Removing the Thin Lining of Arthritic Elbow Pain

Can you blow your nose without bending your elbow? Can you reach for something on top of the refrigerator without straightening your elbow? These are some of the challenges people with rheumatoid arthritis face every day. Almost half of adults with rheumatoid arthritis (RA) have problems with pain and loss of motion in the elbow. These symptoms limit patients' ability to use the arm and reduce overall function.

There are many treatments for RA of the elbow. These include medications, injections into the joint, physical therapy, and surgery. Surgery may mean removing part or all of the synovium. The synovium is the thin layer that lines the tissue capsule around a joint. This surgery can be done by opening up the joint and taking the synovium out.

A newer way to do this is with an arthroscope. An arthroscope is a tool that allows the surgeon to see inside the joint without actually opening it up. A thin tube with a camera on the end is inserted into a body cavity or joint. The arthroscope has a separate attachment that the surgeon uses to cut away the synovium.

Whenever a new operation comes along, researchers must compare the results of the new and old methods. A group of doctors in Japan reported the results of 29 elbow operations done with an arthroscope. The doctors looked at pain levels, motion, joint stability, and X-rays after surgery. Patients were followed for at least two years and sometimes up to 10 years.

Early results were very good for all patients. Patients had pain relief that made it possible to do daily tasks. Over time, there was a decline in the stability of the joint. Also, pain started to come back. The patients with the most severe RA had the worst results. Some needed joint replacement several years later.

Arthroscopic surgery to remove the synovium in arthritic elbows is a safe operation that often relieves pain. After surgery, there is a small incision and no need for a formal rehabilitation program. The best results come from having the surgery early, before the joint is severely damaged.

References: Kiwamu Horiuchi, MD, et al. Arthroscopic Synovectomy of the Elbow in Rheumatoid Arthritis. In The Journal of Bone and Joint Surgery. March 2002. Vol. 84-A. No. 3. Pp. 342-347.