Lesions of the elbow joint

Traumatic arthritis

 

Definition

• Is the result of a direct trauma to the elbow or over-exertion
• Typically seen in the middle aged or elderly
• Loss of motion after elbow injury results from abnormalities of bone, soft tissue, or a combination of both, which may be present intra-articular as well as extra-articular¹

 

Causes

• Fall, injury, impact trauma
• May be the result of fracture of
  • Olecranon
  • Head of radius
  • Distal humerus fracture²

 

Development

• Following an injury there is pain and the patient has difficulty in moving the elbow
  • Stiffness after trauma may be limited by 3-20%³
  • Patients may develop contracture of soft tissue around the elbow after trauma, most especially the capsule, which are associated with loss of motion⁴
  • Fracture of the head of the radius will spontaneously heal, but altering time perspective, may take several months

 

Examination

• Limitation of passive flexion and extension (capsular pattern)
  • Flexion usually more limited than extension but not necessarily
• Swelling can be detected
  • If swelling is immediately after injury aspiration should be done immediately to get rid of blood in the joint which can deteriorate the joint
• If fracture of Olecranon
  • Palpation of olecranon is also very tender
  • Isometric extension is painful and weak
  • If displaced it will require surgery
• If fracture of head of radius
  • Passive pronation and supination are both painful

 

Treatment

• Local treatment, with both respect to exercises and massage is avoided as it may cause irritation of the joint

 

Considerations

• Injury to the elbow may lead to dysfunction of the ulnar nerve, so inquiry regarding the following symptoms should be investigated⁵
  • Sensation of numbness and tingling in the ring and small finger
  • Loss of dexterity
  • Soreness of the ulnar nerve in the posteromedial elbow should be investigated

Arthrosis

Definition

• Characterized by pain, stiffness, mechanical symptoms, weakness, and the presence of hypertrophic osteophytes⁶
• In contrast to most other joints, in the elbow osteoarthrosis presents with a relative preservation of articular cartilage and maintenance of joint space, with hypertrophic osteophyte formation and capsular contracture⁷

Occurrence

• Prevalence is 2%⁸
• Higher occurrence among workers with heavy manual labor
• Among people older than 40 years old there was a prevalence of 55% of elbow arthrosis, symptomatic cases were 22,6%⁹

Causes

• Increased likelihood to develop arthrosis is connected to ¹⁰
  • Increased age
  • Possible nutritional deficiencies

Development

• May develop spontaneously in late middle age
• Often affects both elbows
• May develop after injury such as a fracture or loose body in the joint
• When using the elbow too much the patient will complain of pain in the elbow joint
• Increasingly difficult to extend the elbow completely over time
• Arthrosis of the elbow joint may lead to increased likelihood to develop traumatic arthritis as result of over-exertion

 

Examination

• Limitation of passive flexion and extension (capsular pattern)
  • Flexion usually more limited than extension but not necessarily
• There may be crepitus present when moving the joint

Loose body in the elbow joint

Definition

• Loose osteochondral bodies which are present in the elbow joint
• This may lock and limit certain movements of the elbow joint which is caused by the blocking by the loose body(ies)
  • Limits the elbow from either moving into full flexion or from moving into full extension

Causes

• Loose bodies can be attributed to various factors such as¹¹
  • Osteochondritis dissecans
  • Osteochondral fracture
  • Synovial chondromatosis
  • Fracture of osteophytes in arthritis
• Not uncommon among young female gymnasts

Development

• In adolescence
  • Usually a result of osteochondritis dissecans
  • The patient experiences problems with straightening the elbow to full range due to pain. The pain and limitation is gradually improved in the following days
  • There may be ‘attacks’ with this pain and limitation while having pain-free periods in between when the loose body is not obstructing the joint
• In adults
  • Usually the result of a traumatic event
  • A piece of the cartilage is chipped free and is obstructing the joint
  • Activity increases the pain, the condition in this age is normally not unlocked in the following days
  • The condition may be wrongly identified as a tennis elbow
• Middle-age or old age
  • Patient mentions a aching in the elbow joint
  • Pain attacks last about one week
    • Symptoms come on gradually during a couple of hours
    • Symptoms disappears gradually in the following days

 

Examination

• In adolescence
  • Limitation of passive extension
    • In pain-free periods there is no limitation due to the position of the loose body
  • In adults
    • Limitation of passive extension or flexion (capsular pattern)
      • Depending on position of the loose body
    • In middle-age or old age
      • Limitation of passive extension or flexion (capsular pattern)
        • In pain free periods there is a change but still limitation due to possible structural damage

Treatment

• Surgical removal is adviced as the loose body may continue to grow
  • In adults it may also attach and may become responsible for permanent limitation of flexion