Arthritis is inflammation of the elbow joint. Arthritis leads to the loss of articular cartilage, which covers the ends of the bones, and allows the bones to move smoothly against each other. When the cartilage is damaged, the bones rub together during joint motion, and the patient is said to have 'bone-on-bone' in the joint. This can lead to pain with motion, or at rest, clicking or grinding with motion, and a loss of strength. When arthritis becomes severe, the body attempts to stabilize the joint and limit motion by forming bone spurs, or extra bone around the edges of a joint.
There are two main types of arthritis: rheumatoid and osteoarthritis. Rheumatoid arthritis occurs when the body's immune system causes the inflammation; osteoarthritis occurs when the joint wears out as a result of overuse, age, or injury. When an infection in the joint leads to loss of cartilage, it is called septic arthritis.
Patients suffering from elbow arthritis will experience pain, stiffness and loss of strength. A 'grinding', 'clicking' or 'locking' sensation may be felt in the affected joint. Loss of motion can become severe, and the patient may have trouble performing everyday tasks, such as combing their hair.
Arthritis is diagnosed on physical exam and on x-ray. Your orthopaedic surgeon will examine your elbow, noting range of motion, strength and pain with motion. Your surgeon will obtain x-rays, and sometimes a CAT scan or MRI to evaluate the arthritis.
Elbow arthritis can be treated with physical therapy, to strengthen the muscles that support the joint. The stronger the supporting muscle, the less the body will need to rely on bony architecture to stabilize the joint. This will lead to less stress across the arthritic area. Because arthritis is inflammation, your surgeon may prescribe anti-inflammatory medication or offer an injection to reduce the inflammation. For arthritis in its beginning stages, nutritional supplements are available to slow progression of the arthritis.
When non-operative treatment has failed, your surgeon may suggest surgery. Two surgical options are available for elbow arthritis. Arthroscopy of the elbow, or an 'elbow scope', involves placing a tiny camera in the joint to remove injured cartilage. Although not a cure, this procedure may provide long lasting relief. For more severe cases, a total, or partial elbow replacement may be offered. This involves removing the joint and replacing the injured cartilage with a smooth metal or plastic implant. This allows the elbow to move smoothly, reducing pain and, in many cases, improving motion.
The ends of bones that make out the different joints in the body is covered with firm smooth tissue called cartilage. The humerus head and the glenoid join to form the shoulder joint and the distal end of the humerus and the proximal ulna and radius form the elbow joint. Articular cartilage absorbs shock, allows for smooth movement and protects the underlying bone. When joint cartilage is damaged due to arthritis or small pieces break off due to trauma, these pieces move freely around the joint and receive its nutrition through joint fluid. Small pieces of bone can come loose with the cartilage and especially during mechanical injury of the joint. These loose pieces that float around in the joint are called loose bodies.
Injury to, or gradual degeneration of cartilage from arthritis causes small pieces to break off from the cartilage surface. Another source of loose bodies can be osteophytes that break loose and drift around in the joint. Osteophytes is bony outgrowth on the edges of the joint that occurs as a result of osteo arthritis. Cells which become active during osteo arthritis and are responsible for inflammatory reaction in the bone causes new bone to be deposited on the edges of the joint that eventually becomes osteophytes.
Bone and cartilage fragments can also break loose where there is weak blood supply to the subchondral bone (osteochondritis dissecans). Connective tissue structures that developed during bleeding in the joint or damage to soft tissue in the joint can also cause loose bodies.
Most loose bodies do not cause symptoms. When they do it is usually acute sharp pain that is experienced during episodes of locking or clicking of the joint and there is also a feeling of instability of the joint. Swelling of the joint can occur due to the irritating nature of these loose bodies. A grating feeling called crepitus may be felt of heard during joint movement.
Loose bodies are classified by what they consist of, whether they are free in the joint or whether they are partially attached to the surrounding soft tissue. There are cartilaginous loose bodies from cartilage, fibrous loose bodies from connective tissue origin and osteochondral loose bodies that contains bone and cartilage. Some cartilage loose bodies can calcify and like osteochondral loose bodies be visible on x-rays. Stable loose bodies are usually attached to the synovial membrane.
Loose bodies that cause symptoms must usually be removed. Smaller loose bodies can be removed by arthroscopic techniques through grabbing instruments or suction where with larger loose bodies a small incision will be necessary. Loose bodies can also be removed by burring or breaking it up in smaller pieces. In some cases where large enough pieces break loose from previously normal joint surfaces these loose bodies can be re-attached in their original position through surgery.
A joint that becomes inflamed as a result of an infection is said to be septic. Damage to the joint surface, or cartilage, as a result of infection is termed septic arthritis.
Bacteria may enter a joint through a break in the skin, through the bloodstream from another source of infection, or as a result of an injection or surgery. Some joint infections occur without any known cause. People whose immune systems are impaired are at increased risk for septic joints.
Patients with septic joints complain of pain and swelling in the joint. The joint is hot, red, and extremely painful to bear weight. Range of motion of the joint is greatly reduced. The joint is swollen and tender to the touch. Patients may have a fever.
Your surgeon will diagnose a Septic joint on clinical exam. Laboratory studies may show an elevated white blood cell count, and tests for inflammation such as ESR and CRP will be elevated. Fluid drawn from the affected joint will be purulent and can be analyzed for bacteria and white blood cells. X-rays and an MRI may show fluid in the joint.
Because a bacterial infection in a joint is damaging to cartilage, septic joints are considered to be relative surgical emergencies. Non-operative treatment, consisting of antibiotics and draining the joint several times with a needle and syringe, is reserved only for patients too sick to undergo an operation.
Your surgeon will wash the joint in the operating room, either arthroscopically or through an open incision to remove the bacteria. Cultures will be taken from inside the joint to identify the type of bacteria responsible. Intravenous antibiotics will be given to help eradicate the infection. Blood tests will confirm that the infection has resolved.