Elbow Locking is a mechanical problem where loose bodies (fragments of bone or cartilage) move around inside the elbow joint and get caught between the moving parts.
When this happens the joint gets stuck until the loose body moves. The joint is often painful after locking has happened.
Osteoarthritis is the most common cause of Elbow Locking. As the arthritis progresses extra pieces of bone are sometimes made by the body around the edges of the joint. Sometimes they can break off and become loose inside the joint.
Loose bodies can also form after fractures of the elbow, particularly those involving the smooth joint surface inside the joint.
Often there will be background symptoms of arthritis with intermittent pain, swelling and stiffness. The mechanical episodes of locking occur on top of these symptoms and are usually described as a feeling of something catching inside the joint.
Often the patient history is enough to make the diagnosis. X-rays are taken to look for signs of previous joint injury and arthritis. Sometimes the loose bodies can be seen on the x-rays.
Complex scans, such as computerised tomography (CT) and magnetic resonance imaging (MRI) are occasionally also requested but often do not add much extra information.
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General supportive measures, as used for arthritis, are useful such as keeping the joint mobile and the elbow should be rested when it is very painful.
Painkillers can be helpful in controlling the symptoms of arthritis and allow the joint to keep moving and functioning. If the locking occurs frequently and is interfering with the patient’s daily functions the best solution is to remove the loose bodies.
Often this can be done with a small operation using a telescope to look into the joint and pull out the loose bodies. This may need to be combined with a small open incision if the loose bodies are difficult to retrieve.
This procedure is known as an Elbow Arthroscopy and also gives more information about the inside of the joint and how arthritic it has become. This procedure is often combined with a EUA (Examination Under Anaesthesia). This involves stressing the various ligaments around the elbow to see whether or not they are working properly to stabilise the joint.
Sometimes there are too many loose bodies to be removed. The elbow is a complex joint with many spaces for the loose bodies to hide. For both of these reasons it is not always possible to guarantee that every loose body has been removed.
Fluid is put into the joint during the operation to make it easier for the telescope to go in. This makes the elbow swollen after the surgery.
This can be reduced by keeping the arm elevated and moving all the free joints as soon as possible. In most people the general swelling reduces dramatically in the first couple of days after the operation.
Swelling around the small surgical scars (usually two or three half centimetre wounds) can persist for several months. Swelling can be helped by massaging the tissues and this may also improve any irritability in the surgical scar.
Patients will have stitches and be required to wear a bandage for two weeks after the surgery, but should be back to normal activities by six weeks, although it may take up to three months for residual discomfort to settle.