Primary and Posttraumatic Arthritis of the Elbow

Whether degenerative joint disease of the elbow may be the result of primary or posttraumatic etiologies, arthritis of the elbow commonly leads to pain, loss of motion, and functional disability. A detailed history and focused physical examination, in combination with imaging modalities, can help localize the origin of symptoms and help direct treatment. Although nonoperative treatment is the initial therapy for arthritis of the elbow, surgical interventions may provide substantial relief to the appropriately selected patient. 1. Introduction Degenerative joint disease of the elbow may be a painful condition for a majority of patients. Although primary osteoarthritis is less common than posttraumatic arthritis of the elbow, both conditions result in symptoms which affect the quality of life. The health care provider encountering these conditions must carefully tailor treatments, both nonoperative and operative, to account for the patient’s age, personal preferences, functional demands, and severity of arthritic changes. This paper will review the pathogenesis of both primary and posttraumatic arthritis of the elbow. The principles of nonoperative management will be presented as well as the indications and considerations for operative treatment. 2. Background/Pathogenesis 2.1. Primary Osteoarthritis Primary osteoarthritis of the elbow is an uncommon condition which occurs predominantly within the ulnohumeral joint of the dominant extremity of patients who engage in heavy sport or labor. The intrinsic congruity of the ulnohumeral articulation preserves a majority of the articular cartilage, with degenerative changes and osteophytes initially affecting the tips of the olecranon and coronoid processes as well as their respective fossae within the distal humerus. Accordingly, the most common complaint of patients in our practice with early stages of primary osteoarthritis of the elbow is pain at terminal flexion and extension, as the osteophytes of the coronoid and olecranon engage their fossae. As the degenerative process involves more of the articular surface, pain is encountered throughout the arc of motion, and enlarging osteophytes coupled with anterior and posterior capsular contracture may provide further mechanical impediments to motion and result in measurable loss of motion in terminal flexion and extension. The majority of articular surface involvement is confined to the ulnohumeral joint. Isolated primary osteoarthritis is uncommon within the radiocapitellar articulation. Accordingly, the practitioner should carry out a detailed history and