Elbow
Osteoarthritis
Primary OA
Uncommon and linked with repetitive sports and manual work – commonly noticed in the dominant
arm.
Firstly, degenerative changes and osteophytes occur at the olecranon & coronoid processes whereas
the central surfaces remain intact.
Symptoms: End Range Flexion/Extension causes Pain, Joint Stiffness & as the OA progresses pain
occurs throughout the ROM as well as a loss in ROM due to enlarged osteophytes and capsular
contracture may occur, Ulnar neuropathy
Post-Traumatic OA
A trauma to the elbow joint can lead to Post-Traumatic OA and it is caused by abnormal kinematics.
Following trauma to the elbow joint the articular surfaces can become incongruent because of
malunion of a fracture site or ligamentous instability.
Symptoms: pain and crepitus with flexion and extension movement, extension loss is the main
movement limited, reduced pronation/supination, Ulnar neuropathy
Surgical options
▪ Arthroscopic Debridement
▪ Elbow Fusion
▪ Total Elbow Replacement
If the X-ray confirms osteoarthritis, then a referral to the MSK-MDT for further assessment +/-
consideration of surgery is appropriate. If the X-ray shows no evidence of elbow then an alternative
diagnosis should be sought and managed accordingly.
LCH Pathway:
Since elbow stiffness is very common post-injury, a period of observation for three months is
appropriate because usually this will improve. If stiffness persists after three months, a referral to
Tier 1 physiotherapy is appropriate to assist and advice on exercises to regain a normal range of
motion. If there is no improvement, Tier 1 physiotherapy will refer to MSK-MDT, who may refer
onward to a surgeon.
Inflammatory Pathology
Rheumatoid Arthritis
Inflammation in joints created by the immune system.
Usually, the immune system helps a person fight off infections, but in the case of RA, the body’s
immune system cannot tell the difference between viruses, bacteria, and other germs and the body’s
healthy cells, tissues, or organs. Because of this, the immune system attacks and destroys these
healthy cells, tissues, or organs.
The cause is unknown.
Osteoarthritis
Primary OA
Uncommon and linked with repetitive sports and manual work – commonly noticed in the dominant
arm.
Firstly, degenerative changes and osteophytes occur at the olecranon & coronoid processes whereas
the central surfaces remain intact.
Symptoms: End Range Flexion/Extension causes Pain, Joint Stiffness & as the OA progresses pain
occurs throughout the ROM as well as a loss in ROM due to enlarged osteophytes and capsular
contracture may occur, Ulnar neuropathy
Post-Traumatic OA
A trauma to the elbow joint can lead to Post-Traumatic OA and it is caused by abnormal kinematics.
Following trauma to the elbow joint the articular surfaces can become incongruent because of
malunion of a fracture site or ligamentous instability.
Symptoms: pain and crepitus with flexion and extension movement, extension loss is the main
movement limited, reduced pronation/supination, Ulnar neuropathy
Surgical options
▪ Arthroscopic Debridement
▪ Elbow Fusion
▪ Total Elbow Replacement
If the X-ray confirms osteoarthritis, then a referral to the MSK-MDT for further assessment +/-
consideration of surgery is appropriate. If the X-ray shows no evidence of elbow then an alternative
diagnosis should be sought and managed accordingly.
LCH Pathway:
Since elbow stiffness is very common post-injury, a period of observation for three months is
appropriate because usually this will improve. If stiffness persists after three months, a referral to
Tier 1 physiotherapy is appropriate to assist and advice on exercises to regain a normal range of
motion. If there is no improvement, Tier 1 physiotherapy will refer to MSK-MDT, who may refer
onward to a surgeon.
Inflammatory Pathology
Rheumatoid Arthritis
Inflammation in joints created by the immune system.
Usually, the immune system helps a person fight off infections, but in the case of RA, the body’s
immune system cannot tell the difference between viruses, bacteria, and other germs and the body’s
healthy cells, tissues, or organs. Because of this, the immune system attacks and destroys these
healthy cells, tissues, or organs.
The cause is unknown.
