Degenerative arthritis-of-the-elbow

DEGENERATIVE ARTHRITIS of the ELBOW

ETIOLOGY

• Primary• Secondary

– Trauma• Fracture• Dislocation

– OCD– Sepsis

CLINICAL 1 • Presentation

– Male– 50-60– Discomfort– Stiffness– +/- locking & effusions

CLINICAL 2 • Pain

– activity related (carrying/throwing) – often localised to olecranon fossa

• Stiffness– Flexion loss (hand to mouth)– Extension loss (little functional problem)

• Locking– characteristic LB

INVESTIGATIONS

• Plain XR– AP (ossification fossae)– Lateral (osteophytes - coronoid & olecranon)

• CT scan – loose body

• Arthroscopy

NON-OPERATIVE TREATMENT

• often causes only minor symptoms (esp early)

• Advice• Analgesia• Activity Modification• NSAID

OPERATIVE TREATMENT ALGORITHIM

Symptom Treatment

Loose body Arthroscopy

Mild decrease ROM Debridement/capsular release

Impingement OK procedure

Marked decrease ROM & painful arc

Total Elbow Replacement

OK Procedure

• Ingenious operation• Fenestrate olecranon

fossa• Debride anterior &

posterior osteophytes plus remove LB

Total Elbow Replacement 1

Total Elbow Replacement 2

• Indications– Age > 65 years– Extensive OA with painful arc– Discomfort almost constant & esp. at night– sedentary