What is Chronic Elbow Instability?

Elbow instability is felt as looseness in the elbow joint that may cause the joint to catch or slide out of place while performing specific arm movements. It most frequently results from trauma, typically an elbow dislocation.

A dislocation is an injury when the joint moves out of place. This injury can tear the bone and the ligaments surrounding the elbow joint.
Subluxation is a term for partial dislocation, where the joint partially slides out but then returns to place.
It is recurrent or chronic elbow instability when the elbow is loose and feels like it might slide out of place.

What are the Symptoms of Elbow instability?

Pain and feelings of catching, locking, popping, clicking, or sliding of the elbow are symptoms of instability. One may also feel that the elbow pops out of place, especially when pushing one out of the chair.

What causes Elbow instability?

Elbow instability refers to looseness within the joint, which is said to cause catching, locking, popping, and sliding sensations. This may result from a dislocation or subluxation where the humerus slips partially or totally out of the depressions in the ulna and radius. This often results from a traumatic event or injury.

Recurrent instability can be due to an injury to the ulnar or lateral collateral ligaments with or without a fracture to one of the bones forming the elbow. Injury to the ligaments might result from trauma, such as a fall, previous surgery, stress from repetitive movements (as in overhead athletes, for example, in baseball pitching), or an existing elbow deformity. Three types of recurrent instability:

Posterolateral rotatory instability is most common because of trauma that damages the lateral collateral ligament complex. It is characterized by a sense of sliding in or out.
Valgus instability: Because of ulnar collateral ligament complex injury.
Varus posteromedial rotatory instability: Because of fracture of the coronoid of the ulna with lateral collateral ligament complex injury. Usually results from a trauma. It is characterized by a sense of sliding in or out.

What is the Diagnosis for Elbow Instability?

Elbow with lateral instability following trauma, with that elbow dislocation and fracture of the elbow realigned. Radial head fracture was treated with a radial head prosthesis (as seen on the X-ray on the right with the red arrow).

During physical examination, physicians can check for tenderness, deformity, and locking or catching sensations while moving the arm. Through X-rays and MRI, injuries to the bone and soft tissue that may be underlying the instability can be diagnosed.

What are the Non-surgical treatments for Elbow Instability?

Non-operative treatments for elbow instability include strengthening the musculature of the joint through physical therapy, modification of activities to avoid pain or sensations of instability, a brace to stabilize the elbow in place, and pain management. Elbow dislocations can be treated on a non-operative basis by allowing the elbow to be reduced back into alignment - this may occur in a doctor's office or an emergency department, then a brace, pain management, and eventually physical therapy.

What are some of the surgical treatments of Elbow Instability?

Elbow instability can be fixed through the use of reconstruction of the disrupted ligaments by a tissue graft, either a patient's own ligament or an allograft gotten from a cadaver. If fracture to the bone has occurred, then fragments will be realigned and secured with screws or a plate.

In severe cases of elbow dislocation, surgery might be necessary to reset the elbow. An external hinge stabilizes the elbow while any damaged nerves, ligaments, or blood vessels around the elbow are repaired. Surgery might also be necessary if the elbow stiffens up chronically after the elbow has been reduced to ensure the removal of scar tissue and bone growth.

How long is recovery after chronic elbow instability?

You'll likely be in a splint for the first week after surgery, protecting your elbow as it heals.

Rehabilitation typically occurs about two weeks after your surgery. The brace will normally limit the degree of bending or straightening of your elbow but allow you to begin exercising to increase your range of motion, with protection given to the surgical fixation.

Rehabilitation is essential, and you could get up to full range of motion 6 to 10 weeks after surgery. Because the type of instability and the combination of injured structures at the elbow will be variable, your rehabilitation protocol will be tailored by your surgeon for your particular needs.

Physical or occupational therapists will usually prescribe strengthening exercises 3 months after the procedure; most patients return to complete activities 6 to 12 months after surgery. Throwing athletes may require up to 1 year of rehabilitation before returning to competitive sports.