Physical Therapy in Venice for Osteoarthritis

Welcome to FYZICAL Venice's patient resource about Osteoarthritis.

The elbow joint is injured less often than many other joints in the body. The most common injuries of the elbow joint are fractures and dislocations. Most elbow injuries tend to heal pretty well.

However, an elbow injury can lead to problems later in life. The injury changes the way the joint works just enough to cause extra wear and tear to the surfaces of the joint. Over time, the joint degenerates, causing pain and difficulty with daily activities. This condition is called osteoarthritis, degenerative arthritis, or posttraumatic arthritis.

This guide will help you understand:

• how elbow osteorarthritis develops
• how elbow osteoarthritis is diagnosed
• what can be done to ease the pain and regain elbow movement

What parts of the elbow are affected?

The elbow joint is made up of three bones: the humerus bone of the upper arm, and the ulna and radius bones of the forearm.

Three Bones in Elbow Joint

The ulna and the humerus meet at the elbow and form a hinge. This hinge allows the arm to straighten and bend. The large triceps muscle in the back of the arm attaches to the point of the ulna (the olecranon). When the triceps muscle contracts, it straightens out the elbow. The biceps muscles in the front of the arm contract to bend the elbow.

View animation of hinge movement:

The connection of the radius to the humerus and the ulna allows the forearm to rotate. The upper end of the radius is round. It turns against the ulna and the humerus as the forearm and hand turn from palm down (pronation) to palm up (supination).

View animation of elbow pronation/supination:

In the elbow joint, the ends of the bones are covered with articular cartilage. Articular cartilage is a slick, smooth material. It protects the bone ends from friction when they rub together as the elbow moves. Articular cartilage is soft enough to act as a shock absorber. It is also tough enough to last a lifetime, if it is not injured.

Related Document: FYZICAL Venice's Guide to Elbow Anatomy

What causes osteoarthritis?

Osteoarthritis is caused by degeneration of the articular cartilage of a joint. Degeneration is wear that happens over time. Doctors use the term degenerative arthritis to describe the wear and tear of a joint over many years. Degenerative arthritis is another term for osteoarthritis.

Degeneration

View animation of degeneration:

Some doctors use the term degenerative arthrosis. (Arthrosis just means that the joint is wearing out.) Arthritis is technically a condition of joint inflammation. Often, joints with osteoarthritis aren't inflamed. The term arthritis should really only be used to describe true inflammatory conditions, such as gout, infection, and rheumatoid arthritis.

A bad sprain or fracture can actually damage the articular cartilage. The cartilage can also be bruised when too much pressure is put on the cartilage surface. Osteoarthritis (OA) may be idiopathic, meaning there isn't a known reason for the condition. But most of the time, elbow osteoarthritis is linked with excess use of the arm.

The cartilage surface may not look any different. The injury often doesn't show up until months later. Sometimes the damage to the cartilage is severe. Pieces of the cartilage can actually be ripped away from the bone. These pieces do not grow back. Usually they must be surgically removed. If the pieces aren't removed, they may float around in the joint, causing it to catch. These pieces are referred to as loose bodies. They can also cause a lot of pain and do more damage to the joint surfaces.

Your body does not do a good job of repairing these holes in the cartilage surface. The holes fill up with scar tissue. Scar tissue is not as slick or rubbery as the articular cartilage.

An injury doesn't have to damage the cartilage to start the process of osteoarthritis. Any injury to the elbow joint can change the way the joint works. For example, after an elbow fracture the bone fragments may not line up exactly. They heal slightly differently from their condition before the injury. Even this slight difference can cause the joint to begin the cycle of wear and tear.

A dislocation can also cause lasting damage. After the ligaments have been injured in a dislocation, the elbow joint may move differently. This change in movement alters the forces on the articular cartilage. It's just like a machine, if the mechanism is out of balance, it wears out faster.

Over many years, this imbalance in joint mechanics can damage the articular cartilage. Since articular cartilage cannot heal itself very well, the damage adds up. Finally, the joint can no longer compensate for the damage, and the elbow begins to hurt.

Osteoarthritis of the elbow isn't like OA of the hip or knee. Most of the time, the articular cartilage isn't damaged. The joint space remains close to normal. The biggest changes are hypertrophic osteophyte (bone spur) formation and capsular contracture.

Capsular contracture refers to the process by which the capsule dries out and tightens up. The capsule has two layers: a fibrous covering that surrounds the joint and an inner lining. The inner layer is called the synovium. The synovial layer holds the lubricating fluid inside the joint.

What symptoms does osteoarthritis cause?

Pain and stiffness are the main symptoms of osteoarthritis of any joint. At first, the pain comes only with activity. Most of the time the pain lessens while doing the activity, but after resting for several minutes pain and stiffness increase. As the condition worsens, you may feel pain even when resting. The pain may interfere with sleep.

You may have swelling around your elbow. Your elbow joint may fill with fluid and feel tight, especially after using it. When all the articular cartilage is worn off the joint surface, you may begin hearing a squeak and feel a creak in the joint when you move your elbow. This creaking sensation is called crepitus.

Osteoarthritis eventually affects the elbow's motion. The elbow joint is one of the most sensitive to injury. It quickly becomes stiff and loses motion. The first thing most people notice is that it becomes hard to completely straighten the arm. Later they find it hard to bend.

Loss of motion leads to weakness and decreased function. Carrying heavy objects at the side of the body with the elbow straight is especially difficult.

How will my health care provider know if I have osteoarthritis?

The diagnosis of osteoarthritis of the elbow begins with a medical history of the problem. When you first visit FYZICAL Venice, our Physical Therapist will ask questions about your pain, how it affects your daily activities, and any past injuries to your elbow. Because osteoarthritis develops over a long time, you may be asked questions about things you did long ago.

For example, throwing athletes (such as baseball pitchers) have a higher risk of developing osteoarthritis of the elbow later in life. Men with a history of heavy use of the arm are also at risk. This includes manual laborers and weight lifters.

Our Physical Therapist will also do a physical examination of the elbow and possibly other joints in the body. The moving and prodding may hurt, but it is important that we see exactly where and when you feel pain. Our Physical Therapist will feel for catching sensations as the joint moves. Catching may be caused by loose fragments of cartilage and bone. (These fragments are sometimes called joint mice.)

Some patients may be referred to a doctor for further diagnosis. Once your diagnostic examination is complete, the Physical Therapists at FYZICAL Venice have treatment options that will help speed your recovery, so that you can more quickly return to your active lifestyle.

FYZICAL Venice provides Physical Therapist services in Venice.

Non-surgical Rehabilitation

In almost all cases, it is preferable to try nonsurgical treatments first. Surgery is usually not considered until it has become impossible to control your symptoms.

At FYZICAL Venice, the goal of nonsurgical treatment of osteoarthritis is to help you manage your pain and use your elbow without causing more harm. Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, to help control swelling and pain. We may use other treatments, such as heat, to help control your pain.

The Physical Therapy and occupational therapy programs at FYZICAL Venice have a critical role in your treatment plan for elbow osteoarthritis. Our services can help you learn how to control symptoms and maximize the health of your elbow. Our Physical Therapist can show you ways to calm your pain and symptoms. We may instruct you to use rest, heat, or topical rubs.

You may be issued a special elbow splint to immobilize and protect the elbow. Resting the joint can help ease pain and inflammation. Our Physical Therapist may then begin range-of-motion and stretching exercises to improve your elbow flexibility. Strengthening exercises for the arm help steady the elbow and protect the joint from shock and stress. Our therapist will give you tips on how to get your tasks done with less strain on the joint.

To get rid of your pain, you may also need to modify or limit your activities. You may even need to change jobs, if your work requires heavy, repetitive motions with the hand and wrist.

Although the amount of time required for recovery is different for each patient, as a guideline, you will probably progress to a home program within four to six weeks. When recovery is well under way, your regular visits to FYZICAL Venice will end. Although we will continue to be a resource, you will eventually be in charge of doing your exercises as part of an ongoing home program.

Post-surgical Rehabilitation

After surgery, your elbow will be bandaged with a well-padded dressing and an elbow splint for support. At FYZICAL Venice, you can expect to participate in physical or occupational post-surgical Physical Therapy sessions for up to three months. Our first few treatment sessions will focus on controlling the pain and swelling from surgery. We will then instruct you in exercises that help strengthen and stabilize the muscles around the elbow joint. Our Physical Therapist will also give you tips on ways to do your activities without straining your elbow.

FYZICAL Venice provides Physical Therapy services in *client_area*.