Arthritis of your elbow
What is arthritis?
Arthritis literally means “inflamed joint.” Normally a joint consists of two smooth, cartilage-covered bone surfaces that fit together as a matched set and that move smoothly against one other. Arthritis results when these smooth surfaces become irregular and don’t fit together well anymore and essentially “wear out.” Arthritis can affect any joint in the body, but it is most noticeable when it affects the hands and fingers. Each hand has 19 bones, plus 8 small bones and the two forearm bones that form the wrist. Arthritis of the hand can be both painful and disabling. The most common forms of arthritis in the hand are osteoarthritis, post-traumatic arthritis (after an injury), and rheumatoid arthritis. Other causes of arthritis of the hand are infection, gout, and psoriasis. Osteoarthritis is a degenerative joint disease in which the cushioning cartilage that covers the bone surfaces at the joints begins to wear out. It may be caused by simple “wear and tear” on joints, or it may develop after an injury to a joint
Signs and symptoms of arthritis:
Stiffness, swelling, and pain are symptoms common to all forms of arthritis.
How is osteoarthritis diagnosed?
We will examine you and determine whether you have similar symptoms in other joints and assess the impact of the arthritis on your life and activities. X-rays will also show certain characteristics of osteoarthritis, such as narrowing of the joint space, the formation of bony outgrowths (osteophytes or “nodes”), and the development of dense, hard areas of bone along the joint margins.
Treatment for osteoarthritis:
Treatment is designed to relieve pain and restore function. Anti-inflammatory or other analgesic medication may be of benefit in relieving pain. Brief periods of rest may help if the arthritis has flared up. You may also be advised to wear splints at night and for selected activities. Often soft sleeves may be of some benefit when the rigid splints are too restrictive, especially when the arthritis is affecting the joint at the base of your thumb. Heat modalities in the form of warm wax or paraffin baths might help, and when severe swelling is present, cold modalities may be of help. It is important to maintain motion. Therapy is often helpful with these exercises, splints, and modalities. A cortisone injection can often provide relief of symptoms, but does not cure the arthritis. Surgery is usually not advised unless these more conservative treatments fail.
Surgery is indicated when the patient either has too much pain or too little function. In most cases, the patient knows best and actually tells the doctor when it is time for surgery. The goal is to restore as much function as possible and to eliminate the pain or reduce it to a tolerable level. One type of surgery is debridement, in which the arthritic surface is removed and loose bodies are removed. Another approach is joint reconstruction, in which the degenerated joint surface is removed in order to eliminate the rough, irregular bone-to-bone contact that causes pain and restricts motion. Once the degenerated portion of the joint surface is removed, it may be replaced with rolled-up soft tissue, such as a tendon, or with a joint replacement implant. Which type of surgery is used depends on the particular joint(s) involved, your activities, and your own needs. We can help you decide which type of surgery is the most appropriate for you.
© American Society for Surgery of the Hand.
What is Rheumatoid Arthritis of the elbow? Rheumatoid arthritis affects the cells that lubricate and line joints. This tissue – synovium- becomes inflamed and swollen. The swollen tissues stretch supporting structures of the joints such as ligaments and tendons. As the support structures stretch out, the joints become deformed and unstable. The joint cartilage and bone erode. Often the joints feel hot and look red. Rheumatoid arthritis of the hand is most common in the wrist and knuckles. The disease is symmetric, thus what occurs in one elbow usually occurs in the other.
Signs and symptoms of rheumatoid arthritis of the elbow:
While stiffness, swelling, and pain are symptoms common to all forms of arthritis, there are some symptoms that are classic features of rheumatoid arthritis. They are:• Firm nodules along the elbow • Soft lump on the back of the elbow.
How is rheumatoid arthritis diagnosed:
The diagnosis of rheumatoid arthritis is made based on clinical examination, x-rays, and lab tests. Rheumatoid arthritis may have a hereditary component, thus we will ask whether other family members have had rheumatoid arthritis or symptoms similar to yours. We will do a detailed examination of your hands. The clinical appearance helps to diagnose the specific type of arthritis. X-rays are often helpful; certain findings are characteristic for rheumatoid arthritis. These findings include swelling of non-bony structures, joint space narrowing, decreased bone density, and erosions near joints. There are several blood tests that are often ordered to confirm the clinical diagnosis. These are the rheumatoid factor, sedimentation rate and sometimes the anti-CCP (cyclic citrullinated peptide). MRI- a special imaging study - has also been used to help confirm the diagnosis.
Treatment of Rheumatoid Arthritis:
Treatment for rheumatoid arthritis aims to decrease inflammation, relieve pain and maintain function. While there is no cure for rheumatoid arthritis, medications are available that slow the progression of the disease. Optimal care involves a team approach among the patient, physicians, and therapists. The care of the rheumatoid patient requires not only a hand surgeon but also a hand therapist, rheumatologist, and the patient’s primary care physician. The rheumatologist is often the physician that monitors and decides the specific type of medicine that is felt to be the most effective for the patient’s stage in the disease process.
The hand therapist will provide instruction on how to use your hands in ways that help relieve pain and protect joints. Therapists also can provide exercises, splints, and adaptive devices to help you cope with activities of daily living. Rheumatoid arthritis can be a progressive disease. Surgical interventions need to be appropriately timed in order to maximize function and minimize deformity. In certain cases, preventive surgery may be recommended. There are several types of procedures to treat joints affected by rheumatoid arthritis, including removal of inflamed joint lining, joint replacements. The specific procedure(s) chosen depends on many factors. These factors include the particular joints involved, the degree of damage present, and the condition of surrounding joints. One of the most important factors in deciding the most appropriate surgical procedure is the needs of the patient.
© American Society for Surgery of the Hand.