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Elbow Osteoarthritis
From WikiSM
(Redirected from Elbow Arthritis)
Other Names
- Elbow Osteoarthritis
- Elbow Arthritis
- Post Traumatic Elbow Arthritis
Background
- This page refers to all causes of elbow arthritis, which is often used interchangeably with the term elbow osteoarthritis, although causes can vary
Epidemiology
- Osteoarthritis
- Rare, 2% prevalence (need source)
- Male predominance 4:1 (need source)
- Average age 50 (range 20-70)
- Post-traumatic
- #2 cause of elbow arthritis (need citation)
- Inflammatory
- Rheumatoid Arthritis most common cause (need citation)
Pathophysiology
- General
- Typically dominant arm
Osteoarthritis
- See: Osteoarthritis (Main)
- Primary (No other cause)
- Most cases
- Secondary (Secondary to other pathology)
- Pathoanatomy
- Joint degradation: osteophyte formation, capsular contracture, loose bodies
- Osteophytes reduce motion
- Radiocapitallar Joint most commonly affected, more so than the Humeroulnar Joint
Post-traumatic
- Commonly seen post-operatively after fractures or dislocations involving the elbow
- Pathoanatomy
- Direct articular cartilage damage from traumatic event
- Asymmetric load bearing
- Degenerative changes accelerated
Inflammatory
- Pathophysiology
- Chronic inflammation and synovitis
- Subsequent ligament attenuation, periarticular osteopenia, and capsular contracture
- Pathoanatomy
- Flexion contracture with erosion of articular cartilage, joint space loss
- Cyst formation, joint deformities
- Ulnar Neuropathy
- Progressive instability
Risk Factors
- Systemic disease
- Activities
- Manual laborers
- Weight lifters
- Throwing athletes
Differential Diagnosis
- Fractures
- Adult
- Pediatric
- Dislocations & Instability
- Tendinopathies
- Bursopathies
- Ligament Injuries
- Neuropathies
- Arthropathies
- Other
- Pediatric Considerations
- Little League Elbow
- Panners Disease (Avascular Necrosis of the Capitellum)
- Nursemaids Elbow (Radial Head Subluxation)
Clinical Features
- General: Physical Exam Forearm
- History
- Patients report pain with range of motion, stiffness, weakness
- Progressive pain, most consistently at end of range of motion
- Loss of complete extension
- Locking, catching, clicking
- Physical
- Painful range of motion, including supination and pronation and typically worse at extremes of motion
- Some patients may have tenderness along the joint
- OA: 50% have symptoms of ulnar neuropathy
- Inflammatory: May have flexion contracture,
Evaluation
AP view
Lateral view
Radiographs
- Initial 3 views
- Findings in Rheumatoid Arthritis
- Symmetric joint space narrowing
- Periarticular erosions, cystic changes
- Disuse osteopenia
- Primary osteoarthritis
- Osteophyte and loose body formation on the olecranon and coronoid processes, extending into the fossae
- Typically sufficient for surgical planning
CT/MRI
- Typically unneccesary
- Consider in patients with heterotopic ossification, substantial bony deformities or intra-articular loose bodies
- Useful for surgical planning
Classification
Rettig classification
- Based upon radiograph findings[1]
- Class I: marginal arthritic spurring of the ulnotrochlear joint, normal radiocapitellar joint
- Class II: marginal ulnotrochlear joint arthritis, arthritic changes in radiocapitellar joint; radiocapitellar joint is congruent, without evidence of subluxation.
- Class III: Class II with the presence of radiocapitellar subluxation denotes a class III elbow
Management
Nonoperative
- Considered first line therapy
- In patients with Rheumatoid Arthritis
- Disease modification anti-rheumatic drugs should be emphasized
- Can achieve resolution of signs and symptoms in 10% of patients[2]
- Osteoarthritis
- Relative rest
- Analgesia including Acetaminophen, NSAIDS
- Activity modification
- Physical Therapy
- Corticosteroid Injection
- Consider
- Regenerative medicine, viscosupplementation
Operative
- Indications
- Failure of nonoperative management
- Techniques
- Arthroscopy
- Synovectomy
- Arthroscopic and open debridement
- Outerbridge-Kashiwagi ulnohumeral arthroplasty
- Distraction interposition arthroplasty
- Total elbow arthroplasty (TEA)
Rehab and Return to Play
Rehabilitation
- Needs to be updated
Return to Play
- Needs to be updated
Complications
- Surgical complication rate as high as 43% (need citation)
- Infection
- Wound healing
- Iatrogenic Ulnar Nerve Injury
- Triceps Avulsion
- Fracture
- Hardware failure
- Instability
See Also
- Internal
- External
- Sports Med Review Elbow Pain: https://www.sportsmedreview.com/by-joint/elbow/
References
- ↑ Rettig LA, Hastings H II, Feinberg JR. Primary osteoarthritis of the elbow: lack of radiographic evidence for morphologic predisposition, results of operative debridement at intermediate follow-up, and basis for a new radiographic classification system. J Shoulder Elbow Surg. 2008;17(1):97–105.
- ↑ Brasington R. TNF-alpha antagonists and other recombinant proteins for the treatment of rheumatoid arthritis. J Hand Surg Am. 2009; 34(2):349 –350.
Created by:
John Kiel on 3 January 2020 19:10:16
Authors:
Last edited:
13 October 2022 14:06:14
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