When your elbow plays up
How arthroscopic surgery can restore mobility
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Typical symptoms of osteoarthritis of the elbow
The most common symptoms include elbow pain and a feeling of the joint seizing up during certain movements. Patients often also experience limited ability to extend or flex the elbow. As the condition progresses, the joint may become increasingly stiff.
Pain, stiffness and increasing restricted movement in the elbow can be early signs of osteoarthritis and significantly impair everyday life. Although osteoarthritis of the elbow is less common than wear and tear in the hip or knee, unlike in weight-bearing joints, the condition often remains asymptomatic for a long time. This is why osteoarthritis of the elbow is often only diagnosed at a later stage. Modern arthroscopic techniques now often allow for minimally invasive treatment. In this interview, Elie Hassoun, senior consultant in shoulder, elbow and knee surgery and traumatology, as well as head of the elbow surgery and reconstructive ligament and cartilage surgery department, explains how those affected can recognise the condition and how joint mobility can be preserved.
Mr Hassoun, what is elbow osteoarthritis?
Elie Hassoun: Osteoarthritis involve the wear and tear of the joint cartilage. This cartilage normally covers the joint surfaces and ensures that we can move our joints with minimal friction. In the elbow, this wear and tear is often caused not only by ageing, but also as a result of previous injuries. These include, for example, fractures or dislocations of the joint. If the cartilage is damaged or partially lost, the bone surfaces rub against each other more intensely. In this case, bony spurs form, as do cysts and loose bodies. This leads to pain, inflammatory reactions in the joint and, frequently, restricted movement.
How do patients know that something is wrong with their elbow?
Elie Hassoun: The symptoms often begin with pain in the elbow, particularly when under strain or during certain movements. Those affected frequently report a sensation of the joint ‘locking up’. This gives the feeling that the elbow suddenly ‘gets stuck’ during a movement. Over time, mobility often diminishes as well. In particular, fully extending or bending the arm becomes difficult. Many patients first notice this during everyday activities, for example when they can no longer fully extend their arm or certain movements become more difficult in daily life. In advanced cases, the joint may even become partially stiff..
What causes do you see most frequently in practice?
Elie Hassoun: Elbow osteoarthritis is very often a long-term consequence of an accident. Many patients had an injury years earlier, sometimes as far back as childhood. However, the signs of wear and tear often appear much later. Chronic strain or repetitive microtrauma resulting from continuous overuse can also play a role. This includes sports that place heavy demands on the elbow or physically demanding work.
Why is an early diagnosis so important?
Elie Hassoun: The earlier we detect elbow osteoarthritis, the better we can preserve the joint. In the early stages, conservative measures such as physiotherapy can initially help to improve mobility and relieve pressure on the joint. If troublesome bony mechanical obstructions have already formed in the joint, we can often remove them using minimally invasive techniques.
When is arthroscopic surgery an option?
Elie Hassoun: Surgery is advisable if conservative treatments are no longer sufficient and symptoms continue to worsen. During arthroscopy, we insert a small camera into the joint via incisions measuring just a few millimetres.
During the procedure, we remove structures that cause pain or restrict movement. These include loose bodies, bone spurs or scar tissue. In some cases, the joint capsule is also partially loosened so that the joint can move more freely again.
Arthroscopy explained briefly
Arthroscopy, also known as joint endoscopy, involves performing surgery on the joint using a minimally invasive technique. A camera and fine instruments are inserted through small incisions in the skin. This allows changes within the joint to be treated in a targeted manner, without the need for large incisions.
Elbow arthroscopy is considered a challenging procedure. Why?
Elie Hassoun: The elbow joint is very small, and at the same time, important nerves and blood vessels run in the immediate vicinity of the surgical site. This means the procedure requires a great deal of experience and precise surgical technique. Particularly in cases of osteoarthritis, the joint is often further altered by scar tissue and consequently even narrower. That is why the surgeon’s experience plays a crucial role in achieving a good outcome.
How important is post-operative care following surgery?
Elie Hassoun: Post-operative care is a crucial part of the treatment. Shortly after the procedure, physiotherapists begin with the first mobility exercises. Even after that, patients must continue to exercise regularly. Only through consistent exercise and physiotherapy can the newly regained mobility be maintained and further improved.
What results can those affected expect?
Elie Hassoun: Osteoarthritis cannot be completely reversed, as damaged cartilage does not regrow. Nevertheless, arthroscopic treatment can significantly reduce symptoms. Many patients benefit from less pain and significantly improved mobility in everyday life. In many cases, the progression of osteoarthritis can also be slowed down, thereby postponing the need for joint replacement.
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