Elbow Arthritis

How the elbow works

The elbow is three joints in one: the humerus (upper arm bone) meets the ulna and radius (forearm bones). It bends and straightens the arm and also rotates the forearm to turn the palm up and down. Smooth cartilage covers the bone ends. When this cartilage wears or is damaged, bone rubs on bone, bone spurs form, and the joint lining becomes inflamed.

Types and causes

Rheumatoid arthritis

Rheumatoid arthritis is an autoimmune disease in which the joint lining (synovium) becomes inflamed and damages cartilage and bone. The elbow is commonly affected, usually on both sides, along with the hands and wrists. It causes swelling, warmth and prolonged morning stiffness. Thanks to modern medicines, severe elbow destruction from rheumatoid arthritis is much less common than in the past.

Post-traumatic arthritis

Post-traumatic arthritis develops after an elbow fracture, dislocation or ligament injury, sometimes years later. Damaged cartilage or an uneven joint surface wears faster.

Primary osteoarthritis

Osteoarthritis of the elbow without previous injury is relatively uncommon. It mainly affects middle-aged men who do heavy manual labor (such as construction or using vibrating tools) or athletes in throwing and weight-bearing sports. Bone spurs at the front and back of the joint block movement, and loose fragments of bone or cartilage can cause locking.

Other causes

• other inflammatory arthritis, such as psoriatic arthritis and lupus
• gout and pseudogout
• previous joint infection (septic arthritis)
• hemophilia, from repeated bleeding into the joint
• osteochondritis dissecans in young athletes

Symptoms

• pain: at first with activity, later at rest or at night
• stiffness: especially difficulty straightening the arm fully. Bending may also be limited, making it hard to reach your face or mouth
• swelling, more pronounced in inflammatory arthritis
• locking or catching from loose bodies in the joint
• grinding or crunching (crepitus)
• instability in advanced rheumatoid arthritis
• numbness or tingling in the ring and little fingers, because the ulnar nerve runs close to the elbow and can be irritated by swelling or bone spurs (cubital tunnel syndrome)

Elbow arthritis vs other elbow problems

Diagnosis

• History and examination: range of motion, swelling, stability, nerve function and other joints.
• X-rays: show joint space narrowing, bone spurs and loose bodies.
• Blood tests: rheumatoid factor, anti-CCP antibodies, inflammation markers and uric acid if inflammatory arthritis or gout is suspected.
• Joint aspiration: fluid analysis for crystals or infection when the joint is hot and swollen.
• CT or MRI: to plan surgery or look at cartilage and loose bodies.

Treatment

Nonsurgical treatment

• activity changes: avoid heavy lifting and repetitive movements that worsen pain
• pain relief: acetaminophen (paracetamol) or NSAIDs, as tablets or gel, at the label dose. Avoid oral NSAIDs if you have kidney disease, stomach ulcers or take blood thinners
• ice or heat for flares and stiffness
• physical therapy to maintain range of motion and strengthen surrounding muscles
• corticosteroid injections into the joint for short-term relief
• disease-modifying medicines (such as methotrexate or biologics) for rheumatoid and other inflammatory arthritis, prescribed by a rheumatologist
• splints for rest during flares, or night splints to improve stiffness

Surgery

• Arthroscopy: keyhole surgery to remove loose bodies, bone spurs and inflamed lining (synovectomy). Improves pain and movement, especially in osteoarthritis and early rheumatoid arthritis.
• Open debridement: removing spurs and releasing the joint capsule through a larger incision.
• Ulnar nerve release or transposition if the nerve is compressed.
• Interposition arthroplasty: resurfacing the joint with tissue, for younger, active people.
• Total elbow replacement: replacing the joint with metal and plastic parts. Very effective for pain relief in older adults with rheumatoid arthritis or severe damage, but with permanent lifting restrictions, typically no more than about 5 to 10 lb (2 to 5 kg) repeatedly.

Outlook

Elbow arthritis is long-term, but most people manage well with a combination of treatments. Early treatment of inflammatory arthritis prevents much of the joint damage. Surgery reliably reduces pain and improves function when other treatments are not enough.

Frequently asked questions

What are the symptoms of arthritis in the elbow?

Common symptoms are pain, stiffness, especially being unable to straighten the arm fully, swelling, grinding, and catching or locking. Some people develop tingling in the ring and little fingers from nerve irritation. Symptoms usually worsen gradually over months to years.

What causes elbow arthritis?

The most common causes are rheumatoid arthritis, previous elbow fractures or dislocations (post-traumatic arthritis), and osteoarthritis in people who do heavy manual work or throwing sports. Gout, infection and other inflammatory conditions are less common causes.

Can elbow arthritis be cured?

There is no cure for the cartilage damage, but treatment controls pain and preserves function. Medicines for rheumatoid arthritis can stop further damage. Arthroscopy, debridement and joint replacement can greatly improve pain and movement in advanced cases.

How long does elbow replacement last?

Total elbow replacement provides good pain relief, and many implants last 10 years or more, depending on activity and the reason for surgery. Following lifting restrictions helps them last longer. Revision surgery is possible if the implant loosens.