Orthopaedic Surgeon

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Elbow Instability

Elbow instability means many different things to many different people. It can be anything from a simple sensation of shifting within the elbow to complete dislocation of the joint.

Most commonly it is caused by the outside (lateral) ligament of the elbow being detached or thinned. This is called posterolateral rotatory instability. The symptoms are usually those of clicking, snapping, clunking or locking of the elbow. This is typically when the arm is almost completely straight, with the palm turned downwards and some load being placed on the hand (like pushing yourself out of a chair). There is almost always a history of trauma or prior surgery to the elbow. It may also be associated with soft tissue and collagen disorders.

The diagnosis of elbow instability can occasionally be made by simple clinical examination and investigations are often not helpful unless the joint is actually partially stuck out all of the time. More often the diagnosis is only made at the time of surgery with the patient under a general anaesthetic.

With the patient awake, the muscles around the elbow contract and help to stabilise the elbow. The anaesthetic allows the muscles around the joint to be relaxed enough for the joint to sublux or be dislocated by the examiner to prove the diagnosis. An xray machine is used in the operating theatres to document the type of instability pattern that will need fixing.

Surgery is designed to restore stability to the elbow and it involves either reattaching the ligament (after an acute injury) or reconstructing the ligament with a tendon graft, much like in an anterior cruciate ligament reconstruction.

After surgery the elbow is generally placed in a half plaster for a week to allow the wounds to heal. After that a hinged brace is applied which allows bending but does not allow the elbow to straighten fully (this stops the graft from stretching out). The brace is worn full time for the first 6 weeks and then may be removed and used at night time only for the next six weeks depending on the exact surgery performed. 

Full healing and return to contact sports can take a year after a reconstruction operation but might be as little as 3 – 6 months after an acute repair.

It is common to get radial head fractures and coronoid fractures associated with an acute elbow dislocation. I recommend getting a CT scan to look for these as they may not be seen on a plan xray. Some of these may heal on their own but others may need to be fixed with an operation.

OTHER Elbow Conditions