Surgery for painful elbow joint arthritis, elbow instability, and tendonitis: Elbow replacement, ligament reconstruction and repair, and tendon surgery
Edited By: Thomas Trumble, M.D.
Last updated Friday, September 08, 2006
Review of the conditionCharacteristics of elbow instability, arthritis, and tendonitis Elbow instability presents as giving way or instability, or as pain with
activity such as throwing activities. In trauma, the patient presents with an
acute dislocation that needs to be addressed with an accurate reconstruction.
Arthritis presents with pain and stiffness that gradually increases over
time.
Tendonitis presents with a reoccurring pain over the lateral
(outer) or medial (inner) aspect of the elbow. It is particularly worse with
lifting activities for the lateral elbow and pushing activities with the medial
elbow.
Types Elbow instability
Instability can affect either the lateral (outer) or medial
(inner) aspect of the elbow. In some cases, the patient will present after an
acute injury with the elbow completely dislocated, and then instability reoccurs
when proper reconstruction is not performed. Athletes frequently develop medial
elbow instability and patients with trauma or prior surgery often develop
lateral elbow instability.
Arthritis
These patients present with
either traumatic arthritis when they have had prior injuries such as the
dislocation described above or with instability or fractures. These patients
often have no problems with their other joints. Rheumatoid arthritis patients
present with serious arthritis involving a number of joints. They are often on
powerful systemic medications.
Tendonitis
Tendonitis can be broken
down into a group of patients with lateral epicondylitis, (the most common form
- also known as tennis elbow with pain in the lateral aspect of the elbow), and
medial epicondylitis (golfer¹s elbow), a condition which frequently present with
pain in the medial side of the elbow and pain with certain types of lifting or
pushing activities.
Similar conditions The most difficult aspect in the diagnosis of elbow instability, arthritis, and
tendonitis is that they can often be confused. It is important for the patient
to have a thorough examination, radiographs, and often-additional studies such
as magnetic resonance imaging (MRI) with or without arthrograms.Incidence and risk factors Elbow instability
Instability is common in active individuals, particularly
in individuals involved with sports, such as throwing sports, or contact
sports.
Arthritis
Elbow arthritis is less common, but when it occurs
it has severe impact on the patient’s activities because it prevents the patient
from placing their hand in space, even for simple activities. Traumatic
arthritis is more common than rheumatoid arthritis.
Tendonitis
This is
an extremely common condition. Lateral epicondylitis is more common than medial
epicondylitis and occurs frequently in people over forty years who participate
inrepetitive activities and sports.
Diagnosis Elbow instability
This is best diagnosed with a thorough examination, x-rays,
and then magnetic resonance imaging enhanced with an arthrogram. The arthrogram
involves injecting the elbow with a small amount of dye that helps to add to the
clarity of the MRI images. These images can help to demonstrate ligament
disruption.
Arthritis
Plane x-rays are frequently the best screening
tool to help diagnosis arthritis. Occasionally, arthrograms coupled with
computerized tomography provides an improved definition of the bone surface to
detect which area of the arthritis is more critical and causing the symptoms.
Arthrography, also involving the injection of a dye, helps to demonstrate if
there are loose bodies or small bone chips floating in the joint that can cause
locking and pain.
Tendonitis
Clinical examination is still the best
examination for this condition, along with plane x-rays to help rule out the
possibility of arthritis co-existing with the tendonitis. Magnetic resonance
imaging can help determine the severity and whether the patient will respond to
conservative treatment or will require surgery.
Medications Elbow instability
Medications are not highly effective because these patients have a mechanical problem that needs to be addressed surgically.
Arthritis
Medications can be extremely helpful especially non-steroidal anti-inflammatory medications. Occasionally, food supplements such Glucosamine have been reported to provide relief.
Tendonitis
Anti-inflammatory medications can be very helpful in the initial phase of treatment, but are less helpful in the chronic phases. Again, this is usually non-steroidal medication such as Ibuprofen or Naproxen. The patients are advised to follow the manufacturer’s recommendation when taking these medications. For each medication, the patient should learn the risk and possible interaction of other drugs, the recommended dosage, cost, and adverse effects.
Exercises Elbow instability
Exercise will not help this condition as it truly involves
a biomechanical instability that has to be addressed with a surgical
reconstruction.
Arthritis
Gentle stretching exercises can be helpful
for arthritis, but multiple repetitions can actually aggravate the condition by
putting further stress on the joint. The patient should consult with their
doctor and therapist before embarking on a regular exercise
program.
Tendonitis
Tendonitis can respond to modification, which
means changing the patient’s lifting pattern, more than exercises. It is
important in lateral epicondylitis to make sure to lift objects with the palm
up, which places the stress on the opposite side of the elbow. The opposite is
true for medial epicondylitis where it is important to lift with the palm down
to place the stress away from the medial side of the elbow.
Possible benefits of treatment for elbow instability, and tendonitis Elbow instability
The key aspect of this surgery is to reconstruct the
biomechanics of the joint to repair and replace the ligaments. This provides
stability to relieve symptoms and prevent long-term arthritis.
Arthritis
A joint replacement surgery, either to replace a part of
the joint, such as the radial head or the entire joint with total elbow
prostheses can help to relieve pain and improve motion. In young patients with
an active lifestyle, the goal is to make sure that all possible conservative
options have been used so that the devise is not implanted at too young an age
in a patient which can lead to loosening.
Tendonitis
The
decompression surgery that is performed can be very effective in patients who
have exhausted conservative treatment. Chronic tearing of the muscle attachment
produces pain and is relieved with a debridment and removal of the inflamed
tissue and reattaching the muscle slightly closer to the forearm.
Surgery for Elbow Instability, Arthritis, and Tendonitis at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-4537 to make an appointment.
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