Osteoarthritis of the Elbow
What is Osteoarthritis of the Elbow?
Osteoarthritis occurs when cartilage (the cushioning between the bones within a joint) is lost, allowing bones to rub against each other, causing pain. Additionally, bony spurs or loose bodies may develop within the elbow joint, causing painful grinding and locking.
Causes can include previous injury to the elbow, highly strenuous jobs, or joint degeneration with age. Osteoarthritis may also occur at younger ages secondary to hereditary predisposition. Osteoarthritis most commonly affects men and symptoms usually begin about middle-age.
Signs and Symptoms:
Osteoarthritis of the elbow is characterized by gradually increasing pain within the joint, loss of pronation (palm down) and supination (palm up), as well as locking, stiffness, and loss of full extension and flexion of the elbow. There may even be associated numbness in the ring and small fingers with an ulnar nerve compression secondary to swelling from the elbow joint.
Conservative treatment may include taking anti-inflammatory medication, avoiding aggravating activities, intermittent use of a splint, and doing physical therapy exercises. Also, a cortisone injection may be offered to help reduce pain and swelling.
If conservative treatment is not effective, surgery may be recommended. Various surgical options exist, including arthroscopy, the Outerbridge-Kashiwaghi (O-K) procedure, or joint replacement surgery. Arthroscopy is used to better visualize the degree of arthritis within the joint, and to then remove loose bodies if the patient presents with catching and locking symptoms. Patients with excessive mechanical locking and catching symptoms may most benefit from the O-K procedure. An incision is made at the back of the elbow and loose bodies and bony spurs that inhibit movement are removed. Posterior access to the elbow is gained through a small fenestration (opening) in the humerus, through which additional loose bodies and bony spurs can be removed proximally to clean out the joint. While the O-K procedure does improve symptoms, it is not expected to improve motion. In an older patient with a greater degree of arthritis, partial or total replacement of the elbow joint may prove the most beneficial option. For this surgery, scar tissue is removed and implants are positioned to recreate the arthritic elbow joint. Total replacement can improve both symptoms and motion, but excessive carrying loads are not advised.
Post Operative Rehabilitation:
- Expect a surgical bulky dressing and removable splint to be kept in place for 3-4 days.
- Elevate and ice for at least 3 days; gentle full motion of fingers encouraged several times a day.
- Continue elevation as often as possible until your next clinic visit. (Elevate above your heart.)
- Shower with a plastic bag covering the splint and seal with tape.
- Your pain may be worst in the first 24-48 hours and then will lessen.
- Take your pain medicine as needed and as prescribed. Call if any problems or questions arise.
- Watch for signs of infection and call immediately if these signs develop:
- Fever higher than 102°F, shortness of breath, or have nausea and vomiting that does not improve with anti-nausea meds.
- Warmth, redness, and/or increased drainage coming from your incision site.
- Watch for signs of blood clots and go to the ER immediately if these signs develop:
- Excessive increase in swelling, hardness, pain, or redness in forearm or calf.
3-4 Days Post Op (at therapy):
- Therapist will remove your bulky dressing.
- It is important to keep your incision area clean and dry.
- Initiate continuous passive motion.
- Continue to wear removable splint until 10-14 days post op, or as instructed.
10-14 Days Post Op (at therapy):
- Splint and sutures will be removed.
- Expect a flexion/extension splint to maximize elbow movement until 4-6 weeks post op.
- Therapist will address scar and edema management.
- Active Range of Motion (ROM) exercises initiated.
4-6 Weeks Post Op:
- Follow up appointment in clinic with P.A.
- Splint may be discontinued with doctor’s approval.
12 Weeks Post Op:
- Follow up appointment in clinic with M.D.
- Expect some loss of elbow flexion/extension.
- Sometimes, ulnar nerve decompression may be necessary for patients with pre-op elbow flexion of less than 100°, or patients with ulnar nerve symptoms pre-operatively.
Note: These instructions are to serve as guidelines and are subject to Physician discretion. Actual progress may be faster or slower depending on the individual.