For many people, arthritis of the elbow can cause pain not only when they bend their elbow, but also when they straighten it, such as to carry a briefcase. The most common cause of arthritis of the elbow is rheumatoid arthritis. Osteoarthritis and injuries can also cause arthritis in the elbow joint.
Rheumatoid arthritis is a disease of the joint linings, or synovia. As the joint lining swells, the joint space narrows. The disease gradually destroys the bones and soft tissues. Usually, RA affects both elbows, as well other joints such as the hand, wrist and shoulder.
Osteoarthritis affects the cushioning cartilage on the ends of the bones that enables them to move smoothly in the joint. As the cartilage is destroyed, the bones begin to rub against each other. Loose fragments within the joint may accelerate degeneration.
Trauma or injury to the elbow can also damage the cartilage of the joint. This can lead to the development of arthritis in the injured joint.
Symptoms of elbow arthritis vary and can include:
- Pain. In the early stages of rheumatoid arthritis, pain may be primarily on the outer side of the joint. Pain generally gets worse as you turn (rotate) your forearm. The pain of osteoarthritis may get worse as you extend your arm. Pain that continues during the night or when you are at rest indicates a more advanced stage of osteoarthritis.
- Swelling. This is more common with rheumatoid arthritis.
- Instability. The joint isn't stable and gives way, making it difficult or impossible to do normal daily activities.
- Lack of full movement. You are not able to straighten (extend) or bend (flex) the elbow.
- Locking. Your elbow joint catches or locks. This can happen with osteoarthritis.
- Stiffness. This happens particularly with arthritis that develops after an injury.
- Pain in both elbows. Having pain in both elbows or pain at the wrists or shoulders (or both) as well as pain in the elbows is a sign of rheumatoid arthritis.
During a physical examination, your doctor will first look for tenderness and swelling. He or she will also look at the range of motion you have as well as identifying what positions cause pain to your elbow joint. X-rays often show the joint narrowing as well as any loose bodies (e.g., bony pieces). If your pain is due to arthritis following an injury, the X-ray may show an improper joining or a failure to join of the elbow bones.
The first treatments used for elbow arthritis include:
- Cut back on activity. Osteoarthritis may be caused by the repetitive overuse of the joint. Avoiding certain activities or sports may be helpful. Having periods of rest after exercise or activity involving your elbow can relieve stress on the joint
- Pain management. Acetaminophen or ibuprofen can provide short-term pain relief. More powerful drugs may be prescribed to treat rheumatoid arthritis. These include anti-malarial agents, gold salts, drugs that suppress your immune system and corticosteroids. An injection of a corticosteroid into the joint can often help.
- Physical Therapy. Applying heat or cold to the elbow and gentle exercises may be prescribed. A splint to protect the elbow from the stress of moving may be helpful. Devices that reduce stress on your joints such as handle extensions, to maintain daily activities.
If arthritis does not respond to other treatments, surgery may be discussed. The specific type of surgery may depend on the type of arthritis, the stage of the disease, your age, your expectations and your activity requirements. Surgical options include:
- Arthroscopy. Using pencil-sized instruments and two or three small incisions, the surgeon can remove bone spurs, loose fragments or a portion of the diseased synovium. This procedure can be used with both rheumatoid arthritis and osteoarthritis.
- Synovectomy. The surgeon removes the diseased synovium. Sometimes, a portion of bone is also removed to provide a greater range of motion. This procedure is often used in the early stages of rheumatoid arthritis.
- Osteotomy. The surgeon removes part of the bone to relieve pressure on the joint. This procedure is often used to treat osteoarthritis.
- Arthroplasty. The surgeon creates an artificial joint using either an internal prosthesis or an external fixation device. A total joint replacement is usually reserved for patients over 60 years old or patients with RA in advanced stages.