In the second of our blogs to mark National Arthritis Awareness Month, we are exploring the range of treatments available for people with elbow arthritis.
This type of arthritis is one of the less common forms and you can find more information about the causes and what symptoms to look out for in our blog What Causes Elbow Arthritis?
Diagnosis of elbow pain
Most elbow pain is not caused by arthritis and often such pain improves by itself with at-home treatments, such as taking painkillers and using the RICE method (rest, ice, compression, elevation) to relieve pressure on the joint. It’s important to see a doctor, however, if there’s no obvious injury or infection and the pain doesn’t clear up after a couple of weeks, or if you are experiencing tingling, weakness or numbness in your hand or arm. If you suspect an elbow fracture or infection, you need to see a doctor immediately.
You may be given an X-ray to check for fractures as well as bony growths or loose pieces of bone which can be a sign of arthritis. In some cases, an MRI scan may be used to create a highly detailed picture of the elbow structure or ultrasound scans may be used to show up soft tissue problems. If you have bony spurs, a CT scan can reveal the position and size of these spurs.
Treatment of elbow pain
If arthritis is diagnosed, an orthopaedic consultant will normally recommend conservative treatments first before moving on to more invasive procedures. The possible treatments include:
Exercises recommended by a physiotherapist can help to build up muscle strength and prevent stiffness or loss of mobility in your elbow. You will normally need to exercise your elbow at least once a day within the limits of any discomfort, and the physiotherapist may recommend using resistance bands or light weights.
You may also need to see an occupational therapist who can advise on adapting the way you perform everyday activities to reduce strain on your elbow.
These may be recommended if you are experiencing severe pain that cannot be managed with oral painkillers. Steroid injections provide a variable length of relief of pain, anywhere from a few days to life-long. There is no way of predicting how long it will last before trying one, but it is a very low risk procedure to undergo and may mean that surgery can be avoided. They may be particularly effective for inflammatory forms of arthritis such as rheumatoid or psoriatic arthritis.
Arthroscopic debridement/OK procedure
People with arthritis may develop an overgrowth of bone around the elbow joint. These bony overgrowths are referred to as osteophytes and they can reduce the range of movement in your joint and may cause the bones to catch (impingement). Sometimes these osteophytes or pieces of damaged cartilage can break away and get caught in the joint which may cause it to lock. The process of arthritis also produces a tightness in the soft tissues around the elbow. This exacerbates loss of motion, especially when trying to straighten the elbow.
Arthroscopy is a form of keyhole surgery using a camera and thin instruments inserted through small incisions on the elbow. Under general anaesthetic, you will be positioned to lie on your side with your arm positioned over a support at the edge of the bed. The procedure is ideal for removal of loose bone and small bone spurs. It is also possible to clean up the inflamed lining in the joint and loosen up some of the tight soft tissues that are contributing to stiffness.
For patients will slightly more advanced arthritis, an operation called an OK (Outerbridge-Kashiwagi) procedure is used to remove more extensive bone spurs and more thoroughly release the tight soft tissues. This is an open procedure, as opposed to keyhole, done through a 7-10cm incision over the back of the elbow. Bone spurs are first removed from the back of the elbow before a small hole is made through the thinnest part of the lower end of the humerus bone to further increase motion. Through this window the surgeon can remove spurs and release soft tissues sited at the front of the elbow. Following the procedure, you will normally stay in hospital overnight and wear a temporary plaster to keep your arm comfortable and straight. The day after surgery you will begin motion with physiotherapy, but will continue to wear a straight-arm splint each night for at least 6 weeks to make sure you maintain full extension.
Elbow joint replacement
In cases of severe rheumatoid arthritis or if you are an older person with osteoarthritis, you may be offered an elbow joint replacement. This procedure is less common than other types of joint replacement surgery as elbow arthritis is less common and artificial elbow joints tend to last less time. For this reason, it is not normally recommended for active people and younger patients. During the procedure, the damaged elbow joint is removed and it is replaced with an artificial implant. This is secured in place with special bone cement. Physiotherapy is recommended to help you make a good recovery.
If you have undiagnosed elbow pain or you are suffering from any type of arthritis, contact us for expert diagnostic and treatment advice.
If you are experiencing symptoms of elbow arthritis, it is important to get an accurate diagnosis so you know what is causing the problem. Your orthopaedic surgeon can then discuss the most suitable treatment options with you.
Telephone: 020 376 15987