Elbow Dislocations, Instability and Contracture-Post-traumatic Elbow Instability Overview

Post-traumatic Elbow Instability Overview

Pdf Summary

Chapter 15 discusses post-traumatic elbow instability, specifically focusing on valgus instability, varus/posterolateral instability, proximal radial instability, and forearm instability. <br /><br />Valgus instability can occur acutely through a traumatic event or subacutely through chronic overload. Symptoms include an acute pop during a throw, gradual onset of elbow pain, or arm fatigue and loss of endurance and velocity during throwing. Injuries can lead to compression of the lateral joint or avascular necrosis of the capitellar epiphysis.<br /><br />The anterior bundle of the medial ulnar collateral ligament (MUCL) is often injured in valgus instability. Various tests such as static valgus stress, milking maneuver, and moving valgus stress can determine the competency of the MUCL. Diagnostic studies such as plain radiographs, stress radiographs, MRI, and MRI arthrography help confirm ligamentous pathology.<br /><br />Treatment for valgus instability includes therapy, rest, and anti-inflammatory medication followed by a gradual return to throwing. Surgical repair is generally reserved for acutely unstable elbows or chronic/subacute instability in high-velocity throwing athletes. Rehabilitation post-surgery is crucial for optimal outcomes.<br /><br />Varus/posterolateral instability can occur due to trauma or iatrogenic injury. Symptoms include recurrent instability, clicking, snapping, and locking. Diagnosing posterolateral instability involves performing the posterolateral pivot shift test. Treatment typically involves reconstruction of the lateral ulnar collateral ligament (LUCL) through repair or reconstruction with tendon graft.<br /><br />Proximal radial instability is a theoretical or anecdotal entity often misdiagnosed as radial head instability. Forearm instability, also known as the Essex-Lopresti lesion, involves injury to the proximal and distal radioulnar joints and the interosseous membrane.<br /><br />Overall, the chapter emphasizes the importance of accurate diagnosis and appropriate treatment for different types of elbow instability to restore function and prevent complications.

Keywords

post-traumatic elbow instability

valgus instability

varus/posterolateral instability

proximal radial instability

forearm instability

lateral joint compression

medial ulnar collateral ligament

surgical repair

posterolateral pivot shift test

Essex-Lopresti lesion