Cartilage damage in the elbow

Elbow: Cartilage and articular surfaces

The elbow is made up of three jointed parts: the upper arm bone (humerus), the ulna (ulna) and the radius (radius). The articular surfaces are covered with hyaline articular cartilage. This smooth, elastic cover distributes load, reduces friction and allows pain-free movement. The synovial membrane (synovium) produces fluid that nourishes the cartilage. However, cartilage has only a weak blood supply, which is why it can only regenerate to a limited extent after damage.

• Main affected zones: Capitulum humeri, trochlea and olecranon fossa
• Function: shock absorption, lubrication, power transmission
• Weak point: Low self-healing; Defects can progress

Causes and risk factors

Cartilage damage occurs as a result of single injuries or repeated microtraumas over a long period of time. Athletic overhead and supporting loads (e.g. throwing, racket, gymnastics and climbing sports) are common.

• Trauma: Fall on the outstretched arm, elbow dislocation, bone splinters
• Overload: Repetitive compression and shear forces, particularly at the capitellum (common in adolescents and young adults)
• Osteochondritis dissecans (OCD): Circumscribed circulatory disorder in the joint surface - typical of the capitulum of the humerus in athletes
• Joint instability: Increases shear forces and promotes cartilage abrasion
• Inflammatory diseases: e.g. B. rheumatoid arthritis
• Consequences of fractures and misalignments
• Occupational stress: Repeated, heavy manual tasks
• Systemic factors: metabolic disorders, smoking; relevant in individual cases

Symptoms: How do you recognize cartilage damage?

• Stress-dependent pain in the elbow, later also at rest
• Feelings of pinching, snapping or blocking (indication of free joint bodies)
• Rubbing noise (crepitation) when moving
• Swelling and feeling of tension due to joint effusion
• Restriction of movement (especially stretching and twisting movements)
• Reduced strength in everyday life and sports

Warning signs that should be clarified medically: sudden severe pain after trauma, persistent blockage, fever and pronounced redness (suspected infection), numbness or signs of paralysis in the hand/fingers.

Diagnostics: step by step

The diagnosis is based on a structured approach: anamnesis, physical examination and targeted imaging. The aim is to determine the size, depth and location of the cartilage defect, to identify accompanying factors (e.g. instability) and to rule out other causes.

Severity and forms of cartilage damage

Cartilage defects differ in depth, area and location. The deeper the defect and the larger the area affected, the higher the risk of discomfort and progression.

• Superficial roughening and softening: early form, often reactive and potentially stabilizable
• Fissures and cracks: stress-related pain, especially a. in shear forces
• Partial defects down to the subchondral bone: higher risk of progression
• Full thickness defect with exposed bone: Significantly limited sliding function; frequent entrapments
• Osteochondritis dissecans (OCD): Delimited area with possible fragment formation; In the event of instability, there is a risk of loose joint bodies

In practice, established classifications (e.g. ICRS) are often used to structure findings and plan therapy.

Conservative therapy: basis of treatment

Most cartilage damage in the elbow can initially be treated conservatively. The aim is to reduce pain, reduce inflammation, restore mobility and protect against progression.

• Load adjustment: Temporary reduction in painful activities; technical correction in sports
• Pain and inflammation management: Short-term anti-inflammatory medication (if tolerated), cooling, if necessary temporary bandage/orthosis
• Physiotherapy: joint mobilization, stretching of the flexor and extensor muscles, strengthening of the forearm and shoulder girdle muscles, coordination/proprioception
• Manual therapy and soft tissue-oriented techniques for capsule/muscle relaxation
• Everyday life and workplace: Ergonomic adjustments (mouse/keyboard, forearm rest), break and alternating load
• Return to sport: Gradual, with symptom-guided progression and documentation

Injection treatments may be considered if basic measures do not help sufficiently. The evidence is partly heterogeneous; an individual benefit-risk assessment is important.

• Hyaluronic acid (viscosupplementation): May improve lubrication and relieve pain; Proof of effectiveness for the elbow is smaller than for the knee/hip
• PRP (platelet-rich plasma): The aim is to modulate inflammatory processes; Study situation in the elbow is growing, but not uniformly
• Cortisone injection: short-term anti-inflammatory; cautious and targeted because of possible side effects and cartilage effects

We use regenerative procedures such as PRP selectively in our practice in Hamburg - after a clear diagnosis, exhaustion of conservative basic measures and with transparent information about possibilities and limits.

Surgical options: When does an intervention make sense?

Surgery is considered if symptoms persist despite consistent conservative therapy, if there are mechanical blockages or if there are pronounced, unstable defects (e.g. loose joint bodies, unstable OCD). The selection of the procedure depends on the size of the defect, location, age, activity and accompanying pathologies.

• Arthroscopic debridement/chondroplasty: smoothing of roughened areas, removal of unstable pieces of cartilage
• Removal of loose joint bodies and synovial treatment: Releases blockages, reduces irritation
• Microfracture/marrow stimulation: Stimulation of replacement cartilage (fibrocartilage) in circumscribed full-thickness defects
• Osteochondral cylinder transplantation (OATS/mosaicplasty): Cartilage-bone transfer for circumscribed defects, especially a. at the Capitulum
• OCD-specific: stabilization/fixation or drilling (retrograde/antegrade) depending on the stability and maturity of the focus
• Correction of accompanying factors: Treatment of instabilities or bony misalignments

All procedures have specific limitations and require consistent rehabilitation. Reliable “regrowth” of original hyaline cartilage cannot be guaranteed.

Rehabilitation and return to everyday life and sport

The follow-up treatment is based on the findings and the chosen therapy. The aim is to gradually increase the load, ensure joint mobility and muscular balance in the entire arm-shoulder complex.

Specific protocols apply after surgery (e.g. temporary offloading after marrow stimulation or OATS). The exact planning is done individually.

Course and prognosis

Smaller, stable cartilage damage can be easily controlled with conservative measures. Larger or unstable defects are more likely to cause persistent symptoms and can develop into elbow arthrosis in the long term. The course depends largely on stress control, accompanying factors (e.g. instability, inflammation) and adherence to therapy.

• Early diagnosis and targeted therapy improve symptom control
• Consistent adjustment of sports technique and everyday life reduces relapses
• Regenerative and surgical procedures can improve pain and function, but do not replace healthy original cartilage

Prevention and everyday tips

• Warm up and mobilize before sport and exercise
• Technical training in throwing, racket and support sports; Dose training volumes
• Regular breaks, changes in load and sufficient regeneration
• Ergonomic workplace: forearm rest, neutral wrist position, adapted mouse/keyboard
• Take pain seriously as a signal – reduce stress in a timely manner
• Whole body strengthening (shoulder blade control, trunk) to relieve pressure on the elbow

Common comorbidities and differential diagnoses

• Elbow osteoarthritis: Result of advanced cartilage damage
• Inflammatory arthritis (e.g. rheumatoid arthritis)
• Free joint bodies with blockages
• Joint instability after ligament injuries
• Tendon attachment irritation (epicondylitis), nerve constriction syndromes as differential diagnoses

Your orthopedics in Hamburg-Winterhude

We treat cartilage damage to the elbow with a clear focus on conservative orthopedics. To achieve this, we combine modern diagnostics with physiotherapy control, injection options for appropriate indications and realistic, everyday advice. If necessary, we coordinate operational partners and accompany you through rehabilitation. Our practice is located at Dorotheenstraße 48, 22301 Hamburg.

When should I seek medical advice?

• Severe or increasing pain despite rest
• Repeated entrapments/blockages or noticeable rubbing noises
• Persistent swelling or effusion
• Newly occurring restriction of movement
• Fever, redness and overheating of the joint
• Numbness, tingling or loss of strength in hand/fingers