Elbow Arthritis

Anatomy

  • Positions the hand in space
  • Acts as the forearm lever
  • Weight bearing joint when using walking aids
  • Three articulations, ulnohumeral, radiocapitellar and proximal radioulnar
  • Carrying angle is valgus in extension
  • Functional range 30 to 130 degrees flexion, 50 pronation and 50 supination (Morrey)
  • Ulnohumeral joint highly congruent, stabilised by anterior bundle of MCL and LUCL

Aetiology

  • Primary OA mainly in men with heavy manual work or weightlifting
  • Inflammatory arthritis, mostly RA, also psoriatic arthritis and gout
  • Post traumatic after intra articular fracture or instability
  • Haemophilia, septic and neuropathic arthritis

Pathology

  • Primary OA forms osteophytes on coronoid, olecranon and their fossae
  • Joint space preserved until late in primary OA
  • Loose bodies common in primary OA
  • RA causes synovitis, concentric joint space loss, bone erosion and instability

Classification

Mayo (rheumatoid elbow)

GradeDescription
ISynovitis with normal radiographs
IIJoint space narrowing with preserved architecture
IIIAltered architecture
IVGross destruction

Clinical Features

  • Primary OA gives end range pain from impingement, mid arc pain free
  • RA gives pain through the arc with swelling and instability
  • Locking from loose bodies
  • Ulnar nerve symptoms common, examine the cubital tunnel

Investigations

Elbow Arthritis, lateral radiograph of elbow osteoarthritis
Lateral radiograph of elbow osteoarthritis. Image by Jmarchn, Wikimedia Commons, CC BY-SA 3.0.
  • AP and lateral radiographs
  • CT with 3D reconstruction maps osteophytes and loose bodies

Management

  • Activity modification, analgesia, NSAIDs and steroid injection
  • Arthroscopic debridement for primary OA with impingement
  • Open ulnohumeral arthroplasty (Outerbridge Kashiwagi) for primary OA
  • Lateral column procedure for stiffness
  • Ulnar nerve decompression or transposition with ulnar symptoms or marked flexion loss
  • Synovectomy with or without radial head excision in early RA
  • Interposition arthroplasty in young active patients
  • Linked semiconstrained TEA (Coonrad Morrey) for RA and older low demand patients
  • Lifting limit after TEA about 5 kg single and 1 kg repetitive
  • Arthrodesis as salvage

Complications

  • TEA infection, aseptic loosening and polyethylene wear
  • Ulnar neuropathy, triceps insufficiency and periprosthetic fracture

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.