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Health condition · Clinically reviewed

Elbow arthritis, from post-traumatic OA to inflammatory disease.

A focused guide to the arthritic elbow - the types, the tests, and the ladder from physiotherapy to arthroscopy to total elbow replacement.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, BOA, BSR and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including arthroscopic OCA, DMARDs and biologics, and total elbow replacement.

Key facts

Elbow arthritis at a glance.

The essentials, in plain English - what it is, the types it takes, and how it is treated in the UK today.

  • What it is

    Loss of cartilage and inflammation of the elbow joint - the humero-ulnar, radio-capitellar and superior radio-ulnar joints working under strain.

  • Main types

    Osteoarthritis (primary and post-traumatic), rheumatoid, psoriatic, gout, CPPD (pseudogout), septic arthritis and haemophilic arthropathy.

  • Who it affects

    Primary OA is uncommon and favours men - manual workers, weightlifters and throwing athletes on the dominant side.

  • Post-traumatic OA

    The most common elbow OA in the UK - a legacy of previous fracture, dislocation or loose bodies.

  • Emergency

    A hot, painful, swollen elbow with fever is septic arthritis until proven otherwise - a same-day surgical emergency.

  • Foundation therapy

    Activity modification, physiotherapy and a stepped medical plan - with injections and surgery when needed.

Why this guide matters

The elbow deserves its own plan.

It is not a small knee. The elbow is a hinge and a rotational joint with a nerve running behind it - the arthritic elbow needs elbow-specific thinking.

  • Type shapes treatment

    Osteoarthritis, rheumatoid, psoriatic, gout, CPPD and septic arthritis need very different plans - the type is the pivotal decision.

  • Movement matters more than pain

    Loss of extension changes daily life more than an occasional ache. Preserving range is a core goal at every stage.

  • Surgery has moved on

    Arthroscopic OCA and total elbow replacement give durable relief - worth an early conversation with an elbow specialist.

How the diagnosis is made

From first ache to a clear plan.

The steps a UK GP, rheumatologist or elbow surgeon will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Focused history

    Onset, trauma, occupation, sport, morning stiffness and joint pattern - clues to whether this is degenerative, inflammatory or crystal-driven.

  2. 02

    Assessing

    Elbow examination

    Range of movement (extension is lost first), crepitus, tenderness, stability and a careful ulnar nerve check at the cubital tunnel.

  3. 03

    Assessing

    Systemic review

    Other joints, skin, eyes and gut - the story of psoriatic disease, RA, gout or connective tissue disease is often written elsewhere.

  4. 04

    Confirming

    Plain X-ray

    Osteophytes, joint space narrowing, loose bodies, fractures and erosions - the first investigation in almost every case.

  5. 05

    Confirming

    Blood tests

    FBC, CRP, ESR, urate, RF, anti-CCP, HLA-B27 and iron studies when the pattern suggests inflammatory or metabolic disease.

  6. 06

    Confirming

    MRI or ultrasound

    MRI for soft tissue and early erosions; ultrasound for guided injection or aspiration of a suspected effusion.

  7. 07

    Planning

    Joint aspiration and MDT

    Aspiration is essential for suspected septic arthritis or crystal disease - then a rheumatology and orthopaedic MDT plans what comes next.

Typical timeline: first appointment to a working plan in weeks, not months.

Symptoms

What elbow arthritis actually feels like.

Pain with use, lost extension and crepitus in OA - morning stiffness and swelling in inflammatory disease. And a few features that need urgent review.

  • Pain with use

    A deep ache with lifting, carrying and pushing - worse at the end of extension and often felt at the back of the elbow.

  • Loss of extension

    Straightening the elbow goes first - a fixed flexion deformity develops as osteophytes and capsule tighten.

  • Loss of flexion

    Reaching the mouth, hair or back pocket becomes harder - a later feature in advanced disease.

  • Crepitus and locking

    Grinding through range and true mechanical locking suggest loose bodies - a strong signal for imaging and surgical review.

  • Morning stiffness

    Prolonged early-morning stiffness lasting over 30 minutes points to inflammatory arthritis rather than OA.

  • Ulnar nerve symptoms

    Tingling in the little and ring finger, weakness of grip - see our guide to cubital tunnel syndrome for details.

  • Swelling and warmth

    A boggy, warm posterior swelling - synovitis in RA, an effusion in OA or a bursitis worth distinguishing.

  • Red flag - hot, febrile elbow

    A hot, exquisitely tender elbow with fever, malaise or rigors is septic arthritis until proven otherwise. Same-day A&E.

Treatment

How elbow arthritis is treated in the UK.

Load management and physiotherapy first, medical therapy tailored to the type, injections for flares - and arthroscopy or replacement when the joint has had enough.

  • Activity and load management

    Modify the lifts, throws and repetitive work that flare pain - the single biggest lever in early OA.

  • Specialist elbow physiotherapy

    Range, scapular control and eccentric strengthening - tailored to the joint, not generic shoulder rehab.

  • Simple analgesia and topical NSAIDs

    Paracetamol and topical NSAIDs (ibuprofen, diclofenac) first - a short oral NSAID course if needed and safe.

  • Corticosteroid injection

    Ultrasound-guided intra-articular steroid can settle a flare and buy months of function - see our large-joint cortisone injection guide.

  • DMARDs and biologics

    Methotrexate, sulfasalazine or hydroxychloroquine, escalating to TNF or JAK inhibitors - specialist rheumatology-led for RA and psoriatic disease.

  • Gout therapy

    Allopurinol or febuxostat to lower urate, colchicine for flares - see our gout guide for the full ladder.

  • Arthroscopic OCA

    Arthroscopic osteocapsular arthroplasty (Outerbridge-Kashiwagi) removes osteophytes and loose bodies and releases the capsule in OA.

  • Total elbow replacement

    For end-stage disease - inflammatory arthritis has the best long-term outcomes; lifetime lifting limits apply.

Cortisone injection (large joint)

Ultrasound-guided intra-articular steroid for flare control and function.

DMARD monitoring clinic

Safe, guideline-based monitoring while on methotrexate and biologics.

Total elbow replacement

The end-stage option - most reliable in inflammatory arthritis.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, rheumatologist or elbow surgeon knows your joints and history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Osteoarthritis in over 16s: diagnosis and management (NG226).

  • British Society for Rheumatology (BSR). Guidelines on rheumatoid, psoriatic and crystal arthritis.

  • British Orthopaedic Association (BOA). Standards for elbow surgery and total elbow replacement.

  • EULAR. Recommendations for the management of rheumatoid and psoriatic arthritis.

  • British Elbow and Shoulder Society (BESS). Consensus statements on elbow arthritis.

Red flags

When elbow arthritis needs urgent attention.

Most elbow arthritis is manageable in primary and specialist care. These are the situations that need same-day or urgent review.

  • Septic arthritis

    Hot, exquisitely tender elbow with fever or rigors - a same-day emergency needing aspiration, IV antibiotics and often surgical washout.

  • True mechanical locking

    The elbow catches or locks mid-range - loose bodies until proven otherwise and a clear indication for imaging and surgical review.

  • Progressive ulnar nerve deficit

    Worsening numbness or weakness in the little and ring finger warrants urgent nerve studies and specialist review.

  • Acute monoarthritis

    A single hot, swollen elbow in a previously well person is septic arthritis or crystal disease - aspirate first, treat second.

  • Systemic upset with joint symptoms

    Fever, weight loss, rash or eye inflammation alongside elbow pain - a rheumatology assessment is needed early.

  • Immunosuppressed patient with a hot joint

    On DMARDs, biologics or steroids? Any hot, painful joint is treated as septic until proven otherwise.

  • Post-injection flare

    Increasing pain, swelling and fever 24 to 72 hours after an injection - iatrogenic septic arthritis needs urgent review.

  • Haemophilic joint bleed

    A tense, painful haemarthrosis in someone with a bleeding disorder needs factor replacement, not simple analgesia.

  • Fracture on a background of OA

    A low-energy fracture around an arthritic elbow changes the surgical plan - image early and refer.

Living with it

A workable joint, with a clear ladder.

Four things that make the biggest difference day to day - respect the load, keep the joint moving, protect the ulnar nerve at night, and ask for the next step when you need it.

A quiet reminder

Occupation, PIP and Access to Work can help.

An occupational health assessment, a PIP application when appropriate, and Access to Work adjustments can make the difference between staying in the job and stepping away.

  1. 01 Load

    Respect the joint

    Swap heavy pushing and lifting for pulling, or share the load across both arms. Small changes prevent big flares.

  2. 02 Movement

    Keep it moving

    Gentle daily range work stops the elbow from stiffening into a flexed position - the deficit that matters most for daily life.

  3. 03 Sleep

    Protect the nerve at night

    Avoid sleeping with the elbow bent tight to the chest - a soft night-splint can settle ulnar nerve symptoms.

  4. 04 Escalate

    Ask for the ladder

    If pain and stiffness stop the job or the sport, ask for the next step - injection, arthroscopy or replacement all have their place.

Frequently asked

Everything we get asked about the arthritic elbow.

Quick answers on types, injections, ulnar nerve symptoms and surgery.

  • What is elbow arthritis?

    A group of conditions where the elbow joint is damaged by wear, inflammation, crystals or infection. The commonest are osteoarthritis - usually post-traumatic in the UK - rheumatoid arthritis, psoriatic arthritis, gout, pseudogout (CPPD) and septic arthritis. The elbow is a hinge and a rotational joint, so any of these can steal both bending and turning.

  • How is elbow osteoarthritis different from shoulder or knee OA?

    Primary elbow OA is uncommon and tends to affect men - manual workers, weightlifters and throwing athletes - on the dominant side. Most UK cases are post-traumatic, after a previous fracture, dislocation or repeated loose-body trauma. It causes loss of extension before flexion and often produces mechanical symptoms from loose bodies.

  • When should I worry about ulnar nerve symptoms?

    Tingling in the little and ring finger, a weak grip or wasting of the small hand muscles points to ulnar nerve compression at the elbow - cubital tunnel syndrome, often secondary to elbow arthritis. Progressive numbness or weakness needs urgent nerve studies and a specialist opinion.

  • Do steroid injections work for elbow arthritis?

    Ultrasound-guided intra-articular corticosteroid can settle a painful flare and buy months of better function, particularly in OA and inflammatory arthritis. They are not a cure and repeated injections are limited by joint tolerance - a considered, ladder-based plan works best.

  • What surgery is available for elbow arthritis?

    For OA, arthroscopic osteocapsular arthroplasty - the Outerbridge-Kashiwagi procedure - removes osteophytes and loose bodies and releases the capsule to restore movement. For end-stage disease, total elbow replacement is very effective, especially in inflammatory arthritis, but requires lifetime lifting limits of around 2 to 5 kg.

  • Is rheumatoid arthritis of the elbow still common?

    Historically the elbow was one of the classic joints damaged by rheumatoid arthritis. Since the arrival of methotrexate, sulfasalazine, TNF inhibitors and JAK inhibitors, severe rheumatoid elbow disease has become much less common in the UK - good disease control has changed the picture dramatically.

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