spurring of the ulnotrochlear joint, normal radiocapitellar joint
- Class II: marginal ulnotrochlear joint arthritis, arthritic changes in radiocapitellar joint; radiocapitellar joint is congruent, without evidence of subluxation.
- Class III: Class II with the presence of radiocapitellar subluxation denotes a class III elbow
Treatment
Nonoperative
- Considered first-line therapy
- In patients with Rheumatoid Arthritis
- Disease modification anti-rheumatic drugs should be emphasized
- Can achieve resolution of signs and symptoms in 10% of patients[2]
- Osteoarthritis
- Relative rest
- Analgesia including Acetaminophen, NSAIDs
- Activity modification
- Physical Therapy
- Corticosteroid Injection
- Consider
- Regenerative medicine, viscosupplementation
Operative
- Indications
- Failure of nonoperative management
- Techniques
- Arthroscopy
- Synovectomy
- Arthroscopic and open debridement
- Outerbridge-Kashiwagi ulnohumeral arthroplasty
- Distraction interposition arthroplasty
- Total elbow arthroplasty (TEA)
