ELBOW

ELBOW INSTABILITY

Elbow instability means many different things to many different people. It can be anything from a simple sensation of shifting within the elbow to complete dislocation of the joint. Most commonly it is caused by the outside ligament of the elbow being detached or thinned. The symptoms are usually those of clicking, snapping, clunking or locking of the elbow. This is typically when the arm is almost completely straight and with the palm turned upwards. There is almost always a history of trauma or prior surgery to the elbow. It may also be associated with soft tissue and collagen disorders.

The diagnosis of elbow instability can occasionally be made by simple clinical examination and investigations are often not helpful. More often the diagnosis is only made at the time of surgery with the patient under a general anaesthetic. With the patient awake the muscles around the elbow contract and help to stabilise the elbow. The anaesthetic allows the muscles around the joint to be relaxed enough for the joint to sublux or be dislocated by the examiner to prove the diagnosis.

The surgery is designed to restore stability to the elbow and it involves either reattaching the ligament or reconstructing the ligament with a tendon graft, much like in an anterior cruciate ligament reconstruction.

LATERAL LIGAMENT RECONSTRUCTION

There is a tendon called the palmaris longus present in the wrist of approximately 90 percent of the population. This tendon no longer has any function and is not missed when harvested for ligament reconstruction. If this ligament is not present, occasionally a tendon can be harvested from the back of the knee to act as a graft.

A cut is made on the outside of the elbow to allow access to the bones. Drill holes are made in the bones and the tendon passed in such a fashion to recreate the old lateral ligament complex of the elbow. This is secured in place, ensuring that the arm maintains a full range of movement.

After the wounds are closed, the elbow is placed in a splint with the hand facing down wards. Over the next six weeks, the amount of movement allowed is increased and the arm is kept in a protective brace.

The results of the surgery are very reliable at restoring stability of the elbow but some patients do have ongoing pain, loss of motion or subtle symptoms of instability after their surgery. Almost all patients are noticeably better than they were before the operation.