Arthritis is an inflammatory condition of joints. There are several types of arthritis and the most common type is osteoarthritis or wear-and-tear arthritis. Arthritis affects various joints in the body. Arthritis may also affect the elbow joint and the symptoms include swelling, pain, stiffness, and malformation all of which interfere with use of the elbow.

Who develops arthritis?

Arthritis is often seen in people aged over 40 years however may affect people of all ages. The most common cause is wear-and-tear, as you age you are more prone to develop arthritis. Also, traumatic injuries, fractures and joint dislocation make you more susceptible to develop arthritis. Certain types of arthritis are more common in women than men as in rheumatoid arthritis.

What are the types of arthritis?

There are over several types of arthritis. The most common are:

Osteoarthritis: Osteoarthritis is also called degenerative joint disease; this is the most common type of arthritis, which occurs often in older people. This disease affects cartilage, the tissue that cushions and protects the ends of bones in a joint. With osteoarthritis, the cartilage starts to wear away over time. In extreme cases, the cartilage can completely wear away, leaving nothing to protect the bones in a joint, causing bone-on-bone contact. Bones may also bulge, or stick out at the end of a joint, and this is called a bone spur.

Osteoarthritis causes joint pain and can limit a person’s normal range of motion (the ability to freely move and bend a joint). When severe, the joint may lose a lot of movement, causing a person to become disabled. Elbow osteoarthritis can be very disabling.

Rheumatoid Arthritis: This is an auto-immune disease in which the body’s immune system (the body’s way of fighting infection) attacks healthy joints, tissues, and organs. Occurring most often in women of childbearing age (15-50), this disease inflames the lining (or synovium) of joints. It can cause pain, stiffness, swelling, and loss of function in joints. When severe, rheumatoid arthritis can deform, or cause the elbow to bend or curve.

Rheumatoid Arthritis affects mostly joints of the upper and lower limb esp hands and feet and tends to be symmetrical. This means the disease affects the same joints on both sides of the body at the same time and with the same symptoms. About two to three times as many women as men have this disease.

Post-traumatic arthritis:Arthritis developing following an injury to the elbow is called as post-traumatic arthritis. The condition may develop months or years after the trauma such as a fracture, severe sprain, or ligament tear.

Psoriatic arthritis: This form of Arthritis occurs in some persons with psoriasis, a scaling skin disorder, affecting the joints at the ends of the fingers and toes. It can also cause changes in the fingernails and toenails. Back pain may occur if the spine is involved.

How is arthritis diagnosed?

Diagnosis of elbow arthritis is made by examining the elbow. X-rays of the joint may be taken to know the severity of the disease and to determine any bone spurs or calcium deposits.

What are the treatments available for arthritis of the elbow?

Nonsurgical treatment methods for relieving pain in an arthritic joint include activity modification, pain medications, physiotherapy, and use of splints, and steroid injections.

Surgery is usually considered if nonsurgical treatment fails to give relief. There are different surgical procedures that can be used and may include:

Synovectomy, joint lavage and capsular release: This surgery is usually indicated for early cases of inflammatory arthritis where there is significant swelling (synovitis) that is causing pain or is limiting the range of motion of digits and thumb. Synovectomy is a surgical removal of the inflamed synovium (tissue lining the joint). The procedure is often performed using keyhole surgery (elbow arthroscopy). It may also be performed open where the joint is washed out and the capsule is released both in the front and at the back to improve movement. Loose bodies in the front and back of the joint may be removed and bony spurs obstructing movement can be removed as well.

Elbow replacement: In this procedure, the affected joint is removed and replaced with an artificial implant (total elbow replacement). Sometimes only a part of the outer forearm bone forming the elbow is replaced (radial head replacement). This is typically indicated in elderly and low demand patients.

Dr Bala is also trained to deal with failed total elbow replacements requiring revision surgery.

Elbow interpositional arthroplasty: In this procedure, the cartilage is removed and an artificial membrane or graft from the thigh is interposed and sown between both joint surfaces and the ligaments repaired. This is called Interposition arthroplasty of the elbow. Arthroplasty is usually indicated in younger lower demand patients and people who don’t use the limb for manual labour and whose bone quality is good.

Arthroplasty: In this procedure, the affected joint is removed and replaced with an artificial implant (total elbow replacement). Sometimes only a part of the outer forearm bone forming the elbow is replaced (radial head replacement). Sometimes the cartilage is removed and an artificial membrane is interposed and sown between both joint surfaces. This is called Interposition arthroplasty of the elbow. Arthroplasty is usually indicated in people who don’t use the limb for manual labour and whose bone quality is good. Dr Bala has attended cadaver workshops on Elbow replacement.

Dr Bala is also trained to deal with failed total elbow replacements requiring revision surgery.

Arthrodesis: A fusion, also called an arthrodesis involves removal of the joints and fusing the bones of the joint together using 2 plates and screws. Even though this surgery eliminates all motion at the joint, the resulting fusion is very strong and removes pain and the joint is in a functional position.

This surgery is usually indicated when the joints are severely damaged, when there is limited mobility, damage to the surrounding ligaments and tendons, failed previous joint replacement, and when heavy manual use is expected especially in the dominant elbow.

Dr Bala will discuss the options with you and help you decide which type of surgery is the most appropriate for you. In the event you may have a tattoo on the forearm Dr Bala is well versed in suturing tattoos back accurately with absorbable sutures.

Rehabilitation

Following surgery, a rehabilitation program, often involving a physiotherapist may help to regain elbow strength and movement. You may need to use a post-operative splint for a while after surgery that helps to protect the elbow while it heals. You may need to restrict activities for 12 weeks to let the joint reconstruction heal properly. Although recovery is slow, you should be able to resume your normal activities within a few months of surgery.