Elbow osteoarthritis

Anatomy and development of elbow arthrosis

The elbow is made up of three sub-joints: the humeroulnar (upper arm – ulna), the humeroradial (upper arm – radius) and the proximal radioulnar joint (rotational movements). Articular surfaces are covered with hyaline cartilage and surrounded by a capsule and the synovial membrane.

With osteoarthritis, cartilage wear occurs, irritation of the joint lining (synovitis), capsule thickening and bone growth (osteophytes). On the elbow, osteophytes often form in the olecranon and coronoid fossa, which can lead to painful impact in the extended or flexed position (impingement). Abraded cartilage and bone fragments can lead to blockages as free joint bodies.

• Affected compartments: Humeroulnar, humeroradial, rarely radioulnar
• Typical signs of osteoarthritis: loss of cartilage, narrowing of the joint space, osteophytes, sclerosis
• Accompanying problems: capsular contracture, free joint bodies, irritation of the ulnar nerve (ulnar sulcus syndrome)

Symptoms: How to recognize elbow osteoarthritis

• Pain on exertion and movement, initially especially a. in end position (extension/flexion impingement)
• Feeling of stiffness, limited mobility (often stretch deficit)
• Crepitation (rubbing noise/feeling)
• Intermittent blockages caused by free joint bodies
• Sensation of swelling or warmth due to inflammatory irritation
• Tingling/numbness in the ring and little fingers with involvement of the ulnar nerve

The symptoms often develop gradually. Pain at rest, pain at night or inflammatory attacks may occur at times.

Causes and risk factors

Primary (age-related) elbow osteoarthritis is rare. Secondary osteoarthritis due to previous injuries or long-term overuse is more common. Inflammatory joint diseases can cause additional damage to the joint.

• Post-traumatic: previous fractures, dislocations, osteochondral injuries
• Occupational/athletic overload: heavy manual work, repeated terminal stretching/flexing loads, throwing sports
• Misalignment/instabilities of the elbow
• Pre-existing cartilage damage or osteochondrosis dissecans
• Metabolic and systemic diseases (e.g. gout), inflammatory arthritis

If an inflammatory cause or systemic disease is suspected, it is important to differentiate it from arthritis (see also: joint inflammation and rheumatoid arthritis of the elbow).

Diagnosis: This is how we proceed

Diagnosis is based on history, physical examination and imaging tests. What is crucial is the correlation between symptoms and findings – not every X-ray finding causes pain.

• Clinic: Range of motion (especially extension deficit), pain provocation in end positions, crepitation, stability test, test of the ulnar nerve (Tinel sign, sensitivity/motor function)
• X-ray in 2 planes (+ oblique): narrowing of the joint space, osteophytes (olecranon/coronoid spur), free joint bodies
• CT: precise representation of osteophytes and free joint bodies, surgical planning
• MRI: assessment of cartilage, bone edema, soft tissue (if the clinical picture is unclear)
• Ultrasound: effusion, synovitis, visualization of the ulnar nerve
• Laboratory: if inflammatory or crystal-induced arthropathy is suspected

Stages and course

In the early stages, the focus is on mechanical impingement complaints in the final position. Later, stiffness and impairment in everyday life increase; Free joint bodies can cause blockages. In individual cases, comorbidities such as narrowing of the ulnar nerve occur.

• Early: terminal pain, minor x-ray findings
• Means: clear osteophytes, restricted movement, irritation
• Advanced: pronounced loss of cartilage, pain at rest, significant loss of function

Conservative therapy: basis of treatment

Conservative measures are primary and aim to relieve pain, control inflammation and maintain mobility. The therapy plan is individually tailored to the findings, stress profile and goals.

• Education and activity adjustment: Reduce terminal, repetitive movements and heavy loads; Break and alternating load
• Medication: temporary NSAIDs/topical NSAIDs or paracetamol after medical consultation; Observe stomach protection and contraindications
• Physiotherapy: joint-friendly mobilization, capsular stretching, soft tissue techniques, strengthening of the forearm and shoulder girdle muscles
• Aids: short-term bandages/splints during periods of irritation; ergonomic adjustment at the workplace (mouse/keyboard, table height, forearm rest)
• Self-management: heat for stiffness, cold for inflammation, dosed self-exercises
• Weight management and general fitness (indirect effect via load control and muscle function)

Many patients benefit from a structured exercise program and consistent adjustments to everyday life. Too aggressive mobilization during pain peaks should be avoided.

Injections and regenerative procedures: When does it make sense?

Intra-articular injections can temporarily relieve symptoms, but do not replace basic therapy. The data for the elbow is limited; The benefits and risks are discussed individually in advance.

• Corticosteroid injections: may reduce pain/inflammation for a short term (weeks); do not use too often
• Hyaluronic acid: evidence on the elbow is inconsistent; can be discussed for selected indications
• PRP/biological processes: study situation heterogeneous; experimental/individual decision
• Technique: if possible, ultrasound targeted for accuracy; Strictly observe hygiene standards

Possible risks: infection, bleeding, nerve irritation, temporary increase in pain. A guaranteed effect cannot be guaranteed.

Physiotherapy and exercises: examples

• Gentle capsular stretching: place the forearm on the table, slowly extend/bend the elbow, and then hold it with minimal pain (3x30 seconds).
• Pronation/supination: Elbows on the body, rotating the forearm alternately inwards/outwards (3×15 repetitions)
• Strengthening the wrist/forearm: isometric holding exercises with low load (e.g. water bottle), pay attention to the pain threshold
• Shoulder blade stability: rowing strokes with mini band to relieve elbow movements
• Movement breaks: 5-10 minutes per hour when working at a computer screen, changing positions

Individual exercise dosage is coordinated with physiotherapy. Pain is a guiding signal: slight pulling is tolerable, stabbing pain is not.

Everyday life, work and sport

• Design the workplace ergonomically: forearm rests, neutral wrist position, adjusted table/chair height
• Improve lifting techniques: close to the load, use both arms, minimize rotational movements
• Suitable sports: walking, cycling, moderate swimming (adjust technique), Nordic walking
• Be careful with: repeated throwing, heavy dumbbell training, pull-ups - reduce dose/adjust technique
• Warm-up and follow-up: mobilize before exercise, relax/cool down afterwards

Surgical options: targeted and gentle

If conservative measures are inadequate and structural causes dominate (e.g. impingement due to osteophytes, loose joint bodies, capsular contracture), intervention can be considered. The choice of procedure depends on the findings, age, activity level and expectations.

• Arthroscopic/open joint cleaning (debridement): removal of osteophytes and free joint bodies, synovectomy, capsule solution to improve mobility
• Ulnar nerve relief: with accompanying nerve compression
• Interposition arthroplasty (rare): for younger patients with advanced osteoarthritis and high demands when joint replacement does not make sense
• Total elbow arthroplasty (TEA): v. a. with low loads and pronounced destruction; strict post-load limits, therefore rare in primary osteoarthritis

Every procedure has risks (e.g., infection, bleeding, nerve injury, stiffness, ongoing discomfort). Thorough explanation and realistic goal definition are a prerequisite.

Follow-up care and prognosis

After conservative or surgical treatment, structured follow-up care and physiotherapy are crucial. Shortly after arthroscopic debridement, rapid functional recovery is often possible; However, the time course depends on the initial findings and the individual stress.

• Early, painless mobilization to avoid capsular stiffness
• Inflammation control (cooling/elevation in the first few days, medication according to plan)
• Progressive strengthening and everyday integration
• Stress control: gradual return to work and sport

Osteoarthritis itself cannot be cured; However, symptoms can often be significantly reduced. The aim is to achieve a range of motion that is suitable for everyday use and is as painless as possible.

Differential diagnoses: What else is possible?

• Inflammatory arthritis (e.g. rheumatoid arthritis of the elbow)
• Crystal arthropathies (gout/chondrocalcinosis)
• Epicondylopathies (tennis/golfer's elbow)
• Osteochondral lesions (e.g. cartilage damage, osteochondrosis dissecans)
• Free joint bodies without advanced osteoarthritis
• Joint instability after ligament injuries
• Olecranon bursitis
• Ulnar groove syndrome

The exact classification is important because therapy and prognosis differ significantly.

Prevention and self-help

• Consistent rehabilitation after elbow injuries
• Technical training for stressful activities and sports
• Muscular balance of forearm and shoulder girdle
• Regular breaks during repetitive movements
• Early clarification of persistent complaints

When should you see a doctor?

• Persistent pain or increasing limitation of movement over several weeks
• Repeated joint locks
• Neurological symptoms (numbness, loss of strength in hand/fingers)
• Redness, overheating, fever or severe pain at rest
• Acute symptoms after injury

Your orthopedic contact point in Hamburg

Our practice is located at Dorotheenstraße 48, 22301 Hamburg. We take the time for a careful examination, explain the findings in an understandable way and plan a realistic, step-by-step therapy with you - conservative first, surgical only if there is a clear indication.