Elbow

The elbow joint is made up of three bones: the humerus bone (upper-arm bone), the ulna (forearm bone on the little finger side), and the radius bone (forearm bone on the thumb side) which provide two types of motion.

The ulna and the humerus meet at the elbow and form a hinge which allows the arm to bend and straighten. The humerus and the radius provide rotational motion. The tricep muscle in the back of the arm attaches to the ulna. When the muscle contracts it straightens the elbow. When the bicep muscle in the front of the arm contracts it bends the elbow.

The radial head of the elbow works with other bones, ligaments, and tendons to provide stable articulation and movement of the elbow

The joint surfaces are covered with a tough lubricating tissue called cartilage. Cartilage acts like a natural shock absorber, preventing both bone on bone contact and providing a smooth, pain-free surface for the bones to glide against.

Elbow pain is sometimes due to arthritis, but in general, most elbow pain results from overuse injuries. Sports or any activities and professions that require repetitive hand, wrist or arm movements are more prone to elbow injury. Common causes of elbow pain are bursitis, elbow strains, and arthritis.

Topics below cover two common areas of elbow problems.

  • Arthritis
  • Injuries
Arthritic Elbow

Arthritis is a term that is used to describe over 100 different conditions that can affect the human body. There are millions of Americans who are affected by arthritis each year. Arthritis can cause pain, stiffness, swelling, and loss of motion in affected joints.

The two most common forms of arthritis that generally affects the elbow are osteoarthritis and rheumatoid arthritis.

Osteoarthritis, the most common form of arthritis, results in the wearing out of the cartilage that protects the bones in the joints. Once cartilage is damaged or destroyed, cartilage cannot repair or replace itself like many other body tissues. Elbow cartilage can be compared to the tread of an automobile tire, very durable but susceptible to wear over time. As we age, the tread surface slowly erodes until the underlying bone is exposed. This exposed bone can be painful when the joint moves and bears weight.

Often the cause of arthritis is unknown, but may develop as a result of injury to the joint, excess body weight, or years of wear and tear on the joint cartilage. There is no known cure. The best that doctors can do for patients is to restore motion and reduce pain.

Common symptoms of osteoarthritis of the elbow

  • Severe elbow pain that limits everyday activity
  • Loss of range of motion
  • Chronic swelling of the elbow with morning stiffness
  • Numbness in ring finger and small finger

Rheumatoid arthritis is a systemic inflammatory condition of the joint lining, where the body’s immunological system attacks healthy tissue, causing inflammation of the joint lining and subsequent joint damage. When rheumatoid arthritis is present, the cartilage is not being provided with enough lubrication and nourishment. This leads to loss of motion and pain in the elbow.

Elbow Injuries

There are many different types of elbow injuries; however, there are a few that are more common than others. Common types of elbow injuries include golfer’s elbow, tennis elbow, and bursitis. These conditions can cause elbow pain, swelling, and stiffness.

Golfer’s elbow, also called medial epicondylitis, is pain and inflammation on the inner side of your elbow, where the tendons of your forearm muscles attach to the bony bump on the inside of your elbow. It’s not limited to golfers. Tennis players and others who repeatedly use their wrists or clench their fingers also can develop golfer’s elbow.

Symptoms include pain on the inside of the elbow, stiffness, weakness in your hands and wrists, numbness and tingling that may radiate into one or more fingers. Activities that use the flexor muscles in a bending motion or grasping with the hand can make symptoms worse.

Tennis elbow (lateral epicondylitis) is a very common cause of elbow pain. It is an injury that occurs from repeated use of the muscles of the arm and forearm, leading to small tears of the tendons. The pain of tennis elbow occurs primarily where the tendons of your forearm muscles attach to the bony prominence on the outside of your elbow.

Symptoms include pain on the outside of the elbow, pain when you extend your wrist, lifting or grasping objects may be difficult, and sometimes pain will radiate down the arm.

Bursitis is a painful inflammation in your body’s joints usually caused by overuse or repetitive stress on your elbow. There are more than 150 bursae (small, fluid-filled sacs) in your body that lubricate and cushion pressure points between your bones and the tendons and muscles near your joints. When inflammation of the bursa occurs (bursitis), movement or pressure becomes painful.

Symptoms include a dull ache or stiffness, swollen or warm to the touch, redness in the area of the inflamed bursa, and an increase of pain with movement or pressure.

Your surgeon will evaluate your health history, perform a physical examination, and take x-rays to diagnose your elbow pain.

  • Medical history
  • Symptoms
  • Health
  • Activity
  • Exam affected joint
  • Range of motion tests
  • Joint-line tenderness
  • Joint deformities
  • X-rays

An x-ray will help your surgeon diagnose your elbow pain. On an x-ray, a healthy elbow joint appears as if there is a space between the bones in the joint. Although you cannot see the cartilage on an x-ray, in the healthy elbow, the cartilage is working to cushion and smooth the movement of the humerus (upper arm bone) against the ulna (forearm bone on the little finger side), and the radius (forearm bone on the thumb side). On the x-ray of an elbow with osteoarthritis, there is bone on bone contact because the cartilage between the humerus and the ulna (forearm bone on the little finger side), and the radius (forearm bone on the thumb side) has been worn away.

When non-surgical treatments such as diet, exercise, medications, supplements, and physical therapy fail, your orthopedic surgeon may recommend total elbow replacement.

You should discuss your condition and treatment options with your surgeon.

The treatment options covered here relate to osteoarthritis, although many of them may be helpful for patients with other arthritic conditions. Please ask your physician before starting any treatment.

  • Exercise
  • Physical Therapy
  • Modify Your Activities
  • Weight Control
  • Self-Help/Assistive Devices
  • Heat and Cold Treatments
  • Nutritional Supplements
  • Over-The-Counter Medications
  • Injections

Exercise

Moderate doctor-prescribed exercise is an integral part of treating arthritis. Joints that are not regularly exercised can become tight and painful. Activities such as walking, swimming or gardening can assist in keeping your bones strong and your joints limber, which may help relieve stiffness. Low-impact exercise will not wear out your joints. Although exercise may sometimes cause discomfort, proper exercise will help nourish the cartilage, strengthen the muscles, and prolong the life of your joints.

Aquatic Therapy

Aquatic therapy is an excellent form of exercise to help manage arthritis pain. Water’s buoyancy helps protect your joints from impact injury. Water also resists movement, which is helpful for strengthening.

Walking

Walking is an excellent form of endurance exercise for almost anyone, including those with arthritis. Be sure to have a good pair of walking shoes to help cushion impact. Check with your physician to obtain any exercise precautions or guidelines. You should be able to speak clearly without feeling out of breath when you are walking. Always warm up and cool down by walking slowly.

Biking

Either regular biking or stationary biking is an excellent endurance exercise. However, patients with kneecap problems may aggravate their condition with biking. Be careful not to increase the resistance or ride up and down hills too quickly. As with any endurance exercise, you should be able to carry on a conversation while you are engaged in the activity.

How much exercise is too much?

If you note increased joint swelling, decreased joint motion, unusual or persistent fatigue or continuous pain, you may be exercising too much. You should expect some muscle soreness, especially if you are just beginning an exercise program or have changed exercises. Joint pain should not last more than several hours after exercise.

For an in-depth guide on starting and maintaining a walking program, reference Walk With Ease by the Arthritis Foundation.

How do I stay consistent with exercise?
  • Seek help from a health care professional to assist you in setting up an individualized program.
  • Make a plan! Write it down! Set goals!
  • Exercise at the same time each day so it becomes part of your routine.
  • Find an exercise buddy.
  • Look for an appropriate exercise class.
  • Stay in the habit of doing some exercise each day.
  • Vary your exercise routine and rotate your exercises.
  • Evaluate your progress and enjoy your success.

Physical Therapy

Physical therapy is a very important role in the recovery process. A physical therapist may demonstrate a variety of low-impact exercises designed to increase the strength and mobility of your elbow joint. However, you should only perform the exercises that are ordered by your surgeon.

Modify Your Activities

Proper body mechanics can lead to less strain on your joints. The following activity modification guidelines may be helpful:

  • Practice good posture by standing up straight.
  • Avoid stooping while standing.
  • Avoid impact-loading activities.
  • Avoid any activity that causes prolonged discomfort.

Weight Control

Being overweight puts weight-bearing joints under extra pressure and stress. Extra pressure on your joints can make arthritic symptoms worse, leading to pain and stiffness.

A well-balanced diet coupled with regular doctor prescribed low-impact exercise can help reduce excess body weight, decrease pressure on the joints and increase joint strength. Many claims have been made concerning diet as a cause of arthritis but none have been proven to date. Maintaining your ideal body weight will help keep your joints healthy. If you are overweight, ask your doctor to advise you on a weight-loss program to fit your needs.

Self-Help/Assistive Devices

Simple everyday tasks may be hard to accomplish with joint pain. The self-help devices listed below can help minimize pain, discomfort, stress, and can assist you in accomplishing tasks. Ask your physician or physical therapist about these self-help devices:

  • Elbow sling for rest
  • Jar openers
  • Button threaders
  • Large grips for pencils, garden tools or other hand-held objects
  • Abdominal supports to reduce stress on the back
  • Long-handled reachers or grabbers to help you pick things up without bending

Heat and Cold Treatments

Heat or cold treatments may be used to decrease pain and increase flexibility. Heat or cold treatments may be combined with the exercises prescribed by your physical therapist.

HeatCold
Use prior to activity
Increases blood flow
Improves motion
Decreases joint ache
Helps relax muscles
Use after exercise
Decreases blood flow
Decreases swelling
Better for pain
Reduces inflammation

You may want to purchase a gel pack that can be kept cold in your freezer or heated in a microwave.

Nutritional Supplements

Recently, nutritional supplements have become popular with arthritis patients. Glucosamine and Chondroitin have been the most widely used. Consult your physician before beginning treatment.

Glucosamine

Glucosamine is a building block of cartilage and may be found as a hydrochloride or sulfate. It may be useful in strengthening and repairing cartilage. Studies have shown it to be effective in reducing pain, especially painful arthritis of the hands. Glucosamine is not a cure and has not been shown to rebuild cartilage.

Chondroitin Sulfate

Chondroitin Sulfate is commonly taken in conjunction with Glucosamine. It is found in cartilage and acts somewhat like a sponge for the fluid found in cartilage, which makes the cartilage more elastic and spongy. Chondroitin may help prevent the breakdown of cartilage as well.

Vitamins C and D

Some studies have indicated that patients low in Vitamins C and D may have a higher incidence of arthritis. Arthritis patients should take vitamins regularly, or as prescribed by a medical professional.

Calcium

Some people confuse osteoporosis with osteoarthritis. Osteoporosis is a thinning of the bone, not the joint. High amounts of Calcium is not the cause of osteoporosis but calcium may accumulate in bone spurs around arthritic joints in response to increased pressure on the joint.

Talk to your physician before taking any medications.

Over-The-Counter Medications

Many medications are available to help treat arthritis and can function as a pain-reliever and as an anti-inflammatory to help relieve joint swelling and pain. These medications can lead to improvement in everyday function and quality of life. Always consult your physician before beginning treatment.

Tylenol®

The non-narcotic analgesic Tylenol® is generally effective in relieving minor pain and discomfort. The Academy of Rheumatology has suggested this as the first-line arthritis treatment. Tylenol®, however, does not reduce the inflammation caused by arthritis. Ask your physician about dosing and safety.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs) can be purchased over-the-counter with some common forms being Aspirin, Motrin®, Advil®, and Aleve®. NSAIDs are usually indicated for mild to moderate arthritis pain and may be effective where Tylenol® is not. They are very effective in reducing inflammation caused by arthritis. However, they can also increase your chance for gastric (stomach) ulcers and can alter your blood by affecting your platelets. Therefore, patients with stomach problems, bleeding problems or on blood thinners should not take these medications. Always check with your physician before starting NSAIDs.

Patients with chronic pain may need to take medication daily. However, many may only need to take it when necessary or when they anticipate a strenuous activity that is likely to lead to pain. This may not be true for patients with inflammatory forms of arthritis such as rheumatoid arthritis or lupus.

Topical Creams

Many topical creams on the market can reduce pain from arthritis. The American College of Rheumatology does recommend Capsaicin as part of a treatment plan. Capsaicin is thought to help block the release of the body’s painkillers while also blocking a chemical that transmits pain signals. Check with your physician before applying any topical creams.

Talk to your physician before taking any medications.

Injections

Cortisone

Cortisone, which is injected directly into joints, may be used to help relieve both swelling and pain. Cortisone is a naturally occurring hormone produced by the adrenal gland. It helps regulate inflammation and when injected into a joint it can relieve or reduce both swelling and pain. Relief usually occurs within a day or two of the injection. Patients do not need to change activities following injections. Many patients elect to receive cortisone injections prior to big events when they will be more active.

Cortisone may play a role in weakening tendons or cartilage if used too often. Therefore, most physicians limit its use to a few times per year depending on the circumstances.

Always consult your physician before participating in any treatment option.

When non-surgical treatments fail to provide adequate relief from the symptoms of arthritis, your orthopedic surgeon may recommend joint replacement. The technique of joint replacement uses implants typically made from polyethylene (plastic) and metal alloy to replace the damaged sections of bone and cartilage in the joint. The purpose of the procedure is to restore function and mobility and to provide relief from joint pain.

You must decide if your discomfort, pain or stiffness, and overall loss of quality of life justify undergoing surgery.

The technique of total elbow replacement removes the damaged bone and cartilage in a joint. The diseased surfaces are replaced with an implant made of metal alloy on one side and polyethylene (plastic) on the other side. Elbow implants are designed to replace the hinge mechanism in a healthy elbow, to restore movement and decrease or eliminate pain.

Benefits of Total Elbow Replacement

  • Eliminate or reduce pain
  • Enhance movement and mobility
  • Improve quality of life
  • Return to normal activity
  • Low-impact sports and activities

Total elbow replacement is one option available to you and your surgeon. Only your orthopedic surgeon can determine if you are a candidate for this implant.

Complications

While uncommon, complications can occur during and after surgery. Some complications include infection, implant breakage, malalignment, and fracture. Although implant surgery is extremely successful in most cases, some patients still experience stiffness and pain. No implant will last forever and factors such as the patient’s post-surgical activities and weight can affect longevity. Be sure to discuss these and other risks with your surgeon.

Preparing for Surgery

Patients should begin preoperative strengthening exercises to help them prepare for surgery and their recovery. Patients may be given a comprehensive nutrition plan to help ensure optimum health before surgery.

There are many things that your surgeon may do to minimize the potential for complications. Your surgeon may have you see a medical physician before surgery to obtain tests. You may also need to have your dental work up to date and may be shown how to prepare your home to avoid falls.

After Surgery

After surgery, you probably will be hospitalized for 1 to 3 days. The arm is typically immobilized for comfort in a long-arm dressing and protective splint for the first 3 to 5 days. Range of motion exercises may be started after the dressing and splint are removed, allowing for some return to light activities of daily living. At 10 to 14 days, the sutures are removed. Strengthening usually begins 6 weeks after surgery.

At home, it is important to continue with your exercises as your physician has instructed. It is a good idea to enlist the help of friends or family to help you once you do return home.

Recovery

Patients who have had total elbow replacement typically require many weeks before returning to any type of lifting or repetitive movement activities. Every person’s recovery time will vary, but most people should be able to drive in 4 to 6 weeks, garden in 2 months, and golf in 3 months after surgery. Your surgeon will tell you when you can return to these activities and will also tell you which activities to avoid.

You will typically not be allowed to participate in high-impact activities, contact sports, “jamming” activities such as hammering, heavy or repetitive lifting, or activities. These types of activities place extreme pressure on the elbow joint, which could lead to complications.

Planning ahead and preparing for your elbow surgery can help ensure a smooth surgery and an easier recovery.

The following recommendations can help you with this process.

  • Preparing For Elbow Surgery
  • Caring For Your New Elbow Implant

Preparing For Elbow Surgery

When you and your orthopedic surgeon decide that joint replacement surgery is the best option to relieve pain and restore motion, you will begin the normal preparation for surgery. You should notify your surgeon about any of the medications you are presently taking because some medications must be stopped before surgery. All surgeries carry certain risks and possible complications. Before surgery, your surgeon will explain the possible complications. Your orthopedic surgeon may ask you to see your primary care physician to make sure that you do not have any health conditions that may complicate your surgery.

You may be asked to donate blood before your surgery. There are several options regarding blood donation and surgery, and all of these options should be explained to you.

Surgery also requires anesthesia. There may be some options regarding anesthesia and they will be explained to you. Your options will be based on your health history, the medications you presently take, and the results of your physical examination.

Your surgeon may also recommend that you start a strengthening program before surgery. The prescribed exercises are designed to help add strength and flexibility. Strengthening your muscles before surgery can assist your postoperative recovery.

After surgery your surgeon will give you a specific recovery plan that you should carefully follow. Do not attempt exercises that are not prescribed by your surgeon, and do not attempt to alter your recovery schedule. It takes time for your joint to heal properly.

Planning ahead for your return home

  • Launder all of your dirty clothing before your surgery. Have loose, comfortable clothing set aside for your recovery time.
  • Prepare single-serving meals before your surgery. These meals can be heated quickly in a microwave and there is less to clean up.
  • Be sure to remove loose rugs and other trip hazards such as electrical cords and magazine racks from walking paths to avoid accidents or falls.
  • Place regularly used items such as remote controls, medications, and reading materials in easy-to-reach locations.
  • Un-tuck bedding to allow for easier access in and out of your bed. If your bedroom is on a second floor, it may be helpful to temporarily relocate your sleeping
  • arrangements to the first floor. This will avoid having to climb stairs when you are not feeling your best.
  • Having some assistance after total joint replacement can also be very beneficial. Contact family members or friends ahead of time so they may make the necessary
  • arrangements to assist in your recovery.

Caring For Your New Elbow Implant

It is important that you move properly during the first 4-8 weeks after your surgery. Do not use your surgical arm to push yourself up from a seated or lying position. You may not participate in any contact sports or lift anything heavier than one pound. Avoid placing your surgical arm in any extreme position, such as straight out to the side or behind your body.

Continue the prescribed exercises during your entire recovery period, and talk to your doctor about developing an exercise program after you fully recover. Swimming, walking, and bicycling are excellent sources of low-impact exercise if your surgeon feels that these activities are appropriate for your individual condition.

Follow your surgeon’s check-up plan. It is common to visit with your surgeon at three, six, and nine months after surgery and annually thereafter.

As a caregiver, your role is important for helping your friend or loved one recover from joint replacement surgery. When at home, there are a variety of things you need to know for the patient’s safety, recovery, and comfort. This information will help you with some of the many questions and concerns as you prepare to care for your joint replacement patient.

  • Home Safety and Avoiding Falls
  • Body Changes
  • Blood Thinners
  • Incision Care
  • Controlling Discomfort
  • Recognizing & Preventing Potential Complications
  • Pulmonary Embolus

Home Safety and Avoiding Falls

  • Pick up throw rugs and tack down loose carpeting. Cover slippery surfaces with carpets that are firmly anchored to the floor or that have non-skid backs.
  • Place regularly used items such as remote controls, medications, and reading materials, in easy-to-reach locations.
  • Place frequently used cooking supplies and utensils where they can be reached without too much bending or stretching.
  • Be aware of all floor hazards such as pets, small objects, or uneven surfaces.
  • Provide good lighting throughout. Install nightlights in the bathrooms, bedrooms, and hallways.
  • Keep extension cords and telephone cords out of pathways. Do NOT run wires under rugs, this is a fire hazard.
  • Do not let the patient lift heavy objects for the first three months and then only with your surgeons permission.
  • Un-tuck bedding to allow for easier access into and out of the patients bed.

Body Changes

  • The patient’s appetite may be poor. Make sure they drink plenty of fluids to keep them from getting dehydrated. Their desire for solid food should return.
  • Joint replacement patients may have difficulty sleeping, which is normal. Do not let the patient sleep or nap too much during the day.
  • The patient’s energy level will be decreased for the first month.
  • Pain medication that contains narcotics promote constipation. Follow the surgeon’s recommendations for using stool softeners or laxatives such as milk of magnesia
    if necessary.

Blood Thinners

Blood thinners may be given to help avoid blood clots in the patient’s legs. Always follow the surgeon’s recommendations regarding blood thinners.

Incision Care

  • Keep the incision dry.
  • Keep the incision covered with a light dry dressing until the staples or sutures are removed.
  • Patient should request showering/bathing instructions from surgeon.
  • Notify the surgeon if there is increased drainage, redness, pain, odor, or heat around the incision.
  • Take the patient’s temperature if he or she feels warm or sick. Call the surgeon if it exceeds 100.5ºF.

Changing the Dressing (ONLY IF DIRECTED BY SURGEON)

Wash hands.
Open all dressing materials (ABD pads, 4×4 if needed, Betadine® swab if indicated).
Remove the old dressing.
Inspect incision for the following:

  1. increased redness
  2. increase in clear drainage
  3. yellow/green drainage
  4. odor
  5. surrounding skin is hot to touch
  6. If Betadine® is ordered, take one Betadine® swab and paint the incision from top to bottom. Then turn the swab over and paint the incision from bottom to
    top. Use remaining swab to paint the drain site.
  7. Pick up ABD pad by one corner and lay over incision. Be careful not to touch the inside of the dressing that will lie over the incision.
  8. Place one ABD pad lengthwise and place the other ABD crosswise to form a “T” (to cover drain site).
  9. Tape dressing in place.

Controlling Discomfort

  • Pain medicine should be taken at least 30 minutes before physical therapy.
  • Encourage patient to gradually wean him or herself from prescription pain medication. Follow the surgeon’s recommendations for taking over-the-counter medication
    in place of prescription pain medication.
  • Have patient change position every 45 minutes throughout the day.
  • Use ice for pain control. Applying ice to the affected joint will decrease discomfort, but do not use for more than 20 minutes at a time each hour. Use ice before
    and after the patient exercises according to their prescribed program. A bag of frozen peas wrapped in a kitchen towel makes an ideal ice pack. Mark the bag of
    peas and return them to the freezer (to be used as an ice pack later).

Recognizing & Preventing Potential Complications

Signs of Infection
  • Increased swelling and redness at incision site
  • Change in color, odor of drainage
  • Increased pain in surgical joint
  • Fever greater than 100.5º F
Blood Clots in Legs

Surgery may cause the blood to slow and coagulate in the veins of the patient’s legs, creating a blood clot. This is why patients take blood thinners after surgery. If a clot occurs despite these measures, the patient may need to be admitted to the hospital to receive intravenous blood thinners. Prompt treatment usually prevents the more serious complication of pulmonary embolus.

Signs of blood clots in leg

  • Swelling in thigh, calf or ankle that does not go down with elevation.
  • Pain, heat and tenderness in calf, back of knee or groin area. NOTE: Blood clots can form in either leg.

Prevention of blood clots

  • Foot and ankle pumps
  • Walking
  • Compression stockings
  • Blood thinners such as Coumadin® or Heparin

Pulmonary Embolus

This is an emergency, if suspected CALL 911 immediately

An unrecognized blood clot could break away from the vein and travel to the lungs.

Signs of a pulmonary embolus
  • Sudden chest pain
  • Difficult and/or rapid breathing
  • Shortness of breath
  • Sweating
  • Confusion
Prevention of pulmonary embolus
  • Heparin or warfarin therapy. Taking Anticoagulants such as heparin and warfarin decreases your chances of pulmonary embolus.
  • Graduated compression stockings. Compression stockings offer a safe, simple and inexpensive way to keep blood from stagnating after general surgery. They steadily squeeze your legs, helping to increase your blood flow efficiency as long as the stockings are not overly tightened
  • Pneumatic compression. Pneumatic compression can dramatically reduce the risk of blood clots, especially in people who have had joint replacement surgery.
  • Physical activity. Becoming active as soon after surgery as possible can help prevent pulmonary embolism and speed up recovery process.

You may be prescribed a number of physical therapy exercises. Physical therapy is simply an exercise program that gently stretches and strengthens specific muscles and joints. The exercises you may perform are gentle, range of motion (stretching) exercises designed to restore movement and strength to your joint and to promote blood flow for healing.

It is important to stay proactive in your physical therapy since it can have a direct impact on the total outcome of your surgery. Remember to stay diligent and don’t give up. Ask for help if you need it. Friends, family members, and even neighbors can be helpful during your recovery, especially if you ask for their assistance before your surgery.

Physical therapy is a very important role in the recovery process. A physical therapist may demonstrate a variety of low-impact exercises designed to increase the strength and mobility of your elbow joint. However, you should only perform the exercises that are ordered by your surgeon.

The following are examples of exercises that your surgeon may prescribe.

ONLY PERFORM THE EXERCISES PRESCRIBED BY YOUR DOCTOR

  • Wrist Flexion Exercise
  • Wrist Extension Exercise
  • Tubing Exercise for External Rotation
  • Forearm Pronation and Supination Strengthening
  • Elbow Flexion and Extension

Wrist Flexion Exercise: Hold a can or a one pound weight in your hand with your palm facing up. Bend your wrist upward. Slowly lower the weight and return to the starting position. Repeat the recommended number of times.

ALL EXERCISES SHOULD BE PERFORMED AS INSTRUCTED BY YOUR SURGEON, AFTER PROPER DEMONSTRATION BY A PHYSICAL THERAPIST.

Wrist Extension Exercise: Hold a can or one pound weight in your hand with your palm facing down. Slowly bend your wrist upward. Slowly lower the weight down into the starting position. Repeat the recommended number of times.

ALL EXERCISES SHOULD BE PERFORMED AS INSTRUCTED BY YOUR SURGEON, AFTER PROPER DEMONSTRATION BY A PHYSICAL THERAPIST.

Tubing Exercise for External Rotation: Stand resting the hand of your injured side against your stomach. With that hand grasp tubing that is connected to a doorknob or other object at waist level. Keeping your elbow in at your side, rotate your arm outward and away from your waist. Make sure you keep your elbow bent 90 degrees and your forearm parallel to the floor. Repeat the recommended number of times.

ALL EXERCISES SHOULD BE PERFORMED AS INSTRUCTED BY YOUR SURGEON, AFTER PROPER DEMONSTRATION BY A PHYSICAL THERAPIST.

Forearm Pronation and Supination Strengthening: Hold a can or one pound weight in your hand and bend your elbow 90°. Slowly rotate your hand with your palm upward and then palm down. Repeat the recommended number of times.

ALL EXERCISES SHOULD BE PERFORMED AS INSTRUCTED BY YOUR SURGEON, AFTER PROPER DEMONSTRATION BY A PHYSICAL THERAPIST.

Elbow Flexion and Extension: Hold a can or a one pound weight with your palm face up. Slowly bend your elbow so that your hand is approaching your shoulder. Gently lower it slowly so your elbow is completely straight. Repeat the recommended number of times.

ALL EXERCISES SHOULD BE PERFORMED AS INSTRUCTED BY YOUR SURGEON, AFTER PROPER DEMONSTRATION BY A PHYSICAL THERAPIST.

What is arthritis?

Arthritis is a term that is defined as inflammation of a joint and used to describe over 100 different conditions that can affect the human body. Arthritis affects millions of Americans each year with symptoms including pain, stiffness, swelling, and loss of motion in affected joints.

Why does my elbow hurt?

The bones in a joint are covered with a tough, lubricating tissue called cartilage to help provide smooth, pain-free motion to the joint. As the layer of cartilage wears away, bone begins to rub against bone, causing the irritation, swelling, stiffness, and discomfort commonly associated with arthritis.

What are the benefits of joint replacement?

The purpose of a joint replacement is to help restore pain-free or near pain-free movement to a joint. Activities that could not be performed before surgery may be resumed as directed by your surgeon after total joint replacement surgery. Your orthopedic surgeon may have several patients who would be willing to speak with you about their experiences before and after total joint replacement surgery. Ask your orthopedic surgeon about this beneficial resource.

What is a total elbow replacement?

Total elbow replacement involves removing the diseased bone and cartilage and resurfacing it with orthopedic implants. The implants are designed to create a new, smoothly functioning joint that prevents painful bone-on-bone contact.

How long does the typical elbow implant last?

A total joint implant’s longevity will vary from patient to patient. All implants have a limited life expectancy depending on an individual’s age, weight, activity level, and medical condition. It is important to remember that an implant is a medical device that is subject to wear, which may lead to mechanical failure. Following all of your surgeon’s recommendations after surgery may enhance longevity, there is no guarantee that your particular implant will last for any specific length of time.

Do implants fail and can they be replaced?

Since implants are mechanical devices, they are subject to conditions that can lead to mechanical failure. The most common reason for implant failure in elbow replacements is implant loosening or implant wear that leads to loosening. Implant wear particles can react with the bone, causing thinning of the bone that can lead to implant loosening. In most cases, failed implants can be revised successfully to provide good results.

What are my non-surgical options before considering joint replacement?

  • Exercise or physical therapy can strengthen the muscles around the affected joint(s), possibly providing relief from pain while improving mobility and function.
  • Medical management including nonsteroidal anti-inflammatory medications or steroid injections may assist in reducing painful joint inflammation and restoring function.

When should I have joint replacement surgery?

Your surgeon will evaluate your health history, perform a physical examination, and take x-rays to decide if you are a candidate for this surgery. You must then decide if your discomfort, pain or stiffness, and overall loss of quality of life justify undergoing surgery. Generally, there is no harm in waiting to have surgery if conservative, non-surgical treatments are effective.

Is age a consideration for joint replacement?

Age is not a problem if you are in reasonably good health and have the desire to continue living a productive, active life. You may ask to see your personal physician for an opinion about your general health and readiness for surgery.

What can one expect from the surgical procedure?

  • Operation- approximately 1 to 2 hours
  • Hospitalization- usually 1 to 3 days
  • Rehabilitation-usually 3 to 4 months of regular exercise at home. This will vary with each patient and with each surgeon.

Can I expect to regain full motion of my elbow after surgery?

After surgery, patients usually gain additional range of motion previously lost to the diseased joint. It is important to remember that the soft tissues play an important role in elbow movement. Damaged or unrepairable soft tissues in the elbow will have an affect on unrestricted movement of the elbow after surgery. Proper preoperative and postoperative physical therapy will also affect the desired surgical outcome. It is important to talk with your physician prior to surgery so he or she can evaluate your condition and give you a better understanding of what you can expect after the surgical experience.

How long and where will my incision be?

The incision is approximately 5 to 7 inches long, across the back or side of the elbow to gain access to the joint.

Will I notice anything different about my new elbow?

Yes, you may have some numbness on the outside of the scar. The area around the scar may feel warm. You may also notice some clicking when you move your elbow as a result of the artificial surfaces coming together.

Are there risks from surgery?

While uncommon, complications can occur during and after surgery. Some complications include infection, blood clots, implant breakage, malalignment, and premature wear. Although implant surgery is extremely successful in most cases, some patients still experience stiffness and pain. No implant will last forever and factors such as the patient’s post-surgical activities and weight can affect longevity. Be sure to discuss these and other risks with your surgeon.

There are many things that your surgeon may do to minimize the potential for complications. Your surgeon may have you see a medical physician before surgery to obtain tests. You may also need to have your dental work up to date and may be shown how to prepare your home to avoid falls.

How can I prepare for surgery?

Proper preparation and a great attitude are the best ways to accomplish a rapid recovery from joint replacement. With the help of a physical therapist, get yourself as physically fit as you can before surgery. Proper nutrition and optimal medical condition can help avoid complications. See your physician prior to surgery to ensure your blood pressure, heart, and lungs are in good shape. Be prepared to continue with your exercise program after surgery.

What type of rehabilitation can one expect following surgery?

Exercise is necessary for proper healing. The arm is typically immobilized for comfort in a long-arm dressing and protective splint for the first 3 to 5 days. Range of motion exercises may be started after the dressing and splint are removed, allowing for some return to light activities of daily living. At 10 to 14 days, the sutures are removed. Strengthening usually begins 6 weeks after surgery.

A regular exercise program at home to promote strengthening and mobility will continue up to 12 months following surgery. It is important to follow your surgeon’s prescribed recovery outline. Do not attempt exercises that are not prescribed by your surgeon, and do not attempt to alter your exercise schedule without contacting your surgeon.

What activity range can be expected after this surgical procedure?

Although elbow replacement is designed to restore motion and decrease pain, it does not return your elbow to “normal.” Like any mechanical device, it can wear out with use. Activities like heavy lifting or manual labor can cause early wear and failure of the elbow implant. Many activities should not begin until the soft tissues around the elbow heal, which can take 3 to 6 weeks. All postoperative activities should be cleared with your surgeon.

How long until I can resume my regular activities after surgery?

Patients with total elbow replacement typically require several weeks before returning to any type of lifting or repetitive movement activities. Driving can normally be resumed in 4 to 6 weeks after surgery but only if your doctor indicates and you are not taking any pain medication. Talk to your doctor before participating in an activity that may place excess stress or movement on your elbow. Consult with your surgeon or therapist for advice on acceptable activities.

Are regular visits with your surgeon required after surgery?

The surgeon will set a follow-up schedule for the first year after surgery to evaluate your progress. Usually these follow-ups occur three, six and nine months after the surgery. Annual visits may be required thereafter. Complications can occur with implants, so seeing the surgeon when you notice a change in symptoms can assist in evaluating any changes that may occur with your new joint.

All patient education materials are provided by OrthoPatientEd.com and have been reviewed by our Advisory Board of leading Orthopedic Surgeons to ensure accuracy. All materials are provided for informational purposes only and are not intended to be a substitute for medical advice from your orthopedic surgeon. Any medical decisions should be made after consulting a qualified physician.
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