What to know about elbow osteoarthritis

Causes

Osteoarthritis can affect any joint in the body, although the elbow typically remains unaffected because its stable arrangement of ligaments means that it can tolerate large forces. The condition happens when progressive wear damages the tissues in the joints, including the spongy, protective cartilage that protects the ends of the bones. The bones then rub against each other and can become painful, swollen, and deformed.

As individuals age, they become more likely to develop osteoarthritis. It usually occurs in those aged 50 years and over. However, certain factors also increase an individual’s risk, including:

• obesity
• overuse
• family history
• injury or surgery to a joint
• joints that are not well-formed

Additionally, elbow osteoarthritis without previous injury is more common in males than females.

Symptoms

People with osteoarthritis of the elbow may experience a range of symptoms, but the most common are pain and reduced range of motion, which may not occur simultaneously.

Individuals may notice a grating sensation in the elbow as the healthy, smooth joint surface wears away. They may also feel as though the joint is locking as loose pieces of bone and cartilage become dislodged and block movement between the mobile joint surfaces.

The elbow joint may swell as the disease progresses, but this is usually not an initial symptom. Eventually, people may also notice their ring and little finger becoming numb as the elbow swells and compresses the ulnar nerve, which is on the inside of the elbow. Additionally, if a person cannot move their elbow through its normal range of motion, it may stiffen in a bent position, increasing pressure around the ulnar nerve.

Diagnosis

Doctors typically diagnose elbow osteoarthritis based on a person’s symptoms, a physical examination, and imaging.

The doctor looks for signs of injury during the physical examination and assesses the elbow’s range of motion and instability. They may then request standard X-rays to detect any arthritic changes. Most individuals do not require CT or MRI imaging.

Specific findings on the X-ray can help the doctor diagnose osteoarthritis. These include:

• Joint space narrowing: As osteoarthritis wears away the articulate cartilage, the joint space between the ends of the bones narrows. The joint space becomes progressively smaller as the disease progresses until no space remains, and the bones rub against each other.
• Bone spurs: Doctors refer to these bone and cartilage protrusions as osteophytes. When joints degenerate, X-rays can detect bone spurs as the cartilage attempts to repair the damage.
• Subchondral sclerosis: The layer below the cartilage is called subchondral bone, and sclerosis means that the tissue is hardening. Subchondral sclerosis shows on X-rays as areas of increased bone density at the articular surfaces of the bone.
• Subchondral cyst formation: These fluid-filled sacs that form at the joints primarily contain the hyaluronic acid that lubricates the joints.
• Subluxation: This partial dislocation of a bone may result from osteoarthritis as joints become unstable.

A doctor may also request blood tests to rule out rheumatoid arthritis or any other issues.

Learn about the differences between rheumatoid arthritis and osteoarthritis.

Treatment and surgery

There is no cure for osteoarthritis. Therefore, treatment aims to ease the symptoms and reduce the impact of elbow osteoarthritis on a person’s life. Doctors may recommend joint fusion or replacement if medications, exercises, and other therapies do not help.

Medications

Over-the-counter (OTC) and prescription medications can relieve pain and inflammation. These drugs include:

• Analgesics: These pain relievers range from OTC acetaminophen to potent prescription-only opioids.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Many people use these medications to relieve pain and inflammation. They include aspirin, ibuprofen, and naproxen.
• Counterirritants: These OTC products contain ingredients that irritate the nerves, such as capsaicin, menthol, or lidocaine. The purpose is to generate cold or warm feelings to distract from the pain of arthritis.
• Corticosteroids: A doctor can prescribe these anti-inflammatory medications as oral tablets, or they can deliver them via injections at their clinic.
• Platelet-rich plasma (PRP): These injections ease pain and inflammation, but the Food and Drug Administration (FDA) has not yet approved them. Therefore, a person must discuss the possibility of this therapy with a doctor.
• Other medications: The FDA has approved the antidepressant duloxetine (Cymbalta) and the anti-seizure drug pregabalin (Lyrica) to treat osteoarthritis-related pain.

Exercises

Doctors often recommend physical activity as part of an osteoarthritis treatment plan. An exercise program for elbow osteoarthritis should build strength in the muscles surrounding the elbows, as well as increasing joint mobility and reducing stiffness.

The following exercises may help people with elbow osteoarthritis reduce pain and maintain more movement in the joint:

• Elbow bend: With the arms by the sides, slowly bend one arm at the elbow until the hand touches the shoulder and hold for up to 30 seconds. Hold a weight to add additional resistance.
• Wrist flex: Place one arm straight in front with the palm facing down and then bend the wrist down. Use the opposite hand to press the hand gently toward the body. Maintain the stretch for 30 seconds, then straighten the wrist. Next, gently bend the hand up and backward toward the body, using the other hand to hold it in place for 30 seconds. Repeat three times for each hand.
• Wrist turn: Bend the elbow to form a right angle and hold the hand out with the palm facing up. Then, turn the wrist so that the palm faces down. Hold the hand here for 5 seconds and then release. Build up to 30 repetitions with a short break after each set of 10. A person can also perform this exercise holding a light weight.
• Palm lift: Place the palm on a flat surface and place the other hand sideways across the knuckles to push down on them. Try to lift the fingers of the lower hand and feel the muscles of the forearm tensing. Next, swap hands and repeat the exercise.

Surgery

Doctors may recommend surgery if lifestyle changes and medications cannot successfully control an individual’s osteoarthritis-related pain. Surgery can help improve function and reduce pain.

There are several types of elbow surgery, including:

• Synovectomy: Doctors call the membrane that lines the joint capsule the synovium. During this procedure, a surgeon removes this thin layer of inflamed tissue.
• Arthroscopy: If an individual has bone spurs or loose pieces of bone, a surgeon can remove them during an arthroscopy.
• Arthroplasty: This technique uses a piece of the person’s Achilles tendon to cover the ends of the worn joint surfaces.
• Joint replacement: A surgeon replaces the damaged parts of the elbow with a prosthesis.

Outlook

The outlook for a person with elbow osteoarthritis will depend on their specific symptoms and the extent of the loss of joint function.

Some people remain relatively unaffected by the condition, while others experience a severe disability that affects their daily functioning.

For some individuals, joint replacement surgery may provide the best long-term outcome.

Summary

Osteoarthritis in the elbow may develop as part of the normal wear-and-tear process of aging. Individuals with this condition may experience pain, restricted movement, and swelling of the joint.

There is no cure for osteoarthritis of the elbow, but doctors may recommend regular physical activity and medications such as anti-inflammatories and corticosteroids to minimize its effects on the body.

If other therapeutic approaches prove unsuccessful, a doctor may recommend surgery to help control pain and maintain joint mobility.