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Elbow Osteoarthritis

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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

Pathophysiology

  • General
    • Typically dominant arm

Osteoarthritis

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


Differential Diagnosis


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

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

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


See Also


References


  1. 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.
  2. 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:
25 August 2021 18:42:16
Categories: