synonyms: elbow arthritis, elbow osteoarthritis, radiocapitellar osteoarthritis
Radiocapitellar Arthritis ICD-10
Radiocapitellar Arthritis ICD-9
Radiocapitellar Arthritis Etiology / Epidemiology / Natural History
- Arthritis isolated to the radiocapitellar joint.
- Most common etiologies: late sequela of either radial head fracture, capitellar fracture, chondral contusion of the capitellum, or osteochondral lesions of the capitellum.
Radiocapitellar Arthritis Anatomy
Radiocapitellar Arthritis Clinical Evaluation
- Must rule out medial elbow instability and DRUJ instability.
Radiocapitellar Arthritis Xray / Diagnositc Tests
Radiocapitellar Arthritis Classification / Treatment
- Nonoperative: NSAIDs, activity modifications, avoid activities which load the joint, ROM exercises for flexion, extension, pronation, and supination should be performed to prevent further loss of motion and function.
- Arthrosocpic synovectomy and debridement
- Radial head excision, with or without a radial head replacement: 80% good outcomes. Consider arthroscopic radial head excision (Menth-Chiari WA, Arthroscopy 2001;17(9):918). Avoid radial head excision in active throwing athletes.
Radiocapitellar Arthritis Associated Injuries / Differential Diagnosis
- Lateral Epicondylitis
- Cerival disease with radiculopathy
- Intraarticular elbow loose body
- Elbow arthritis
- Posterolateral rotatory instability
- Olecranon bursitis
- Posterior olecranon impingement
- PIN entrapement
- Snapping triceps
Radial Head Excision Complications
- Decreased grip strength
- Decreased supination and pronation strength
- Wrist pain
- Progressive valgus instability
- Proximal migration of the radius
- Risks of anesthesia including heart attack, stroke and death
Radiocapitellar Arthritis Follow-up Care
- Post-op: Splint with forearm in supination or neutral. Start early active range of motion as soon as possible. Consider Indomethacin 75mg QD/NSAIDs for patients with complex dislocations for HO reduction.
- 7-10 Days: Evaluate incision, remove stitches, Begin early active range of motion as soon as possible. Start physical therapy. Avoid flexion in pronation.
- 6 Weeks: Consider static progressive nightime extension splinting if a flexion contracture is present 6 weeks after injury. 10° to 15° flexion contractures are not uncommon.
- 3 Months: Progress with ROM. May take 6-12 months to regain ROM. Begin sport specific therapy.
- 6 Months: May return to full activities provided patient is asymptomatic
- 1Yr: Assess outcomes, repeat xrays.
- Radial Head Fracture Rehab Protocol.
- See also Elbow Outcome Measures.
Radiocapitellar Arthritis Review References