THE CLINICAL SYNDROME

• In clinical practice, patients frequently present with complaints of elbow pain that are traced to degenerative arthritis.

• Pain in the elbow joint is most often caused by osteoarthritis, which is the most common form of arthritis.

• The fact that tendinitis and bursitis can coexist with arthritis pain makes it more challenging to accurately diagnose the condition.

• The olecranon bursa can become inflamed as a result of direct trauma to the elbow joint or from overuse of the joint.

• This bursa is located in the posterior aspect of the elbow joint.

• Bursae that are prone to developing bursitis can also be found in the antecubital and cubital regions of the body, in addition to the area between the insertion of the biceps tendon and the head of the radius.

• Patients who suffer from arthritis of the elbow joint frequently experience a gradual reduction in functional ability.

• This is due to a decreasing elbow range of motion, which makes it difficult to perform simple day-to-day tasks such as using a computer keyboard, holding a coffee cup, or turning a doorknob.

• Patients with arthritis of the shoulder joint often experience a gradual reduction in functional ability.

• Muscle atrophy and the development of adhesive capsulitis, which can lead to ankylosis, are both potential outcomes of prolonged inactivity.

SIGNS AND SYMPTOMS

• The majority of patients who suffer from elbow pain as a result of osteoarthritis or posttraumatic arthritis describe the pain as being localized around the elbow and the forearm.

• The pain is made significantly worse by activity, whereas resting and applying heat offers some relief.

• The pain is consistent and has been described as an aching sensation; it may prevent one from sleeping.

• In addition, certain patients will describe a grating or popping sensation whenever they use the joint, and crepitus may be palpable during a physical examination of the area.

TESTING

• Radiographs in a plain format should be taken of every patient who comes in complaining of elbow pain.

• The clinical presentation of the patient may indicate the need for additional testing, which may include an evaluation of the erythrocyte sedimentation rate, a complete blood count, and testing for antinuclear antibodies.

• It's possible that computerized tomography can help identify any abnormalities in the bones.

• Imaging of the elbow with magnetic resonance and/or ultrasound is recommended whenever there is a possibility of joint instability, nerve entrapment, tumor, or any other soft tissue abnormality.

DIFFERENTIAL DIAGNOSIS

• Common conditions that can cause pain in the elbow include rheumatoid arthritis, posttraumatic arthritis, and psoriatic arthritis.

• Diseases of the collagen vascular system, infections, and Lyme disease are some of the less common causes of arthritis-induced elbow pain.

• Acute infectious arthritis is typically accompanied by significant systemic symptoms such as fever and malaise, and it should be easy to recognize.

• The treatment for acute infectious arthritis consists of culture and antibiotics rather than injection therapy.

• In most cases, collagen vascular diseases present themselves as polyarthropathy rather than as monarthropathy that is confined to the elbow joint.

• Nevertheless, the intraarticular injection technique that will be described in the following section is extremely effective in treating elbow pain that is caused by collagen vascular diseases.

TREATMENT

• The initial treatment for the pain and functional disability associated with arthritis of the elbow consists of a combination of nonsteroidal antiinflammatory drugs (NSAIDs) or cyclooxygenase-2 (COX-2) inhibitors and physical therapy.

• NSAIDs and COX-2 inhibitors are two types of cyclooxygenase-2 (COX-2) inhibitors.

• The application of heat and cold to specific areas of the body may also be beneficial.

• Patients who do not respond to these treatment modalities may benefit from an intraarticular injection of a local anesthetic and steroid as the next logical step in the treatment process.

COMPLICATIONS AND PITFALLS

• If the clinically relevant anatomy is carefully considered before administering the injection, this method does not pose a safety risk.

• In order to prevent infection, sterile technique must be utilized, and universal precautions must be taken in order to lessen the likelihood that the operator will be put in harm's way.

• Infection is the most significant risk associated with intraarticular injections into the elbow joint; however, if proper aseptic procedure is followed, the risk of infection should be extremely low.

• When administering an intraarticular injection, extreme caution must be exercised to avoid causing injury to the ulnar nerve, which is particularly vulnerable to trauma at the elbow.

• Imaging with ultrasound could be of assistance in avoiding this complication.

• After receiving an intraarticular injection in the elbow joint, approximately one quarter of patients experience a temporary increase in the level of pain they are experiencing.

• Patients should be made aware of the possibility that this will occur.