Radiocapitellar Arthritis 715.12

synonyms:

Radiocapitellar Arthritis ICD-9

Radiocapitellar Arthritis Etiology / Epidemiology / Natural History

• Arthritis isolated to the radiocapitellar joint.
• Uncommon
• 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

• See also Elbow anatomy

Radiocapitellar Arthritis Clinical Evaluation

• Must rule out medial elbow instability and DRUJ instability.

Radiocapitellar Arthritis Xray / Diagnositc Tests

• A/P, lateraland oblique elbow films indicated, generally normal.
• Arthrogram MRI: consider to evaluate for loose bodies.

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
• Infection
• CRPS
• DVT/PR
• 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 HOreduction.
• 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 Rehab Protocol.
• See also Elbow Outcome Measures.

Radiocapitellar Arthritis Review References