Elbow instability is a weakness of the elbow joint, in which the joint may present abnormal movements, accompanied by noises and blockages.
Elbow instability is a weakness of the elbow joint, in which the joint may present abnormal movements, accompanied by noises and blockages.
Elbow instability most commonly occurs after trauma leading to elbow dislocation. This type of injury can affect both the bone and ligaments around the elbow joint.
ANATOMY
The elbow is the joint between the humerus and the bones of the forearm (radius and ulna). It is stabilized by the joint capsule as well as by strong ligaments, the collateral ligaments. There are two important ligaments – the lateral collateral ligament and the medial collateral ligament. Also, the muscles that cross the elbow at the level of the arm help stabilize it.
HOW MANY TYPES OF ELBOW INSTABILITY ARE THERE?
There are 3 types of elbow instability:
1. posterolateral rotatory instability – which occurs through trauma affecting the external collateral ligament complex;
2. valgus instability – by damage to the ulnar collateral ligament;
3. posteromedial rotatory instability in varus – which consists of a lesion of the posterolateral medial ligament associated with a fracture of the coronoid process of the ulna.
WHAT ARE THE CAUSES OF ELBOW INSTABILITY?
Posterolateral rotational instability – is the most common elbow instability and is caused by trauma such as: falling on the hand, with the elbow in flexion and external rotation.
Valg instability – is most commonly caused by repetitive stress, and occurs more frequently in athletes.
Posteromedial rotatory instability in varus – is commonly caused by trauma, such as falling on the hand.
WHAT ARE THE SYMPTOMS OF ELBOW INSTABILITY?
Instability can manifest itself by the appearance of cracks, abnormal movements in the elbow joint. There may also be a sensation of a small blockage in flexion-extension movement.
In athletes, it may manifest as pain in the elbow joint or a decrease in movement speed.
HOW TO DO THE PHYSICAL EXAMINATION?
It is done by moving the arm in several directions, to test the stability of the elbow and sometimes blocking movements or cracks can be identified. Muscle tone is also checked for nerve damage.
WHAT IMAGING TESTS DO WE USE?
X-ray – which is useful for identifying fractures, dislocations or mal positions of the elbow.
WHAT IS THE TREATMENT FOR ELBOW INSTABILITY?
CONSERVATIVE TREATMENT – is especially effective in patients with valgus instability and is aimed at reducing symptoms.
In some cases of posterolateral rotatory instability, functionality can be improved by conservative treatments, but surgery is necessary if elbow instability persists.
Posteromedial varus instability always requires surgery for fracture fixation and ligamentous stabilization.
Conservative treatment includes:
– medical rehabilitation – which helps to reduce symptoms and increase muscle capacity and muscle tone.
– replacement of current activities with activities in which the elbow joint is not under stress;
– immobilization in a brace for a short period can reduce symptoms.
SURGICAL TREATMENT
1.Ligament reconstruction – it is necessary to stabilize the elbow joint, most of the times the torn ligament can be sutured. In situations where the ligament tear is large, ligament grafting – autograft or allograft – can be used.
2. Fracture fixation in patients with posteromedial rotatory instability in varus, it is important to fix the fracture of the coronoid using screws or sometimes a metal plate with screws, as well as repairing the ligament.
HOW IS POSTOPERATIVE RECOVERY?
In the first week after surgery, the elbow joint is put at rest with the help of a support orthosis. Recovery begins in the 2nd postoperative week, the orthosis is removed and passive mobilization exercises are started to increase elbow range of motion.
Recovery of full elbow mobility is expected to be achieved at about 6 weeks postoperatively, after which muscle tone is restored and the patient can perform any activity 6 months after surgery.
In the case of high performance athletes, the recovery period can last up to 1 year.
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