Osteoarthritis of the elbow is much less common than in other joints. It is characterised by pain and stiffness at the elbow and often the first sign that patients will notice is loss of the ability to fully extend or straighten the elbow, sometimes even before they develop pain. With time for most patients the arthritis deteriorates. The elbow becomes increasingly painful and patients notice increasing restriction in their movement, both further loss of the ability to straighten the elbow, ie the elbow is held in a permanently bent position, and in addition patients will lose the ability to fully flex or bend the elbow.
It is the loss of full bend that starts to cause functional problems as most of the function of the elbow is performed with it in a bent position. As the loss of full bend becomes more significant patients can struggle to get their hand to the head or mouth such that activities such as washing, dressing and feeding can become increasingly difficult.
In the early stages of arthritis anti-inflammatory medication, physiotherapy and injections may all be helpful in controlling symptoms. If the condition deteriorates despite these forms of treatment then surgery may be necessary. This generally consists of removing excess bone that has formed around the edges of the joint as well as loose fragments in the joint to improve not only the pain but the range of movement, in particular the ability to bend the elbow. Sometimes this can be performed with keyhole surgery although if the excess bone growth is advanced open surgery may be needed. In the keyhole (arthroscopic) surgery a telescope is introduced into the elbow and from the opposite side of the joint instruments can be introduced to remove inflamed capsule or lining of the joint as well as burr or remove the excess bone creating a smoother surface to the joint. Removing the excess bone at the edges of the joint may improve the restricted range of movement.
In the open procedure an incision or cut is made at the back of the elbow joint and the hollow at the back of the elbow joint again is cleared of excess bone which helps the elbow to straighten more fully. A hole is then made at the back of the elbow allowing entry into to the front of the elbow joint where, in similar fashion, the excess bone at the edges of the joint at the front can be removed, again improving both pain and movement.
Following the surgery physiotherapy will be needed to improve the movement and later on to strengthen the joint.
In rheumatoid arthritis there can be signnifcant destruction of the joint surfaces of the elnow causing pain, stiffness and loss of function. Recent advances in medication to treat rheumatoid by Rheumatology specialists has greatly reduced the number of severely arthritic elbows needing surgery.