Elbow Instability
by Mr. David Shields
Elbow instability is when your elbow joint feels loose and might catch, pop, or slide out of place during certain movements. It’s like your elbow isn’t quite as secure as it should be. This often happens after an injury, like an elbow dislocation or fracture that damages the bones and ligaments around the elbow joint. When this feeling of looseness occurs repeatedly it is called chronic elbow instability.
What Causes Elbow Instability?
Your elbow is made up of three bones: your upper arm bone (humerus) and the two bones in your forearm (radius and ulna). These bones are held together by strong ligaments on the inner and outer sides of the elbow, called collateral ligaments, which prevent dislocation. The main ligaments are the lateral (outside) and ulnar (inside) collateral ligaments.
There are three main types of elbow instability, often occurring together:
- Posterolateral rotatory instability (PLRI): The elbow slides in and out of the joint due to an injury to the lateral collateral ligament (on the outside of your elbow). It is often caused by a fall onto an outstretched hand.
- Valgus instability: The elbow is unstable because of an injury to the medial collateral ligament (on the inside of your elbow). This is common in athletes who do a lot of throwing.
- Posteromedial rotatory instability (PMRI): The elbow slides in and out due to an injury to the lateral collateral ligament complex and a fracture of the ulna bone. It’s usually caused by a traumatic event, like a fall.
What are the Symptoms?
You might experience:
- Pain or an ache, especially during or after certain activities
- A feeling of the joint catching, locking, popping or clicking
- A sense of the elbow sliding out of place
- Loss of power or weakness, particularly during overhead movements
How is Elbow Instability Diagnosed?
Diagnosing elbow instability can be tricky and needs an expert. Here’s how it’s usually done:
- Medical History and Physical Exam: Doctors will ask about your symptoms and examine your elbow, checking for tenderness, deformities, and any clicking or sliding sensations when you move your arm.
- X-rays: These can help identify fractures, dislocations, or changes in the elbow’s alignment. They won’t show soft tissues like ligaments.
- MRI scans: These provide a better look at soft tissues and can show tears in ligaments, muscles, or
tendons. However, they aren’t always necessary to make a diagnosis. - Ultrasound: Sound waves are used to capture images of your anatomy. This can show tears in ligaments, muscles or tendons and can be used to compare the injured elbow with the healthy elbow.
- Specific Tests: These tests will check for specific types of instability such as the posterolateral rotary pivot-shift test, or the posterolateral drawer test, if PLRI is suspected.
Treatment Options for Elbow Instability
Treatment will depend on the cause and severity of your symptoms. It’s important to explore all non-surgical options first.
Non-Operative Treatment
- Physiotherapy: A tailored program to strengthen the muscles around your elbow, improve range of motion, and help regain stability.
- Activity Modification: Avoid activities that make your elbow feel unstable or irritated, but don’t stop moving completely to avoid stiffness.
- Rest: Following a dislocation, some rest will allow the soft tissues to heal, but you need to balance this with avoiding stiffness.
- Bracing: A brace can help to limit painful movements and stabilise the elbow.
- Medication: Anti-inflammatory drugs can help reduce pain in the short term.
Surgical Treatment
Surgery might be considered if non-operative treatments aren’t successful:
- Ligament Reconstruction: The torn ligament is replaced with a tissue graft (either from your own body or a donor), creating a new ligament.
- Fracture Fixation: If you have a broken bone, the fragments are put back into place and held together with screws and sometimes a metal plate.
- Ligament Repair: Some ligament injuries can be repaired with specific stitches. Repairs can also be combined with extra suturing for added support.
- A Complex dislocations: These may require surgery to realign the elbow, which can also involve repairing any damage to nerves, ligaments, or blood vessels.
Recovery
After surgery, you’ll likely wear a splint for the first week to protect your elbow. Rehabilitation usually starts in the second week, with a brace
to help with range of motion. With commitment to your rehab programme, you should regain full range of motion 6 – 10 weeks after surgery. You will start with strengthening exercises 3 months after your procedure. Most patients return to full activities 6 – 12 months after surgery.
FAQs About Elbow Instability
What is the most common type of elbow instability?
Posterolateral rotatory instability (PLRI) is the most common type of elbow instability. It’s caused by an injury to the lateral collateral ligament on the outside of the elbow.
How can I tell if I have elbow instability?
You might have elbow instability if you experience pain, catching, popping, clicking or a feeling of looseness in the elbow, especially during certain arm movements. You may feel like your elbow might pop out of place, especially when pushing yourself up from a chair.
Can elbow instability heal on its own?
Some cases of elbow instability can improve with non-surgical treatment like physiotherapy and activity modification. Surgery might be needed if symptoms persist or if there are significant associated fractures. If the lateral ulnar collateral ligament is incompetent, time alone will not restabilise it.
What is the difference between dislocation and subluxation?
A dislocation is when the joint stays completely out of place. A subluxation is a partial dislocation, where the joint partially slips out and then goes back in.
What is the lateral pivot-shift apprehension test?
The posterolateral rotary pivot-shift test is used to test for elbow instability. The test is considered positive when there is a subluxation of the radial head followed by a reduction at the end of the test. It’s also known as the lateral pivot-shift apprehension test because a patient may feel apprehension or pain if the test is positive.
FAQs About The Upper Limb Clinic
What services does The Upper Limb Clinic provide?
The Upper Limb Clinic specialises in the diagnosis, treatment and rehabilitation of conditions affecting the shoulder, elbow, wrist and hand. Mr David Shields is an experienced orthopaedic surgeon specialising in sports injuries and instability of the elbow.
Why should I choose The Upper Limb Clinic?
The Upper Limb Clinic offers expert care with a focus on individualised treatment plans. Our goal is to bring you back to your activities with a fully functioning upper limb. We use the most advanced techniques and offer a patient-centred approach, meaning we focus on you and your specific goals for recovery.
How can I book an appointment?
You can book an appointment by visiting our website. Contact information can be found on our website.
