I see three major types of arthritis that affect the elbow and shoulder joints. Osteoarthritis is the “wear-and-tear” arthritis caused from degenerative conditions, and occurs most frequently. Rheumatoid arthritis is less common and is a systemic inflammatory condition of the joint lining (the synovium). Posttraumatic arthritis is a form of arthritis that develops from an injury, such as a dislocation or fracture.

Elbow Arthritis

Many patients wonder, “What is arthritis”. For any joint, arthritis means, “joint inflammation”. In the case of the elbow, if the cartilage surface of the elbow becomes worn from age or damaged, elbow arthritis occurs. If you have elbow arthritis, you probably have pain, swelling, stiffness, and loss of normal range of motion. Some people complain of a “locking” or “grating” sensation in the joint.

These sensations are related to the loss of normal smooth joint surface and when pieces of loose bone or cartilage lodge between the joint surfaces interfering with normal movement. Often, my patients may notice numbness of the ring finger and pinky finger. This is related to the pressure placed on the ulnar nerve or funny bone from the swelling.

How is elbow arthritis diagnosed?

I can diagnose elbow arthritis based on your symptoms, a simple physical examination, and standard X-rays. This disease tends to be more common in men than women, and it generally occurs in people over the age of 50 years. You are at increased risk for elbow arthritis if you have a history elbow injury, inflammatory arthritis, or a family history of arthritis. Others at risk for elbow arthritis include people who have jobs or participate in activities that place demands on the elbow joint, such as professional baseball pitchers.

How is elbow arthritis treated?

I treat elbow arthritis predominantly based on your symptoms. Factors to consider include the stage of the disease, patient goals, and your overall medical condition and physical health. Nonsurgical treatment for elbow arthritis involves measures to alleviate or reduce pain, increase range of motion, and restore function. This includes physical therapy, activity restrictions and limitations, and oral anti-inflammatory or pain medications. If these conservative measures do not work, many patients benefit from corticosteroid injections, which can give several months of relief and can be both therapeutic and diagnostic.

Surgery may be necessary if nonsurgical measures do not control and alleviate symptoms. If the damage is not too severe, I can do minimally invasive and sometimes even arthroscopic procedures to remove loose bodies and degenerative, inflammatory tissue from the joint. This smoothes out the irregular joint surfaces and provides symptom relief. If the joint space is severely worn, I may suggest a joint replacement for you.

Shoulder Arthritis

The shoulder is made up of two joints. One of these is the acromioclavicular (AC) joint, located where the collarbone (the clavicle) meets the tip of the shoulder blade (the acromion). The other is located at the junction of the upper arm bone (the humerus) and the shoulder blade (the scapula), and this is called the glenohumeral joint. Both of these shoulder joints are often affected by arthritis. The symptoms of shoulder arthritis include pain, stiffness, decreased or limited range of motion, and crepitus. Crepitus is a “clicking” or “snapping” sound made with shoulder movement.

How is shoulder arthritis diagnosed?

I diagnose shoulder arthritis based on a thorough physical examination, symptoms, and basic X-rays. Most people with shoulder arthritis have a narrowing of the joint spaces, formation of bone spurs, and changes in the bone structure. People over the age of 50 years are at increased risk for shoulder arthritis. Also, having a history of an injury to your shoulder joint puts you at risk for developing this condition.

How is shoulder arthritis treated?

I treat shoulder arthritis based on the severity of the disease, health status and overall condition, activity level and work responsibilities, and prior history. Nonsurgical measures include oral medications, physical therapy, and activity restrictions and limitations. Patients that do not respond to these methods could have a corticosteroid or hyaluronic acid injection. When the joint is severely damaged or worn, or if the patient does not improve with conservative measures, the glenohumeral joint can be replaced with a prosthesis in a procedure called a total shoulder arthroplasty.

If necessary, the head of the humerus is replaced. For arthritis of the AC joint, a resection arthroplasty could help. I do this by taking a small piece of bone from the collarbone to leave room for movement.

A thumb sprain is an injury of the main thumb ligament at the base of the thumb, the ulnar collateral ligament. Skier’s thumb is another term for a thumb sprain. Ligaments are the soft tissue components that hold two bones together to stabilize a joint. You weaken your pinching and grasping abilities if you tear the ulnar collateral ligament. Because of the popularity of recreational skiing in the United States, skier’s thumb is a common orthopedic injury. When the ulnar collateral ligament is completely torn, the injury must be surgically repaired.

What is the cause of skier’s thumb?

It is normal to extend your arms in front of you when you fall. People do this to reduce the impact from hitting the ground. With skiers and other who pitch forward, falling on the hand can stretch or tear the ulnar collateral ligament. Another cause of this injury is an automobile accident, with the driver’s thumb being impacted over the steering wheel. Basically skier’s thumb can result from any injury where the thumb is abnormally bent backward or to the side.

What are the symptoms of skier’s thumb?

The signs and symptoms of skier’s thumb can occur minutes to hours after the initial injury:

• Swelling of the thumb
• Pain at the base of the thumb and in the space between the thumb and index finger
• Bruising of the skin over the thumb
• Inability to grasp or weak grasp
• Tenderness along the index finger side of the thumb
• Thumb pain that is worse with movement
• Pain in the wrist

How is skier’s thumb diagnosed?

To determine if you have a sprained thumb, I will examine your thumb in different positions to determine if your joint is stable. Also, diagnosis depends on your signs and symptoms as well as the history of your injury. I may perform X-rays to evaluate the joint with tension applied to the injured ligament. In addition, I check for normal functioning of the three major nerves of your hand.

What is the treatment for skier’s thumb?

Nonsurgical Treatment

Treatment depends on whether the ligament is stretched, partially torn, or completely torn. If only stretched or partially torn, I immobilize your thumb joint with a splint or bandage until it heals. For relief of pain and swelling, I recommend ice application 3 or 4 times each day. You will wear the splint or bandage for at least three weeks. After a specified amount of time, I encourage you to do strengthening exercises for your thumb. Physical therapy helps with this. This will continue for another 2 or 3 weeks. Most stretching and partial tearing injuries of this ligament heal after 4 to 6 weeks.

Surgical Treatment

When the ulnar collateral ligament is completely torn, surgery is often necessary. This procedure involves reconnecting the ligament to the bone to regain normal movement. With a skier’s thumb injury, the fragments of the bone may be pulled away with the torn ligament. These types of injuries require fixation with a pin or screw. After your surgical procedure, you will wear a short arm cast or splint for 6 to 8 weeks while the ligament heals.

What is my prognosis like with skier’s thumb?

The prognosis of this type of injury depends on the severity of the tear, how soon you get treatment, and your current bone and joint health. If a sprained thumb is treated promptly and properly, full normal function will be preserved and restored. If you delay treatment of skier’s thumb, however, chronic weakness, instability, and/or arthritis could develop. These late complications can be repaired with a joint fusion procedure or ligament rebuilding procedure.

Can I prevent skier’s thumb?

If you ski, you should discard the ski pole when you fall. Falling onto an outstretched hand without the pole will lessen your chance of a sprained thumb. Also, you should use a ski pole with finger-groove grips without restraining devices such as a closed grip or a wrist strap.

What should I do if I suspect I have skier’s thumb?

If you think you have sprained your thumb, I recommend you be evaluated as soon as possible in our office. While you are making your appointment, apply ice to the injury for around 30 minutes at a time. Avoid moving the thumb, and immobilize it with an ACE wrap. Take some ibuprofen for pain relief and anti-inflammation action.