Patient resources
NHS Lothian MSK Self Help Resources Webpage
Versus arthritis: Osteoarthritis (OA) of the elbow and shoulder
Definition
Elbow joint osteoarthritis (OA) is characterized by age related changes of articular cartilage and subchondral bone with narrowing of the glenohumeral joint.
Typical signs and symptoms
- Pain, stiffness and loss of function
- Restriction of active and passive movement in a capsular pattern, typically loss of extension
- May have crepitus on movement
- Catching or locking may represent presence of loose fragments
- Symptoms may fluctuate with acute-on-chronic flares
A diagnosis of OA should be suspected if a person is 45 years or over with:
- Activity related joint pain.
- No morning joint-related stiffness, or morning stiffness lasting no longer than 30 minutes.
- Possible functional limitation.
- Examination findings may include: restricted and painful range of joint movement, bony swelling, joint deformity, mild synovitis or joint effusion, crepitus, and joint instability.
Prevalence and risk factors
The prevalence of OA varies depending on the joint(s) affected, the person’s age, sex, socio-economic group, and comorbidities. Primary osteoarthritis is rare, secondary osteoarthritis accounts for the majority of cases such as following trauma, surgery, osteochondritis dissecans, synovial chondromatosis and valgus extension overload.
Risk factors include: advancing age, female > male, history of joint trauma/ fractures, obesity, lifestyle, occupational stresses, genetics, certain metabolic diseases e.g. diabetes, haemochromatosis, inflammatory arthritis; traumatic or degenerative rotator cuff tears.
Prognosis/ risks factors for poor outcome
- OA is not always a progressive condition
- Symptoms may fluctuate with intermittent acute-on-chronic flares
- Prognosis will depend on contributing factors – OA is a complex multi-factorial condition involving genetic, biological (age, obesity, metabolic health, genetics), lifestyle (physical activity, smoking, alcohol) and biomechanical (joint injury and structural changes) components
Other considerations
OA is largely a clinical diagnosis and doesn’t always require an x-ray. Arrange an x-ray if there is diagnostic uncertainty, atypical features, or sudden worsening symptoms.
Relevant Standards and Guidelines
NICE Clinical Knowledge Summaries: Osteoarthritis
P.A & M.A – 15-7-26
Who can refer:
- All primary care clinicians with relevant appropriate scope of practice i.e. GPs, Primary care MSK advanced practice physiotherapists, advanced nurse practitioners
- Patient self referral (resident of East Lothian HSCP, Edinburgh HSCP and West Lothian HSCP Where To Find Us – Musculoskeletal Physiotherapy)
- Secondary care consultants and associated teams
- MSK physiotherapists who identify patients with suspected serious conditions of the shoulder or elbow shoulder follow agreed pathways and processes NHS Lothian Integrated Shoulder & Elbow Service
Who and How to refer:
| Condition | Referral Type | Referral destination and process |
|---|---|---|
| Suspected septic arthritis/ septic bursitis | Same day | Orthopaedic registrar via Flow navigation centre on 03000 134000/ on call Orthopaedic registrar via switchboard 0131 242 1000 |
| Suspected facture or dislocation | Same day | Orthopaedic registrar via Flow navigation centre on 03000 134000/ on call Orthopaedic registrar via switchboard 0131 242 1000 |
| Suspected acute distal biceps rupture | Same day | Orthopaedic registrar via Flow navigation centre on 03000 134000/ on call Orthopaedic registrar via switchboard 0131 242 1000 |
| Suspected acute traumatic rotator cuff tear in the younger patient | Urgent | Orthopaedics via SCI gateway > Lauriston Buildings > Orthopaedics- Elbow & Shoulder |
| Suspected malignancy/ tumour specific to shoulder* | Urgent | Orthopaedics via SCI gateway > Lauriston Buildings > Orthopaedics- Elbow & Shoulder |
| Suspected inflammatory condition | Consider referral to Rheumatology – see RefHelp Rheumatology. | |
| Suspected neurological condition | Consider referral to Neurology – see RefHelp Neurology. |
* Please also see Sarcoma – RefHelp. If clinical assessment leads to a very strong suspicion of suspected underlying malignancy, with no specific localising signs or symptoms to suggest a specific underlying primary, consider recommendations and referral options detailed on GP Access to CT for Suspected Cancer (No Clinically Obvious Primary) – RefHelp
Who not to refer:
- Patients who have the presence of significant red flags/ suspicion of serious shoulder and elbow conditions or have suspected inflammatory condition – see serious shoulder & elbow conditions
- Age <16
For further information see associated sections
- Link to NHS Lothian patient internet site including patient information resources – https://services.nhslothian.scot/ISES/Pages/default.aspx
- Link to NHS Inform page shoulder problems https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/self-management-advice/shoulder-problems
- Link to NHS Inform shoulder problems- Patient self help guide https://www.nhsinform.scot/self-help-guides/self-help-guide-shoulder-pain
- Link to NHS Inform page elbow problems https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/self-management-advice/elbow-problemsopens a new window
- Link to intranet site NHS Lothian Integrated Shoulder and Elbow Service http://intranet.lothian.scot.nhs.uk/Directory/physiotherapy/NHSLIntegratedShoulderandElbowService/Pages/default.aspx
