Elbow Instability Treatment

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Dr Poh Seng Yew

MBBS

MRCSEd

MMED (Ortho)

FRCSEd

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What is Elbow Instability?

Elbow instability is a condition characterised by a looseness in the elbow joint, causing symptoms such as the joint catching, popping, or sliding out of place during certain arm movements.

When the elbow experiences recurrent or chronic instability, it frequently feels as if it might slip out of place, especially when the joint is loaded. This ongoing instability can adversely impact daily activities and sports performance, leading to discomfort and limiting functional capabilities.

Types of Elbow Instability

There are three primary types of elbow instability, each caused by specific factors:

Posterolateral Rotatory Instability

This form typically follows a trauma, such as a fall, and can also be a consequence of previous elbow surgery or long-standing deformities.

Valgus Instability

This type also emerges from acute traumatic events. It is mostly seen in athletes engaging in repetitive throwing motions.

Varus Posteromedial Rotatory Instability

This usually results from a traumatic fall, leading to complex injuries involving both the ligaments and the bones.

Causes of Elbow Instability

Elbow instability often stems from specific types of injuries and stress factors.

  • Traumatic Injury
    The most common cause of elbow instability is a traumatic event leading to dislocation or subluxation. These injuries can sometimes spontaneously resolve, making it possible for patients to remain unaware of the initial displacement.
  • Impact Injuries
    Falling on an outstretched hand can result in ligament damage, which subsequently may cause instability.
  • Pre-existing Conditions
    Those with long-standing elbow deformities may be more susceptible to instability due to the pre-existing compromise in joint integrity.
  • Repetitive Stress
    Overhead athletes, like baseball pitchers, often experience elbow instability due to the repetitive stress on the elbow ligaments during their sporting activities.

Symptoms and Signs

Common symptoms and signs of elbow instability include:


  • Joint Abnormalities: Patients may experience locking, catching, or clicking of the elbow, indicating an issue with the joint’s normal function.
  • Instability Sensations: A frequent symptom is the feeling that the elbow might pop out of place, especially under stress or certain movements.
  • Pain and Loss of Function: Overhead athletes, such as baseball pitchers, often report pain on the inside of their elbows during throwing motions. They may also experience a decrease in throwing velocity and ball control, suggesting a compromise in elbow stability.
  • Limitations in Movement: Those with the condition may face limitations in sports performance and regular daily functions due to pain and a lack of joint stability.

Diagnosis

The process of diagnosing elbow instability involves several steps:

  • Medical History and Symptom Analysis: Initially, the elbow specialist will inquire about the patient’s symptoms, medical history, and any specific incidents that might have contributed to the injury.
  • Physical Examination: The elbow will then be examined for tenderness over the ligaments or any visible deformity. The elbow specialist will move the patient’s arm in various directions and apply stress tests to check for signs of instability, such as a popping or sliding sensation. Testing arm strength and checking for nerve injuries are also part of this examination.
  • Diagnostic Imaging Tests: This can include X-rays and MRI scans. While X-rays do not show soft tissues like ligaments, they can be useful in identifying fractures, dislocations, or subtle changes in elbow alignment. An MRI is not always necessary, but can also be used to provide detailed images of soft tissues to reveal tears in the ligaments, muscles, or tendons.

Non-Surgical Treatment Options

Non-surgical interventions are often preferred for less severe cases of elbow instability. These treatments focus on managing symptoms and improving joint stability.

Activity Modification

In the early stages, elbow specialists may recommend altering or limiting certain activities that trigger pain or instability in the elbow. For athletes, this might mean adjusting techniques to reduce stress on the elbow. For non-athletes, it could involve avoiding specific movements or tasks that exacerbate symptoms.

Physical Therapy

This involves exercises specifically designed to strengthen the muscles around the elbow joint. This strengthening aids in stabilising the elbow, improving joint function, and reducing the risk of further injury.

Bracing

A brace can be used immediately after an injury to provide support to the elbow. It stabilises the joint, allowing ligaments time to heal and preventing further displacement or injury. Braces are particularly beneficial in the acute phase post-injury.

Medications for Pain and Inflammation

Elbow specialists may prescribe pain relievers or non-steroidal anti-inflammatory drugs (NSAIDs) to help manage discomfort and inflammation.

Surgical Treatment Options

In cases where non-surgical treatments are insufficient or when the elbow instability is severe, surgical intervention may be necessary. Surgical options for elbow instability focus on restoring the stability and functionality of the elbow joint.

Ligament Repair

In cases where the ligament injury is relatively recent and the surrounding tissues are healthy, the elbow specialist might opt to repair the ligament using sutures. This approach is less invasive than reconstruction and can be effective for certain types of injuries.

Ligament Reconstruction

This is a common procedure for chronic elbow instability. The surgeon replaces the damaged ligament with a tissue graft, which could be either an autograft (taken from the patient’s own body) or an allograft (donor tissue). This procedure aims to re-establish the strength and stability of the elbow joint.

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Prevention Strategies

While it is not always possible to prevent elbow instability, certain strategies can help reduce its risk.

  • Using Proper Techniques to Minimise Injury Risk - Practicing correct form and technique, especially in sports that involve repetitive arm movements, can lower the risk of injuries.
  • Use of Protective Equipment to Support the Elbows - Wearing appropriate protective gear, like elbow pads, provides additional support and can prevent injuries during physical activities.
  • Regular Exercise and Joint Health Maintenance - Engaging in regular exercises that strengthen the muscles around the elbow can enhance joint stability. Maintaining a healthy weight also reduces undue stress on the elbow joint.
  • Avoiding Overuse - Particularly relevant for athletes, avoiding excessive repetitive movements can prevent the development of chronic conditions that contribute to elbow instability.
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Dr Poh Seng Yew

MBBS

MRCSEd

MMED (Ortho)

FRCSEd

With over 18 years of experience, Dr Poh Seng Yew is an orthopaedic surgeon specialising in hip, knee, shoulder and elbow surgery, sports medicine, and trauma surgery.

  • Bachelor of Medicine, Bachelor of Surgery (MBBS), National University of Singapore
  • Member, Royal College of Surgeons of Edinburgh (MRCSEd)
  • Master of Medicine (Orthopaedic Surgery), National University of Singapore
  • Fellow, Royal College of Surgeons of Edinburgh, FRCSEd (Orthopaedic Surgery)
  • Clinical Hip and Sports Medicine Fellow, Orthopädische Chirurgie München (OCM), Germany

 

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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
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Weekdays: 9.00am – 5.00pm
Saturdays: 9.00am – 1.00pm
Sundays and Public Holidays: Closed

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    Mount Elizabeth Novena Specialist Centre
    38 Irrawaddy Road, #08-62/63
    Singapore 329563

    Frequently Asked Questions (FAQ)

    Can I Continue to Participate in Sports with Elbow Instability?

    Participation in sports depends on the severity of the instability and the type of sport. Some individuals may need to modify their techniques or use supportive equipment. Consult an elbow specialist for personalised guidance for your specific condition.

    How Long Does It Take to Recover from Elbow Instability Surgery?

    Recovery time varies based on the individual and the specific surgery performed. A typical recovery period may range from several weeks to several months.

    Can Elbow Instability Occur in Both Elbows?

    Elbow instability can potentially affect both elbows, although it often develops in one. Each elbow should be evaluated separately and managed through individualised treatment plans.

    Should I Bend or Straighten My Elbows if I Have Elbow Instability?

    Try to avoid movements that exacerbate symptoms of instability. Consult an elbow specialist for guidance on how to manage your condition, including recommendations on exercises and movements to avoid.