Cartilage is the substance that lines our bones to allow smooth gliding surfaces for our joints. As the cartilage wears out and deteriorates, our bodies are not able to regenerate or replace the loss of joint cartilage. Eventually, this loss of cartilage leads to symptoms of arthritis including joint stiffness, swelling, and pain. As a joint becomes more arthritic, synovial tissue that lines the joint capsule thickens, synovial fluid production increases, and bone spurs develop along the joint margins which can further restrict motion and cause increased pain. In the elbow, bone spurs can eventually enlarge and distort the normal shape of the joint which can block full elbow motion like a doorstop blocks motion of a door. Symptoms of pain can often vary, but when arthritis becomes more symptomatic, even simple activities of daily living can become difficult to perform. Arthritis can greatly affect one’s quality of life.
Arthritis can be defined as either degenerative or inflammatory. Degenerative arthritis (also known as osteoarthritis) is the most common form of arthritis. Osteoarthritis occurs from “wear and tear” on the joints and generally affects older patients. Another form of degenerative arthritis that can affect younger patients is post-traumatic arthritis, a condition that results from injury to a joint such as an elbow fracture or fracture-dislocation.
Inflammatory arthritis is often associated with systemic (total body) symptoms that may appear throughout one’s body. The most common form of inflammatory arthritis is rheumatoid arthritis. Eventually the inflammatory process can lead to erosive and destructive changes to the joints, and eventually secondary deformities of the wrist, hand, or elbow. Advanced inflammatory arthritis can greatly affect functional use of the upper extremity. Patients with inflammatory arthritis should be evaluated by a Rheumatologist for appropriate evaluation and medical management, although surgery may be necessary for more advanced arthritis and deformities to help alleviate pain and to restore functional use of the hand, wrist, and elbow.
Treatment for arthritis of the elbow typically begins with conservative non-operative options. Basic treatment measures include modification of activity, medications, and corticosteroid injections. However, the success of treatment and options available depends on several factors which include the anatomic location of the arthritic joint, the degree of arthritis, and the patient’s age, activity level, and medical conditions. It should be understood that these methods of treatment, particularly use of medication, do not provide a cure for arthritis or restore cartilage, but are used to reduce arthritic flares and to alleviate symptoms. With the successful reduction of symptoms, one can expect improvement of functional use of the elbow, but some limitations of activity could persist depending on the degree of arthritis.
A period of activity modification for the elbow with avoidance of heavy lifting or bearing load to the joint may help reduce symptoms of pain and swelling. Splinting intermittently may also help to rest the joint by reducing activity level. Splints are generally worn when symptoms flare or with activities that increase pain. However, joint range of motion exercises intermittently are typically encouraged to avoid the potential for increased stiffness of the joint.
Non steroidal anti-inflammatory medications (NSAID’s) are the most common type of medications used for arthritis. These medications can reduce pain and swelling by blocking the body’s pathways responsible for inflammation. However, it is important to have follow-up evaluations with your primary care physician if these medications are used on a long term basis as some side effects to other organ systems such as the kidneys can occur, particularly in patients with a history of diabetes or hypertension. Use of these medications may also be difficult for patients that have a history of gastric reflux or stomach ulcers and may not be allowed for patients that require other blood thinning medication. You may need to consult with your physician on their use. Other medications such as chondroitin sulfate and glucosamine have also been used for arthritis and may have an anti-inflammatory effect. Another medication that can offer effective pain relief for arthritis is acetaminophen which is not classified as an NSAID.
Injections with a corticosteroid (also known as “cortisone” injection) can also be offered, particularly if NSAID’s are not effective or a patient is unable to take anti-inflammatory medication. Although corticosteroid injections can be very effective for alleviation of joint pain and swelling, the long-term relief following an injection can be unpredictable. Pain relief following an injection may be limited to several weeks, but could possibly last over months. Based on some of the potential side effects of injectable corticosteroids, there are limitations on the number of allowable injections that can be done. Your doctor will discuss these limitations of an injection.
If the prescribed non-operative treatment options are no longer effective or fail to provide relief, then surgery is generally considered. The goal of surgery is to optimize pain relief and allow return of functional use of the elbow. For less severe arthritis of the elbow, surgical techniques, including bone spur removal, partial joint replacements, or partial resections of the joint with resurfacing, may be possible solutions to alleviate pain and improve functional activity. For more advanced stages of elbow arthritis, total elbow joint replacement arthroplasty can reliably eliminate pain and restore functional activity. However, based on the complexity of the elbow, these surgical options each have limited success and are only suitable for select patients. Dr. Katz will discuss these various options to help you choose the treatment that is best for you.