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Elbow Pain

The elbow is a unique and remarkable joint that allows us to position our forearm and hand in space and carry out a multitude of functions, from throwing a ball to removing a cup or plate from a cupboard. Normally, we take for granted the functionality of our elbows. However, when RA affects the elbow, it can make a range of common tasks and movements difficult or impossible, leading to pain and discomfort, as well as significant disability.

As is true with RA and joints throughout the body, the sooner diagnosis is made and treatment initiated, the greater the likelihood that joint damage can be minimized or prevented. The availability of disease-modifying anti-rheumatic drugs (DMARDs) and newer biologics that have been shown to be effective at slowing or preventing structural damage to the joints means that the elbow and other joints can often be preserved and function maintained.1


How can RA affect my elbow?

In RA, the elbow is a common site of joint involvement. In fact, the elbow is one of the earliest joints affected by RA, with the patient experiencing loss of complete extension of the arm. The elbow may become inflamed and swollen, with visible bulging between the radius and the upper end of the ulna. This swelling may cause nerve compression, resulting in numbness and tingling in the fingers. Inflammation of the bursa (bursitis) at the elbow also may occur.2,3

With chronic inflammation, over time the joint structures may become damaged, with erosion of cartilage and bone. As is the case with many different joints throughout the body, as joint damage progresses, dislocation and migration of bones may occur, resulting in the deformities that are characteristic of RA. In addition to RA-related joint involvement, the elbow is also the most common location for RA nodules to form.2,3

Similar to the wrists, hands, and other joints in RA, elbow involvement is usually symmetrical, with elbows on both sides of the body affected.3

How is RA-related elbow involvement treated?

Treatment of RA symptoms affecting the elbow depends on the severity of symptoms and the nature and extent of damage, as well as the patient’s goals and needs. Options include drug and non-drug treatments, and surgery.1

Drug treatments. The initial approach to treatment should involve medications to control inflammation and pain (including analgesics [NSAIDs], disease-modifying anti-rheumatic drugs [DMARDs], and glucocorticoids). Injection of glucocorticoids directly into the elbow may be useful in controlling acute inflammation.1

Non-drug management approaches. Rest and/or restricted activity and application of heat or cold may be used to provide relief of acute pain in the elbow. A brace may be used to immobilize and support the elbow and provide relief of acute pain. However, immobilization of the elbow for too long a period of time may result in atrophy of the muscles that stabilize injured joints.1

Physical therapy and other forms of rehabilitation may be useful in maintaining and improving range of motion and strength.

Surgery. If joint symptoms do not respond to medication or other management approaches and there is progressive loss of function in the elbow, surgical interventions may be used. The goal of elbow surgery is to improve or restore joint function and to provide pain relief.

If symptoms do not improve with medication, surgery may be used to remove part of the synovial membrane and/or affected bone. In cases where joint damage is severe, joint replacement may be considered. In joint replacement surgery, the damaged joint is removed and replaced with an artificial or prosthetic joint. With this procedure, elbow movement may be preserved or recovered.1

Learn more about elbow surgery

Written by: Jonathan Simmons | Last reviewed: September 2013.
1. Dyer GS, Blazar PE. Rheumatoid elbow. Hand Clin 2011;27:43-8. 2. Venables PJW, Maini RN. Clinical features of rheumatoid arthritis. In: O'Dell JR, Romain PR, eds. UptoDate. Wolters Kluwer Health. Accessed at: 2013. 3. Posalski J, Weisman MH. Articular and periarticular manifestations of established rheumatoid arthritis. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatoid Arthritis. Philadelphia, Penn: Mosby Elsevier; 2009:49-61.