Elbow Instability.
Elbow stability relies on a combination of normal bone anatomy, stabilizing soft tissues and muscle strength. Elbow instability is laxity in the elbow joint that may cause the joint to catch, pop, or slide out of place during certain arm movements or activities.
It most often occurs as a result of an injury, typically an elbow dislocation or fracture. This type of injury can damage the bone and ligaments that surround the elbow joint which usually keep it stable. When the elbow is loose and repeatedly feels as if it might slip out of place, it is called recurrent or chronic elbow instability.
Sometimes the first symptoms of instability can be elbow pain or an ache during or after certain activities. Patients will often report loss of power or weakness during overhead activities as well as clicking, clunking or popping sensations.
What causes Elbow Instability?
The elbow is made up of your upper arm bone (humerus) and the two bones in your forearm (radius and ulna). On the inner and outer sides of the elbow, strong ligaments (collateral ligaments) hold the elbow joint together and work to prevent dislocation.
The two important ligaments are the lateral (outside) ligament and ulnar (inside) collateral ligament. It is crucial that the exact cause for your elbow instability is determined prior to surgery being considered. There are three main types of instability, which can often co-exist:
Posterolateral rotatory instability. The elbow slides in and out of the joint due to an injury of the lateral collateral ligament, which is a soft tissue structure located on the outside of the elbow. This is usually caused by a fall onto an outstretched hand.
Valgus instability.The elbow is unstable due to an injury of the medial collateral ligament, which is a soft tissue structure located on the inside of the elbow. This is common in repetitive throwing athletes.
Posteromedial rotatory instability. The elbow slides in and out of the joint due to an injury of the lateral collateral ligament complex, in addition to a fracture of the ulna bone. This is typically caused by a traumatic event such as a fall.
How is Elbow Instability diagnosed?
Elbow instability is often quite subtle and requires expert evaluation to arrive at the correct diagnosis. The mainstay of diagnosis is a careful assessment of the history of your symptoms and thorough clinical examination. Further diagnostic tests are used for confirmation and to plan treatment:
X-rays can be obtained on the day of your consultation and although they do no show soft tissues like the ligaments, they can be useful in identifying fractures, dislocations, or subtle changes in alignment of the elbow.
MRI scans may show tears in the ligaments, muscles, or tendons. However MRI scans are not always necessary for a diagnosis of elbow instability.
Treatment options
Mr Moverley will tailor your treatment specifically to the underlying cause of your symptoms,
Non-operative Management
Non-operative treatment can be successful in some cases of elbow instability and this should always be exhausted before considering any form of surgery.
Possible non-operative options include:
A focused physiotherapy program to strengthen the muscles around the elbow can prevent stiffness, help regain stability and improve range of motion. This will prove beneficial even if surgery is eventually required.
Rest, activity modification. It is usually unadvisable to stop moving or using your elbow altogether as this can lead to stiffness. However avoiding aggravating activities can help to reduce the irritation of your elbow. Following a dislocation it may help to protect soft tissues to allow healing and reduce inflammation, but it is important to balance this with the need to avoid unwanted stiffness.
Surgical Management
Ligament reconstruction
To surgically repair the injury and restore elbow strength and stability, the ligament must be reconstructed. During the procedure, Mr Moveley will replace the torn ligament with a tissue graft. This graft acts as a new ligament.
Elbow fracture fixation
Patients with posteromedial rotatory instability may require surgery repair the broken ulna bone, as well as a repair of the torn ligament. During the operation, the broken bone fragments are repositioned into normal alignment and then held together with special screws and sometimes a metal plate.