Elbow instability

Abstract

The elbow joint consists of the ulnohumeral joint, radiocapitellar joint and the proximal radio-ulnar joint. The osseous anatomy, static ligamentous restraints and dynamic stabilizers all contribute to maintain elbow stability. Elbow instability is a commonly encountered condition in clinical practice. There are several ways to classify elbow instability. Instability can be classified as simple or complex based on presence of an associated fracture, it could be classified based on mechanism of injury or it could be classified in a temporal fashion as acute or chronic. It is critical to understand injury patterns that can be treated non-operatively with physiotherapy and mobilization and the ones that need surgery. Surgical management of elbow instability could involve a combination of interventions addressing various ligaments like the lateral ulnar collateral ligament and medial collateral ligament; osseous structures including the radial head, coronoid and proximal ulna based on the mechanism and extent of injury. Adjunctive and salvage procedures may be necessary in delayed presentations or severe injuries. These include application of an internal joint stabilizer, external fixator, internal bracing of the ligament and bone grafting of the coronoid. The goal of treatment of instability is to provide an elbow that is stable and amenable to early active mobilization.