Elbow anatomy
The elbow joint is composed of three bones:
- The humerus (arm bone),
- The ulna (forearm bone on the little finger side),
- The radius (forearm bone on the thumb side).
At the joint level, the surface of these bones is covered with cartilage, a smooth tissue that protects the bones and allows them to move easily. The joint is surrounded by a membrane called the joint capsule. The inner part of the capsule, the synovial membrane, produces a small amount of fluid that lubricates the cartilage and virtually eliminates friction during elbow movement. In addition to muscles, tendons and ligaments are inserted all around the joint.
Evolution of elbow osteoarthritis
Osteoarthritis is a degenerative disease that can affect the elbow primarily (idiopathic), post-traumatically or as part of a rheumatic disease. Osteoarthritis corresponds to progressive wear of the cartilage. Over time, bone growths (osteophytes) are produced, which can limit mobility, pieces of bone or cartilage break off and cause blockages, and bones rub against each other, which can cause pain and grinding/cracking.
Causes of elbow osteoarthritis
Primary elbow osteoarthritis is more common in men than in women, and generally occurs between the ages of 40 and 50. Heavy activity (work, sport), cartilage damage, fracture of the articular surface, dislocation of the elbow and chronic inflammation of the joint can precipitate the development of osteoarthritis.
Symptoms of elbow osteoarthritis
The most common symptoms are
- Pain
- Loss of mobility/stiffness
Other symptoms such as a grinding/cracking sensation and/or blockages may also be present. Squeaking/cracking is due to wear of the cartilage and loss of the joint's normal smooth surface. Blockages are due to pieces of cartilage or bone breaking off and wedging themselves between joint surfaces, thus blocking movement. In more advanced stages of the disease, patients may experience numbness and/or tingling of the ring and little fingers due to compression or irritation of the ulnar nerve, which lies in a tunnel behind the medial side of the elbow.
Treating elbow osteoarthritis
Treatment options depend on :
- Patient's age
- Patient's functional demand/activity level
- Stage of disease progression
- History of elbow trauma and/or surgery
Conservative treatment of elbow osteoarthritis :
Conservative treatment is generally indicated in the early stages of osteoarthritis, or when the functional impact is low and in the absence of blockages due to intra-articular loose bodies. It may include adaptation/modification of activities, analgesic treatment, physiotherapy or intra-articular infiltrations.
Surgical treatment of osteoarthritis of the elbow:
Surgical treatment is indicated in the absence of symptomatic improvement with conservative therapy. Its aim is to reduce pain, improve mobility and remove blockages. There are several treatment procedures, the main ones being arthroscopy and elbow arthroplasty.
Arthroscopy is indicated to "clean up the joint" when the joint spaces are still preserved. It involves removing bony growths (osteophytes), smoothing irregular surfaces, releasing adhesions and removing loose bodies through several small incisions around the elbow. Arthroscopy delivers significant overall functional improvement. What's more, recovery is relatively rapid, as the procedure does not require large incisions.
Prosthetic replacement is indicated when the articular surfaces of the elbow are completely worn away. This treatment is generally indicated for an elderly population with low functional demand, as it is associated with long-term restrictions. Indeed, it is not recommended to lift more than 5 kg with an elbow prosthesis. The decision to proceed with total elbow arthroplasty must therefore be taken with caution.
When should you contact the Doctor?
Pain, swelling, stiffness, locking and grinding/cracking are all signs of cartilage deterioration and justify medical consultation.
Care at Hôpital de La Tour
Clinical examination and standard X-rays of the elbow are sufficient to establish the diagnosis in the majority of cases. Advanced imaging studies, typically CT scans of the elbow, may be indicated on a case-by-case basis. MRI is generally not necessary in the management of osteoarthritis.
FAQ on elbow osteoarthritis
1. What are the main causes of osteoarthritis of the elbow?
Osteoarthritis of the elbow can be caused by normal wear and tear due to aging. It can also be post-traumatic or linked to rheumatic diseases. It can be precipitated by heavy activity, cartilage damage, fractures affecting the articular surface, elbow dislocations and chronic inflammation of the joint.
2. What treatments are available to relieve the pain of elbow osteoarthritis?
Treatments to relieve the pain of elbow osteoarthritis include conservative approaches such as activity adaptation, pain medication, physiotherapy and intra-articular infiltration. If conservative treatment fails, surgical options such as arthroscopy to clean the joint or elbow arthroplasty to replace worn joint surfaces may be considered.
3. Is elbow osteoarthritis more common in the elderly?
In general, elbow osteoarthritis is more common in men than in women, and usually manifests itself between the ages of 40 and 50. However, it can also affect younger people, particularly in cases of trauma or heavy repetitive activity.
4. What are the main risk factors for osteoarthritis of the elbow?
The main risk factors include repeated trauma and physical activity, as well as cartilage damage, joint fractures and elbow dislocations.
5. How can we prevent the progression of elbow osteoarthritis?
Maintaining a healthy weight, regular physical activity and taking precautions during high-risk activities can help prevent the progression of elbow osteoarthritis.