Risk factors for cartilage damage and osteoarthritis of the elbow joint: case-control study and systematic literature review
Spahn G, Lipfert JU, Maurer C, Hartmann B, Schiele R, Holm Torsten K, Gifka J, Hofmann GO. Arch Orthop Trauma Surg. 2017; 137(4):557-566
Take Home Message: Workers and athletes exposed to greater elbow stress (from vibration, high forces, or high repetition) may be more likely to develop elbow osteoarthritis.
Elbow anatomy is complex and the joint is often put under mechanical stress. This stress spans across both sexes and many occupations, from athletics to construction or assembly. Review of the literature fails to demonstrate if osteoarthritis (OA) of the elbow joint is related to trauma, age-related changes, occupation, or if there is no relationship between OA and these possible risk factors. Therefore, Spahn and colleagues reviewed previous research and conducted a case-control study to compare people with no elbow joint issues to a group of patients who experienced chronic symptoms that required elbow surgery. The researchers recruited 218 adults (126 controls, 92 cases) between 30 and 60 years old who reported the last 10 years’ worth of injuries, physical activities, occupational stress, and potential risk factors for OA. The researchers evaluated the stress on the elbow from occupational and athletic activities by considering the force, vibration, and repetitiveness of activity. The case group also received X-rays to assess the severity of OA. Nearly half of all participants self-reported occupational stress to the elbow joint and/or involvement in sports activities. Almost half those who participated in sports were in sports that stress the elbow joint (e.g., throwing sports, gymnastics). People exposed to occupation-based elbow stress were almost ~3.8 times more likely to have elbow OA or cartilage damage. Specifically, exposure to heavy work, repetition, and vibration, especially low-frequency vibrations (for example demolition hammer), increased the chances of elbow OA. Construction workers or adults who work in a continuous assembly line tended to have higher degrees of cartilage damage. People who participated in elbow-stressing sports were ~2.5 times more likely to have elbow OA or cartilage damage. The cartilage damage was mainly to the radiocapitellar articulation. The presence of olecranon osteophytes was higher in construction and assembly line workers than for those who worked in an office setting or in healthcare. These results confirm previous research findings that exposure to low-frequency vibrations is a risk factor for elbow OA.
This study and systematic review provides valuable information regarding OA and occupational stress. At the same time, prior research reveals that the development of elbow OA, from biomechanical factors and sports- or occupational-related stressors, can take anywhere from 3 to 27 years post-activity. The researchers admit that it would be ideal to prospectively study people to determine the true incidence of elbow OA among these high-risk populations. Further, the control group included only patients who had no history of elbow OA or cartilage damage from clinical indicators, even though they may have had asymptomatic radiographic OA. Nevertheless, clinicians can use this information to guide prevention, treatment, and rehabilitation of elbow injuries. The risk of damage to the cartilage and/or radiographic OA in the elbow joint is rare when compared to the hip or knee joints, however clinicians should still be aware of occupational and recreational activities that place stress on the elbow joint. This may be particularly relevant in regards to prevention strategies. Clinicians may take steps to modify the stress on elbows. For example, clinicians may modify a patient’s exposure to vibration, high forces, or high repetitions by having workers/athletes alternate tasks or applying pitch counts.
Questions for Discussion: Have you seen a case of OA of the elbow joint in your practice? Did the patient’s occupation align with the research findings?
Written by: Catherine E. Lewis
Reviewed by: Jeffrey Driban
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