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Elbow instability

Elbow instability is an orthopedic condition in which the elbow joint becomes loose. This can cause the elbow to pop, click, catch and feel like it is shifting out of place when performing certain arm movements, such as throwing a baseball. Untreated, it can lead to damage of the surrounding bones and connective tissue.

  • Types

    • Posterolateral rotatory instability is the result of an injury to the lateral collateral ligament complex (positioned on the outside of the elbow) and causes the elbow joint to repeatedly shift out of alignment.
    • Valgus instability is recurrent elbow instability that is caused by an injury to the ulnar collateral ligament (positioned on the inside of the elbow).
    • Varus posteromedial rotatory instability, like posterolateral rotatory instability, also causes the elbow joint to repeatedly shift out of alignment, but it is the result of both an injury to the lateral collateral ligament complex and a fracture to the coronoid process of the ulna bone (positioned on the inside of the elbow).
  • Symptoms

    • Elbow popping, clicking, catching, locking and/or sliding out of place
    • Reduced throwing speed for athletes
    • Sensation of pain on the inside of the joint during certain arm movements, such as throwing
  • Prevention

    • Avoid activities that increase the risk for elbow injuries.
    • Take breaks when performing repetitive tasks that are strenuous on the joint to avoid overuse.
  • Risk factors

    • A prior elbow injury
    • Participation in sports or other physical activities that place stress on the elbow
  • Diagnosis

    • Review of medical records and physical exam. Oftentimes, healthcare providers can diagnose elbow instability by listening to patients’ symptoms, reviewing their medical history and performing a physical evaluation of the joint.
    • Imaging. X-rays can be used to pinpoint any breaks, dislocations of the joint and other alignment issues. MRI is usually not needed to diagnose elbow instability but can be used if imaging of soft tissue tears is required.
  • Treatment

    • Nonsteroidal anti-inflammatory drugs may provide temporary pain relief. 
    • Limiting certain physical activities may help prevent symptoms and reduce the likelihood of further aggravating the elbow joint.
    • Physical therapy can help strengthen the muscles around the joint
    • Use of an orthopaedic brace or splint will stabilize the joint and limit range of motion, which can reduce the chance of reinjury. 
    • Internal fixation of fracture will brace the injury using screws and possibly a metal plate. 
    • Ligament reconstruction will surgically reconstruct the torn ligament using a tissue graft.
  • Follow-up care

    • After surgery, patients will be advised to wear a splint to protect the elbow from reinjury during the recovery process.
    • During the second week of recovery, patients will begin rehabilitation. At this time, the splint will also typically be traded out for a brace, which allows for greater range of motion. Patients’ complete range of motion generally returns approximately six weeks after surgery.
    • After rehabilitation, patients will continue to engage in a series of prescribed exercises to build strength in the elbow. • Most patients return to their normal activities within six months of surgery. However, throwing athletes may need to undergo rehabilitation for as long as a year before they are able to return to competitive play.