Elbow Dislocation and Instability / Posterolateral Rotatory Elbow Instability
I’ve had a fall and Injured my Elbow
If you had a fall on the outstretched arm you might have injured the ligaments that stabilise your elbow. It is not uncommon to have a combined injury together with a fracture around the elbow.
What is Elbow Dislocation?
The elbow is a hinged joint and allows motion in on plane only. There is a complex system of ligaments and bony structures that secure stability of the elbow joint. Severe trauma to the elbow can lead to elbow dislocation which describes the separation of joint partners or articulating bone ends. In order, for this to occur at the elbow one or more stabilising structures around the elbow joint break. This involves in most cases the ligament on the inside of the elbow but often elbow dislocations cause complex injuries that involve multiple ligaments as well as fractures.
What is Elbow Instability?
If the ligaments, after tearing heal incomplete or in elongation chronic instability can result. This is expressed by pain and inability to withstand certain loads to the elbow joint.
Who gets Elbow Instability?
Patients who sustained an elbow dislocation and did not fully heal can end up suffering from chronic elbow instability. Also certain ball sports such as baseball or cricket which require a fully extended and locked elbow during pitching or fast bowling can lead to weakness of the inside ligament and subsequent chronic instability.
How is Elbow Instability Diagnosed?
The history of a traumatic event causing dislocation or certain high level sports activity is often the first clue. Clinical testing can reproduce instability but most often this is masked by pain and apprehension of the patient. X-ray and CT scan will show fractures around the elbow and MRI will show ligament injuries.
Ligaments always take six to eight weeks to heal and during this period the elbow need to be protected to regain stability as well as exercised to avoid stiffness.
Certain injury patterns with combinations of fractures and ligament injuries require surgical repair.
Surgery for Elbow Instability
To address the various injuries to the elbow your surgeon might choose two or three smaller incision or a single larger one at the back of the elbow. This is to approach torn ligaments and fractures for direct repair. In cases of chronic instability tendon grafting might be required. Sometimes the fractured radial head is not repairable and requires replacement. Due to the extent of the surgery clinical admission overnight is preferred for adequate main management.
Preparing for Surgery for Elbow Instability
If required we will arrange for a bulk billed pre-admission clinic at the hospital. This is run by a specialist anaesthetist who will gather information and request investigations that are required for safe anaesthesia. Our reception staff will advise of costs, hospital and admission details. Often we will arrange for fitting of a thermoplastic custom brace which will be used before and after the surgery.
Recovery from Surgery for Elbow Instability
At the end of the procedure local anaesthetic will be injected to the surgical field and a compression bandage will be placed. The arm will be placed in a thermoplastic custom brace. Exercises can be commenced roughly two to three weeks after the procedure but a brace has to be worn in the exercise free time until six weeks after surgery. Dressings can be removed 10-12 days after the surgery, sutures are commonly internally and absorbable, hence nothing needs to be removed. Full recovery with regaining range of motion and strength can be expected at the ten to twelve week mark