Elbow Pain (cont.)

Arthritis of the elbow

Inflammation of the elbow joint (arthritis) can occur as a result of many systemic forms of arthritis, including rheumatoid arthritis, osteoarthritis, gouty arthritis, psoriatic arthritis, ankylosing spondylitis, and reactive arthritis (formerly called Reiter's disease). Generally, they are associated with signs of inflammation of the elbow joint, including heat, warmth, swelling, pain, tenderness, and decreased range of motion. Range of motion of the elbow is decreased with arthritis of the elbow because the swollen joint impedes the range of motion.

Cellulitis

Inflammation of the skin related to infection (cellulitis) commonly occurs as a result of abrasions of the skin. When abrasions or puncture wounds occur, bacteria on the surface of the skin can invade the deeper layers of the skin. This causes inflamed skin characterized by redness, warmth, and swelling. The most common bacteria that cause cellulitis include Staphylococcus and Streptococcus. Patients can have an associated low-grade fever. Cellulitis generally requires antibiotic treatment, either orally or intravenously. Heat application can help in the healing process. Cellulitis can lead to infection of the olecranon bursa, causing olecranon bursitis, as described above.

Infected elbow joint (septic arthritis)

Infection of the elbow joint with bacteria (septic arthritis) is uncommon. It is most often seen in patients with suppressed immune systems or diabetes, those taking cortisone medications, or intravenous drug abusers. The most common bacteria that cause infection of the elbow joint are Staphylococcus and Streptococcus. Septic arthritis of the elbow requires antibiotic treatment and often surgical drainage. It is characterized by heat, swelling, redness, and pain, with limited range of motion of the elbow joint. Septic arthritis is often associated with fever, sweats, and chills.

Osteochondritis dissecans

Osteochondritis dissecans is an uncommon disease of cartilage in the joint whereby the cartilage effectively flakes away from the bone. This can lead to locking, pain, and loss of range of motion of the elbow. Osteochondritis dissecans is diagnosed by MRI scan or contrast CT scan imaging of the involved elbow joint. This is generally treated by arthroscopic surgical repair and removal of the diseased cartilage.

Tumors

Bone tumors of the elbow joint are rare. Primary bone cancer can occur. It can be painless or associated with pain in the elbow joint. It is usually detectable by X-ray testing. Nuclear medicine bone scanning can also be helpful for detection.

Ulnar nerve entrapment

The ulnar nerve is the "funny bone" nerve which travels between the tip of the elbow and the inner elbow bone. At this site it can be "pinched" by normal structures or swollen structures after injury. This pinching is referred to as entrapment. When ulnar nerve entrapment occurs, numbness and tingling of the little and ring finger of the hand may be felt. Pain may occur in the entire forearm, usually the inner side. Hand dexterity can be affected. Sometimes, the numbness is reproduced by elevating the hand. Treatment consists of avoiding repeated trauma or pressure to the elbow area and resting the elbow joint. Occasionally, ice can help. In severe cases, surgical repositioning of the ulnar nerve can be required. This relocates the ulnar nerve to a position where it will not be continually compressed by the surrounding structures.

REFERENCES:

Koopman, William, et al., eds. Clinical Primer of Rheumatology. Philadelphia: Lippincott Williams & Wilkins, 2003.

Ruddy, Shaun, et al., eds. Kelley's Textbook of Rheumatology. Philadelphia: W.B. Saunders Co., 2000.

Last Editorial Review: 2/25/2011