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ELBOW ARTHRITIS

What is it?

Arthritis is wear and tear of any joint.

What causes it?

There are different types of arthritis. In osteoarthritis of the elbow, this can be primary (wear and tear of a joint with increasing age) or secondary (occurs after a fracture at the elbow). The joint becomes narrowed, bone spurs form and there may be loose bodies.

What are the symptoms?

The main symptoms are pain and stiffness in the elbow. This can be associated with grinding and clicking noises at the elbow and loss of function of the elbow due to pain and stiffness. There can be locking or “sticking” of the elbow due to loose bodies. (see fig.1)

How is it diagnosed?

The key investigation is a radiograph or x-ray (see Fig.2). Sometimes a CT scan or MRI scan may be required if surgery is being considered.

How is it treated?

Early symptoms can be treated with painkillers, anti-inflammatories such as Ibuprofen and physiotherapy. The second line might be an injection of corticosteroid and local anaesthetic into the elbow joint, which can be done in the clinic. If these measures fail and there is significant limitation of function, surgery can be considered. There are 3 main operations for arthritis in the elbow.

  • Arthroscopic Surgery:
    »Keyhole surgery in the elbow with removal of bits of extra bone that can cause locking and pain in the elbow as well as a washout of the elbow joint. This is done as a day-case (come into hospital and go home the same day) under a general anaesthetic. (see video)
    » After the operation, the arm is bandaged and the patient is encouraged to move the elbow as tolerated. After two weeks, the wound is inspected in clinic and physiotherapy can begin.

  • Radial head excision
    If the arthritis is mainly over the outside part of the elbow, one option might be to cut out a small part of bone called the radial head and this can relieve the symptoms of pain and stiffness. This procedure is more suitable if the rest of the elbow joint is in reasonable condition
  • The OK procedure
    This surgery is when there are lots of extra bone blocking the elbow movement and causing pain. It is also a day-case procedure under general anaesthetic. Rather than keyhole surgery, a 10cm incision is made at the back of the elbow and a window made in the arm bone. The loose bone and extra bony spurs are then removed and the joint is washed out. The elbow is put into a splint for two weeks and following this, physiotherapy can be begun.
  • Elbow Replacement
    This is reserved for patients with significant arthritis in the elbow where the options above have been tried and failed or if the arthritis is very severe. This is a bigger operation to the rest. In this operation, all the damaged bone is cut away and is replaced with an implant (like a hip or knee replacement). This operation is primarily reserved for the less active patient who is a great deal of pain and can tolerate a lower level of function in the elbow.

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