Elbow Issues

Osteoarthritis

Causes
Osteoarthritis is caused by degeneration of the articular cartilage of a joint. Degeneration is wear that happens over time. Doctors use the term degenerative arthritis to describe the wear and tear of a joint over many years. Degenerative arthritis is another term for osteoarthritis.

Some doctors use the term degenerative arthrosis. (Arthrosis just means that the joint is wearing out.) Arthritis is technically a condition of joint inflammation. Often, joints with osteoarthritis aren’t inflamed. The term arthritis should really only be used to describe true inflammatory conditions, such as gout, infection, and rheumatoid arthritis.

A bad sprain or fracture can actually damage the articular cartilage. The cartilage can also be bruised when too much pressure is put on the cartilage surface. Osteoarthritis (OA) may be idiopathic, meaning there isn’t a known reason for the condition. But most of the time, elbow osteoarthritis is linked with excess use of the arm.

The cartilage surface may not look any different. The injury often doesn’t show up until months later. Some-times the damage to the cartilage is severe. Pieces of the cartilage can actually be ripped away from the bone. These pieces do not grow back. Usually they must be surgically removed. If the pieces aren’t removed, they may float around in the joint, causing it to catch. These pieces are referred to as loose bodies. They can also cause a lot of pain and do more damage to the joint surfaces.

Your body does not do a good job of repairing these holes in the cartilage surface. The holes fill up with scar tissue. Scar tissue is not as slick or rubbery as the articular cartilage.

An injury doesn’t have to damage the cartilage to start the process of osteoarthritis. Any injury to the elbow joint can change the way the joint works. For example, after an elbow fracture the bone fragments may not line up exactly. They heal slightly differently from their condition before the injury. Even this slight difference can cause the joint to begin the cycle of wear and tear.

A dislocation can also cause lasting damage. After the ligaments have been injured in a dislocation, the elbow joint may move differently. This change in movement alters the forces on the articular cartilage. It’s just like a machine, if the mechanism is out of balance, it wears out faster.

Over many years, this imbalance in joint mechanics can damage the articular cartilage. Since articular cartilage cannot heal itself very well, the damage adds up. Finally, the joint can no longer compensate for the damage, and the elbow begins to hurt.

Osteoarthritis of the elbow isn’t like OA of the hip or knee. Most of the time, the articular cartilage isn’t damaged. The joint space remains close to normal. The biggest changes are hypertrophic osteophyte (bone spur) formation and capsular contracture.

Capsular contracture refers to the process by which the capsule dries out and tightens up. The capsule has two layers: a fibrous covering that surrounds the joint and an inner lining. The inner layer is called the synovium. The synovial layer holds the lubricating fluid inside the joint.

Symptoms
Pain and stiffness are the main symptoms of osteoarthritis of any joint. At first, the pain comes only with activity. Most of the time the pain lessens while doing the activity, but after resting for several minutes pain and stiffness increase. As the condition worsens, you may feel pain even when resting. The pain may interfere with sleep.

You may have swelling around your elbow. Your elbow joint may fill with fluid and feel tight, especially after using it. When all the articular cartilage is worn off the joint surface, you may begin hearing a squeak and feel a creak in the joint when you move your elbow. This creaking sensation is called crepitus.

Osteoarthritis eventually affects the elbow’s motion. The elbow joint is one of the most sensitive to injury. It quickly becomes stiff and loses motion. The first thing most people notice is that it becomes hard to completely straighten the arm. Later they find it hard to bend.

Loss of motion leads to weakness and decreased function. Carrying heavy objects at the side of the body with the elbow straight is especially difficult.