Elbow Osteoarthritis

Elbow Osteoarthritis

Elbow osteoarthritis (OA) is relatively rare compared to OA in weight-bearing joints such as the knees and hips. However, its impact on function can be significant, especially in individuals with a history of trauma to the elbow. The elbow is susceptible to injuries such as fractures and dislocations, which can disrupt normal joint mechanics, increasing the risk of post-traumatic OA. Over time, these changes lead to pain, inflammation, stiffness, and difficulty performing daily tasks.

Elbow Osteoarthritis


Clinically Relevant Anatomy

The elbow is a synovial hinge joint that allows flexion, extension, pronation, and supination. It comprises the following:

Bones Involved:

  • Distal humerus
  • Proximal radius
  • Ulna

Articular Surfaces:

The trochlea of the humerus and trochlear notch of the ulna form an articulation that is angled at approximately 45°, allowing smooth and extensive flexion.

Carrying Angle:

It is the angle formed between the upper arm (humerus) and the forearm (ulna and radius) when the arm is fully extended and the palm is facing forward (supinated). It’s called the “carrying angle” because it allows the forearm to angle away from the body, helping it clear the hips when carrying objects.

  • Males: 10°–15°
  • Females: 20°–25°

 

Elbow Osteoarthritis

Pathophysiology

There are two main types of elbow OA:

1. Primary Osteoarthritis

  • Rare and typically seen in individuals involved in heavy manual labor or sports.
  • Begins at the olecranon and coronoid processes.
  • Early stage - pain is mainly at the end range of motion.
  • Later stage - pain becomes more generalized due to osteophyte formation and capsular tightness.

2. Post-Traumatic Osteoarthritis

  • More common form of elbow OA.
  • Caused by malunion of fractures or instability after dislocations or trauma
  • Clinical features include - pain, crepitus (crackling) during flexion-extension or rotation and progressive joint degeneration

 

Clinical Presentation

  • Pain - initially at end range, later throughout the range of motion.
  • Range of Motion Loss - especially extension in post-traumatic cases.
  • Ulnar Neuropathy - weakness or numbness in the hand, particularly in the 4th and 5th fingers.
  • Functional Impairments - difficulty with activities like lifting, pushing, or gripping.
  • Trauma History - essential to determine past elbow injuries.
  • Red Flags - consider post-surgical infections or septic arthritis if systemic signs are present.

 

Diagnosing Elbow Osteoarthritis

Elbow Osteoarthritis

Elbow Osteoarthritis


Differential Diagnosis


Physiotherapy Management of Elbow Osteoarthritis

1. Goals of Physiotherapy

  1. Alleviate pain and inflammation
  2. Maintain or restore elbow ROM
  3. Improve strength in the upper limb and related regions
  4. Enhance functional performance and joint protection
  5. Delay surgical need in younger individuals

 

2. Non-Operative Physiotherapy Management

2.1. Education & Activity Modification

  • Teach joint protection strategies:
  •  Avoid heavy lifting
  • Use forearm cuffs/braces for support
  • Ergonomic adjustments for writing, computer work, lifting

2.2. Pain and Swelling Management

2.3. Range of Motion (ROM) Exercises

It is performed dailywithin pain-free range.

Examples:

  • Elbow Flexion-Extension AAROM - slide forearm on table or use opposite hand to assist
  • Forearm Supination-Pronation with Wand or Hammer - hold a stick and rotate forearm side to side
  • Wall Slide (Flexion Stretch) - slide hand up wall to improve elbow flexion range
  • Towel Stretch for Extension - use towel around wrist, gently pull to straighten elbow

2.4. Strengthening Exercises

Start with isometrics → progress to dynamic resistance

Phase 1 – Isometric Strengthening (Hold for 5–10 sec, repeat 10x):

  • Elbow Flexor Isometrics (Biceps) - push against immovable surface without actual movement
  • Elbow Extensor Isometrics (Triceps) - press back of arm against wall
  • Forearm Isometrics - resisted pronation and supination using hand pressure

Phase 2 – Dynamic Strengthening (Theraband or 0.5–1 kg weight):

  • Biceps Curls (Theraband or Dumbbell)
  • Triceps Kickbacks
  • Wrist Flexion/Extension
  • Radial/Ulnar Deviation with Light Dumbbell
  • Supination/Pronation with Hammer or Weighted Stick

Phase 3 – Functional & Proximal Strengthening:

  • Push-Ups (progress to table or modified knee push-ups)
  • Wall Scapular Retractions using resistance bands
  • Shoulder Abduction/Flexion with Theraband
  • Core Stability Exercises (e.g., dead bug, bridges)

2.5. Manual Therapy Techniques

  • Soft tissue release: Biceps, triceps, forearm flexors/extensors
  • Maitland Mobilizations: Grade I–II for pain, Grade III–IV for stiffness
  • MWM (Mobilization with Movement): For functional movement patterns

 

3. Post-Surgical Rehabilitation (e.g., after TEA, debridement, arthroplasty)

3.1. Immediate Post-Op Phase (Week 0–2)

  • Pain/swelling control (ice, elevation, gentle compression)
  • Splinting for joint prot
  • Initiate passive elbow ROM if allowedection
  • Gentle active ROM of wrist, hand, shoulder

3.2. Intermediate Phase (Week 2–6)

  • Gradual restoration of elbow ROM (pain-free range)
  • Light resistance exercises as tolerated
  • Begin proprioception training

3.3. Advanced Phase (Week 6–12+)

  • Functional strengthening (elbow, wrist, shoulder)
  • Introduce closed kinetic chain (CKC) exercises
  • Retraining for work/sport-related movements
  • Emphasize compliance to movement precautions (e.g., weight restrictions after TEA)


4. Adjunct & Emerging Therapies

4.1. Platelet-Rich Plasma (PRP)

  • It can be used alongside physiotherapy to help relieve pain
  • Physiotherapy should follow a structured progression post-injection

 4.2. Partial Denervation

  • Post-denervation rehab focuses on preserving motion and strength while monitoring for neuropathic symptoms

4.3. Regenerative Medicine (Stem Cell Therapy)

  • If used, focus on gentle ROM and unloading strategies to support cartilage repair

4.4. Osteochondral Autografts

  • Customized rehab focusing on localized joint protection and progressive loading


Progress in elbow osteoarthritis is tracked using tools like the Mayo Elbow Performance Score (MEPS) and DASH Questionnaire to assess function and daily activity limitations. Pain levels are measured using the Visual Analog Scale (VAS). Range of motion is assessed with a goniometer, while muscle strength is evaluated through Manual Muscle Testing (MMT) or a dynamometer. These tools guide treatment and track recovery.

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