Elbow arthritis is caused by the loss of the cartilage or lining of the joint surfaces. It is either primary (due to degeneration) or secondary (due to injury or dislocation of the joint). Primary osteoarthritis of the elbow most commonly occurs in the dominant elbow of male manual workers. If the elbow joint surfaces are damaged by fracture or injury, the cartilage or lining of the joint will wear more quickly resulting in arthritis. Similarly if the ligaments around the elbow are damaged, the forces through the joint can be altered and early thinning of the cartilage occurs.
What are the signs and symptoms?Elbow arthritis is not common, but presents with pain and stiffness of the joint, and occasionally with irritation of the ulna nerve causing tingling in the little and ring fingers of the hand.
How is elbow arthritis diagnosed?A history of previous injury is common, often from many years ago, though elbow arthritis is also seen in manual workers. Patients complain of progressive pain and stiffness in the elbow, and some experience catching or locking of the joint. A careful examination from a specialist will help to decide what part of the joint the arthritis is coming from, and how the patient is affected. The elbow has two important parts to it: a hinge that allows the elbow to bend and straighten (ulnohumeral joint), and a part that allows the forearm to rotate (radiocapitellar joint). Treatment options will depend on where the problem is. X-ray of the elbow can confirm the area of concern; occasionally a CT scan may be needed for surgical planning.
How is it treated?Elbow arthritis, much like arthritis affecting other joints, can be treated by either non-surgical or surgical means.
Activity modification, avoidance, rest and painkillers are the mainstay of non-surgical treatment. However, injections (corticosteroids) into the joint may be helpful in alleviating the painful symptoms.
Surgical treatments are considered when non-surgical treatments have failed or where patients have mechanical symptoms such as locking or impingement-type pain. Arthroscopic or keyhole surgery may be appropriate depending on the level of symptoms and the changes seen on the X-rays. For example, removal of loose bodies and release of the tight capsule that results in the stiffness of the joint can be performed via keyhole surgery in the early stages of elbow arthritis. In younger patients with elbow arthritis resulting in pain and limited range of movement (impingement), an Outerbridge-Kashiwagi procedure can reduce pain and improve range of movement of the elbow without replacing the joint.
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This procedure removes the excess bone (osteophytes) that builds up in and around arthritic joints and stops them from impinging or rubbing on each other. The results are good and patients can often avoid elbow joint replacement surgery. If the arthritis is solely at the radiocapitellar joint, with pain felt on the outside of the forearm, which is increased with forearm rotation, then addressing this part of the joint may be all that is required. In this circumstance, the radial head is either excised or replaced depending on the patient’s age and level of activity. Ultimately if the joint surfaces are completely worn, and pain is interfering with daily activity and preventing a good night’s sleep, an elbow replacement may be offered. Ideally patients should be elderly and low demand, as elbow replacements need to be looked after to prevent wearing out the replacement (loosening of the components that are fixed in the arm bones). Very few elbow replacements are performed each year, as patients with rheumatoid arthritis are better treated by medications and osteoarthritis is relatively rare, however more elbow replacements are being performed for a select group of trauma or fracture patients (see elbow fractures).
What are the potential complications?Arthroscopic / keyhole elbow surgery
Keyhole surgery to the elbow carries a slightly higher risk of injury to the nerves around the joint. If the risk of nerve injury is considered too high, open surgery may be offered. Stiffness of the elbow is rare following keyhole surgery.
Outerbridge-Kashiwagi (OK) procedure / radial head excision
Stiffness can reoccur following surgery and as there is underlying arthritis pain and stiffness will likely re-occur at some point in the future as the disease process progresses, the benefits however can last many many years.
The results of elbow replacement are good but if excessive use of the elbow is permitted the fixation of the replacement to bone via cement can be disrupted (loosen), due to the wear of the joint surfaces. Loosening results in pain and loss of function, this is why elbow replacement is best performed in elderly, low demand patients.
A big thank you to Simon and his team for their care, patience and perseverence looking after me through all stages of both shoulder and elbow surgery.
Since the shoulder stabilisation I have continued my sailing and fitness training without the worry that my shoulder might dislocate; and I don’t have to think twice whether my ulnar nerve will hinder any progression in my sports.
With their amazing help, I’ve been able to get back to sailing competatively and am now a double National champion.
After multiple shoulder dislocations Charlie helped me set a route for recovery, which has been nothing but smooth sailing. Surgery went successfully and I am well on my way to playing the sports I was previously. Would highly recommend.
Simon successfully operated on my frozen left shoulder in 2012 with fantastic results. This year he has overseen and advised treatment for my frozen right shoulder (via hydrodilation injection). His unrivalled experience in orthopaedic shoulder treatments, coupled with his reassuring bedside manner and excellent results, gave me huge confidence throughout. I’m hugely grateful to have my quality of life back and wouldn’t hesitate to recommend his services. Thank you Simon.
I had suffered with a painful shoulder and pins and needles for three years following a right shoulder fracture and failed half joint replacement prior to meeting Mr Pennington. He explained the situation in a way I could relate to and I’m delighted to say my revision shoulder replacement has gone well and for the first time in years I can use my arm and am pain free. I was even able to walk my daughter down the aisle 3 months after surgery! Many thanks.
I would like to thank Charlie Talbot and his team for the operations performed on both my shoulders and also the aftercare put in place after my operations. I have played golf since I was 12 years of age and thought at one point that I would never get back to playing again. Charlie was always very positive and told me that he would get me playing golf again. Well, I have now been playing golf for nearly 2 years. Before surgery I had a handicap of 12 and I am now down to 9, not bad at the age of 68. So many many thanks.
I had PRP injections into my right elbow last year and within 3 months I was pain free, a year on it is more or less 100% better. Fabulous I would recommend it to anyone with Tennis Elbow, in fact I have gone back again this year to get my left elbow done. Thanks Simon.
Mr Pennington I really wanted you to know how very thankful I am for the excellent care & treatment you and your staff gave me. It really meant a lot that you were so clear, friendly & professional and listened to me – so thank you again.
After more than four decades of shoulder problems with a total of three surgeries the full shoulder replacement surgery by Mr. Talbot has changed my life beyond expectations. I am now able bodied for the first time in years and pain free.
Thank you to Mr Boyle and team for the excellent care and attention both before and after Replacement Shoulder surgery, using the Tornier Simpliciti procedure. After very many months of severe pain and lack of movement I was pain free from day one. Now, after nine weeks, the shoulder and arm movement continues to improve, beyond expectation, with physiotherapy and exercise. I am extremely grateful for all the continuing care.
Following two years of recurrent problems with my left shoulder I was recommendedto Consult Mr Neil Pennington. I had the opportunity to have my surgery quickly and at my convenience, this fitted well around my professional and home commitments. The surgery was carried out as a day case procedure and Mr Pennington visited me following the surgery to explain everything. My operation was a minimally invasive procedure so my recovery was straightforward with only a few restrictions; in fact I was encouraged to keep my shoulder moving. I was driving and back to work after 2 weeks – after 2 years of pain and sleep disturbance I found this operation to be life changing! I found Mr Pennington to be a very professional and compassionate surgeon and he is surrounded by a whole team of professionals that gave me the utmost confidence in the care and treatment I received.
I would like to thank Mr. Talbot and the amazing team of nurses, physiotherapists and support staff for their care and support during my recent visit to the Duchy Hospital, Harrogate, for a replacement shoulder. The care and attention I received was unparalleled. The pain free movement I now have has changed my life.