Feeling Unstable? Understanding Stabilisation of Unstable Elbows

Does your elbow feel loose, like it might ‘give way’ or even pop out of place? This unsettling sensation, known as elbow instability, can significantly impact your daily life, making simple tasks painful and difficult. It often stems from injuries that damage the ligaments and bones responsible for keeping the elbow joint secure. Fortunately, effective treatments are available, including procedures focused on the stabilisation of unstable elbows.

If you’re experiencing symptoms of an unstable elbow, you’re not alone. This condition can arise after a fall, a direct blow, or even from repetitive stress. Understanding the causes, diagnosis, and treatment options is the first step towards regaining strength, function, and confidence in your arm. This article will guide you through everything you need to know about elbow instability and how surgical stabilisation can help restore your joint’s integrity.

### What Makes an Elbow Unstable? Causes and Types

Elbow stability is a complex interplay between bones, ligaments, and muscles. The primary stabilisers are:

  1. Bony Anatomy: The interlocking shapes of the humerus (upper arm bone), ulna (forearm bone on the pinky side), and radius (forearm bone on the thumb side).
  2. Ligaments: Strong bands of tissue connecting bones. Key players include the medial collateral ligament (MCL) or ulnar collateral ligament (UCL) on the inside and the lateral collateral ligament (LCL) complex on the outside.

Elbow instability occurs when these structures are damaged, usually due to:

  • Trauma: Most commonly, an elbow dislocation where the joint surfaces are forced out of alignment. This often tears crucial ligaments like the LCL and sometimes the MCL. Fractures of the radial head or coronoid process (part of the ulna) can accompany dislocations, creating complex instability.
  • Repetitive Stress: Common in overhead throwing athletes, leading to stretching or tearing of the MCL/UCL (valgus instability).
  • Previous Surgery: Sometimes, prior elbow surgery can inadvertently affect stabilising structures.

There are several patterns of instability, often described by the direction the elbow tends to slip:

  • Posterolateral Rotatory Instability (PLRI): The most common type, usually resulting from an LCL injury. Patients may feel clicking, locking, or a sensation that the elbow is slipping out, especially when pushing up from a chair.
  • Valgus Instability: Instability on the inner side of the elbow, often due to MCL/UCL injury. Common in throwers.
  • Varus Posteromedial Rotatory Instability (VPMRI): A less common pattern involving LCL injury and often a fracture of the coronoid process.

Symptoms often include:

  • A feeling of looseness, clicking, snapping, or locking.
  • Pain, especially with certain movements.
  • A sensation that the elbow feels like it might pop out or dislocate.
  • Recurrent dislocations or subluxations (partial dislocations).

### Diagnosing the Instability: How We Pinpoint the Problem

Accurate diagnosis is crucial for effective treatment. If you suspect elbow instability, a specialist will likely perform:

  1. Medical History Review: Discussing your symptoms, how the injury occurred (if applicable), and any previous elbow problems.
  2. Physical Examination: Your surgeon will assess your elbow’s range of motion, check for tenderness, and perform specific elbow instability physical exam tests. These maneuvers gently stress the ligaments (like the valgus stress test for the MCL/UCL or tests for PLRI) to check for laxity or apprehension (the feeling the elbow might dislocate).
  3. Imaging Studies:
    • X-rays: Essential for checking bone alignment, detecting fractures (radial head fracture, coronoid process fracture), and looking for signs of arthritis or loose bodies. Stress X-rays (taken while applying gentle force) may be used to visualise instability.
    • MRI (Magnetic Resonance Imaging): Provides detailed images of soft tissues, making it excellent for evaluating ligament injury (MCL/UCL or LCL tears).
    • CT (Computed Tomography) Scan: Sometimes used to get a more detailed view of complex fractures or bone shapes.
    • Ultrasound: Can be useful for dynamic assessment of ligaments, especially the MCL/UCL.

Based on these findings, your specialist can confirm the diagnosis, identify the specific type of elbow instability, and determine the severity of the damage.

### Exploring Treatment Options: Non-Surgical vs. Surgical Stabilisation

Treatment for elbow instability depends on the type and severity of the instability, associated injuries (like fractures), activity level, and whether the condition is acute (recent) or chronic (long-standing).

#### Non-Surgical Management

For milder or certain types of instability, especially after a first-time simple dislocation that was properly reduced (put back in place), non-surgical options may be tried first:

  • Immobilisation/Bracing: A splint or specialised elbow brace may be used initially to protect the joint and allow ligaments to heal. Hinged braces can allow controlled movement while preventing unstable positions.
  • Physical Therapy: Crucial for regaining range of motion, strengthening the muscles around the elbow (dynamic stabilisers), and improving joint sense (proprioception). Elbow instability physical therapy is a cornerstone of both non-surgical and post-surgical recovery.
  • Activity Modification: Avoiding activities that provoke symptoms or put stress on the injured ligaments.
  • Pain Relief: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help manage pain and swelling.

#### Surgical Stabilisation of Unstable Elbows

When non-surgical methods fail, instability is severe or recurrent, or significant associated injuries (like displaced fractures) are present, elbow instability surgery is often recommended. The goal of stabilisation of unstable elbows is to restore the joint’s normal anatomy and stability. Common surgical procedures include:

  • Ligament Repair: If a ligament (like the LCL or MCL/UCL) is torn acutely, it can sometimes be repaired by stitching it back to the bone using sutures or suture anchors. This is often done for simple dislocations or as part of complex elbow dislocation treatment.
  • Ligament Reconstruction: For chronic instability or when the ligament tissue quality is poor, the damaged ligament is replaced with a tendon graft. This graft (often taken from your own wrist, hamstring, or a donor) is passed through bone tunnels and secured to recreate the ligament’s function. Ulnar collateral ligament reconstruction (Tommy John surgery) is a well-known example for valgus instability. Lateral collateral ligament reconstruction is performed for PLRI.
  • Fracture Fixation (Open Reduction Internal Fixation – ORIF): If instability is associated with fractures (e.g., radial head fracture, coronoid fracture, olecranon fracture), these bones must be surgically realigned and fixed with plates and screws to restore bony stability.
  • Addressing Other Issues: Surgery might also involve removing loose bodies or addressing cartilage damage.

Elbow stabilisation surgery aims to create a stable joint that allows for early, safe range of motion and rehabilitation.

### The Road to Recovery: Rehabilitation After Stabilisation Surgery

Recovery after elbow stabilisation surgery is just as important as the operation itself. A structured rehabilitation program, usually guided by a physical or occupational therapist, is essential.

  • Initial Phase (Protection): Immediately after surgery, your arm will likely be protected in a splint or brace. The focus is on controlling pain and swelling. Gentle motion, within safe limits prescribed by your surgeon, may begin early.
  • Intermediate Phase (Regaining Motion): As healing progresses, therapy focuses on gradually restoring your elbow’s range of motion through specific exercises. The brace may be adjusted or discontinued during this phase.
  • Late Phase (Strengthening & Function): Once motion is improving and the repairs are sufficiently healed, strengthening exercises for the elbow, forearm, and shoulder begin. The goal is to return to daily activities and, eventually, sports or heavier work if applicable. Elbow instability exercises focus on controlled strengthening.

Elbow stabilisation surgery recovery takes time and dedication. Full recovery can take several months, depending on the complexity of the surgery and individual factors. Adhering to your surgeon’s and therapist’s guidelines is key to achieving the best possible outcome.

### Taking the Next Step Towards Stability

Living with an unstable elbow can be challenging, limiting your activities and causing persistent discomfort or anxiety about dislocation. Understanding that effective treatments exist, ranging from targeted physical therapy to advanced elbow stabilisation surgery, is the first step toward recovery.

Stabilisation of unstable elbows aims to restore the joint’s integrity, allowing you to regain function and confidence. If you’re experiencing symptoms like looseness, clicking, or pain, seeking an evaluation from an upper limb specialist is crucial.

Key Takeaways:

  • Elbow instability results from damage to the bones and/or ligaments that keep the joint stable.
  • Causes include traumatic dislocations, fractures, and repetitive stress.
  • Symptoms include feelings of looseness, popping, pain, and recurrent dislocations.
  • Diagnosis involves a thorough history, physical exam, and imaging (X-rays, MRI).
  • Treatment ranges from non-surgical options (physical therapy, bracing) to elbow instability surgery (ligament repair/reconstruction, fracture fixation).
  • Stabilisation of unstable elbows surgically aims to restore joint integrity.
  • Rehabilitation is critical for a successful outcome after surgery.

Don’t let elbow instability hold you back. To discuss your symptoms and explore treatment options, including the potential for stabilisation of unstable elbows, schedule a consultation.

Book an appointment with Mr. David Shields: https://www.circlehealthgroup.co.uk/consultants/david-shields
Or contact us via email: info@theupperlimbclinic.co.uk