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Elbow Arthritis
Arthritis is chronic (long lasting) inflammation of a joint. There are several forms of the disease, but all are characterized by the progressive loss of cartilage in a joint.
The elbow is a hinged joint formed by the articulation of three bones, the humerus of the upper arm and the radius and ulna of the forearm. Each articulating surface is covered with protective smooth cartilage that cushions the bones and enables them to slide across each other without friction. The conformation of the bone ends that form the elbow, and the strength of the supporting ligaments result in a joint that usually articulates evenly. With age and use this articular cartilage deteriorates, leaving bone surfaces exposed. Bones often respond by growing more bone, decreasing the distance between them. Eventually movement of the elbow joint causes the bones to rub directly against each other, triggering inflammation, pain and deformity, the condition known as osteoarthritis. Osteoarthritis is a progressive condition also known as degenerative joint disease and is more likely to develop when a person is aged 50 or over.
Rheumatoid arthritis is an autoimmune condition that results in inflammation of the synovial membrane, a tissue that lines the joints. The term autoimmune means that for unknown reasons the body attacks its own healthy tissues. With rheumatoid arthritis the synovial membrane becomes thickened, and the synovial fluid (a nourishing substance that lubricates the joint) increases, leading to pressure within the elbow. The membrane then begins to produce pannus, an abnormal, gritty tissue that destroys the cartilage. Without treatment, exposed bone ends eventually become fused and the joint ceases to function. Rheumatoid arthritis is the most commonly diagnosed arthritis in the elbow, and is likely to affect both arms.
Juvenile rheumatoid arthritis (JRA) is an autoimmune disease that begins when a child is under the age of 16. It commonly affects the elbows, destroying articular cartilage in the manner described above.
Gouty arthritis is caused by the accumulation of urate crystals in the elbow joint. Symptoms normally develop in the toes first, but subsequent attacks may produce symptoms in the elbows.
Pseudogout arthritis is similar to gouty arthritis, but is caused by the accumulation of calcium deposits.
Causes:
Arthritis is caused by the loss of articular cartilage that leads to bones having direct contact with each other as they move.
A previous injury to the elbow, such as a dislocation or fracture, is the most likely cause of osteoarthritis later in life. This is particularly so if the elbow needed surgical repair, or some of the cartilage was lost.
Other risk factors are:
Age: Cartilage degenerates over time and with use, becoming thinner and more brittle, and therefore more vulnerable.
Infection or illness: Inflammation caused by an infection can result in arthritis.
Occupation: Some occupations or sports that involve repetitive movements of the elbow are more likely to cause stress or overuse injuries that may lead to osteoarthritis.
Heredity: A family history of arthritis increases the risk of developing the disease.
Symptoms:
Arthritis is a progressive disease, and symptoms usually appear gradually.
The most common symptoms are:
- Pain felt in the elbow joint, worse as the disease progresses
- Stiffness, particularly with arthritis developed after injury
- Loss of full range of motion
- Instability, making normal activities more difficult
- Grating sensation on bending or straightening the elbow
- Possible ‘locking’ of the joint at a certain angle
- Swelling of the elbow, more likely with rheumatoid arthritis
- Numbness felt in the little and ring fingers, if the arthritis is severe
Symptoms tend to be worse in the morning, or after not moving the elbow for a length of time. Any activity that involves bending the elbow is likely to increase the pain, and there may be a feeling of weakness in the joint. The weather can also affect the level of pain for some people, with cold and damp weather making it worse.
Diagnosis:
After your doctor has asked about your medical history, including the details of any previous injury to your elbow, he or she will discuss your current symptoms. The elbow will then be physically examined. Stability and range of motion will be evaluated, and any swelling or numbness noted.
X-rays will reveal the presence of arthritis. Other diagnostic tests such as CT (computed tomography) or MRI (magnetic resonance imaging) scans are usually not necessary.
Treatment:
Treatment for arthritis of the elbow is primarily aimed at relieving symptoms and increasing function. The precise plan of treatment will depend on your medical history, your overall health, your desired level of future activity, and the severity of your arthritis.
The use of Tylenol (acetaminophen) and NSAIDs (non-steroidal anti-inflammatory drugs) can be helpful, as can cortisone injections, although the cumulative side effects of the corticosteroids mean that only a few injections may be given each year. Your doctor may prescribe stronger drugs for rheumatoid arthritis. Some research has shown that taking supplements such as glucosamine and chondroitin, and receiving saline injections into the elbow are not effective treatments. That being said, if these measures provide relief and if your doctor agrees, you should use them.
Applying heat or cold to the elbow may help with your symptoms, and using an elbow splint can provide support. If the arthritis is severe enough to limit normal movements, special devices can be obtained that reduce the stress placed on the joint.
If conservative treatment for arthritis fails, surgery might be indicated. Surgery can be used to repair torn cartilage, remove loose fragments of cartilage in the joint, graft new cartilage onto the bones, replace severely damaged cartilage with other materials such as metal and plastic, smooth rough areas of cartilage, or trim part of the bones to improve joint alignment. With a case of rheumatoid arthritis, the synovium can be surgically removed. Arthroscopy (camera-guided knee surgery) is the preferred technique as it minimizes trauma to the elbow. Arthroscopy uses narrow instruments inserted through very small incisions around the joint to carry out the necessary repairs. Recovery times from an arthroscopic procedure, which is typically done on an outpatient basis, are much faster than with traditional open surgery.
Your doctor or physiotherapist will develop an exercise program specifically for you, tailored to increase flexibility and mobility of your elbow. It is important to keep moving your elbow in order to minimize stiffness. With medical approval, you can perform the following exercises:
Exercises:
Sit at a table with your forearm resting on it. Ten repetitions make 1 set. Build up to 3 sets.
1. Hold a can in your hand with your palm down. Keeping your forearm on the table, slowly bend the wrist backwards towards you. Hold for 5 seconds.
2. Hold a can in your hand with your palm up. Keeping your forearm on the table, slowly bend the wrist towards you. Hold for 5 seconds.
3. Hold the can upright with your thumb pointing up and slowly move your wrist up and down.
4. Hold the can upright with your thumb pointing up. Slowly curl your wrist towards you as far as you can without forcing, hold for 5 seconds then slowly curl the wrist away from you as far as you can and hold for 5 seconds.
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