Elbow
Instability
- Ulnar Nerve Subluxation
- Lateral Ulnar Collateral Ligament Ruptures (Posterolateral Rotatory Instability)
- Dislocation
Description
The ulnar nerve supplies sensation to the hand and controls muscles in the forearm and hand. It passes through a groove in the humerus on the inside of the elbow and sits just under the skin. In this groove, it is commonly referred to as the 'funny bone', because striking the ulnar nerve with an object will result in numbness and tingling in the hand. An ulnar nerve subluxation occurs when the nerve slips out of its groove with elbow motion.
What are the causes?
Ulnar nerve subluxation occurs with elbow motion, combined with lax or absent soft tissue attachments.
What are the symptoms?
Ulnar nerve subluxation may cause pain and clicking sensation on the inner aspect of elbow. Numbness and tingling in the ring and pinky fingers may occur if the nerve is irritated, compressed or stretched with the subluxation.
How is it diagnosed?
Your surgeon will perform a thorough history and physical exam, aided by X-rays. Range of motion may cause the nerve to slip out of its groove. Strength in the ring and pinky fingers may be reduced if the nerve is injured during the subluxation. X-rays are typically normal.
How is it treated?
Non-operative
Non-operative treatment of ulnar nerve subluxation is usually the first line of treatment. Your surgeon may recommend anti-inflammatory medicine, physical therapy and activity modification to help reduce the pain and inflammation.
Operative
Surgery is recommended when the nerve continues to slip in and out of the groove, particularly if numbness, tingling and weakness occur in the hand due to nerve irritation. An incision is created over the nerve, and the nerve is permanently moved out of the groove in the forearm and sewed to the surrounding soft tissue to relieve pain, eliminating subluxations.
Description
The lateral ulnar collateral ligament connects the ulna, a bone in the forearm, to the humerus or arm bone. Tears of this ligament are the leading cause of chronic elbow instability.
What are the causes?
Lateral ulnar collateral ligament ruptures are caused by falls on an outstretched hand and elbow dislocations are common causes of LUCL tears. Other causes include fractures, genetically loose connective tissue, long term use of crutches, and injury during surgical procedures.
What are the symptoms?
Lateral ulnar collateral ligament ruptures cause pain and clicking/locking sensation as the arm is moved from a bent to a straight position with the palm facing up.
How is it diagnosed?
Your surgeon will perform a thorough history and physical exam, aided by X-rays. Your surgeon will position the elbow above the patient's head and perform a maneuver designed to test the integrity of the ligament. If the elbow joint is felt to separate, or the patient's pain is reproduced then instability is present. X-rays are usually normal, but may show partial dislocation of the elbow in severe cases.
How is it treated?
Non-operative
Non-operative treatment of lateral ulnar collateral ligament ruptures is usually the first line of treatment. Your surgeon may recommend anti-inflammatory medicine, physical therapy and activity modification to help reduce the pain and inflammation and increase the strength of the surrounding muscles in an attempt to reduce instability.
Operative
Surgery is recommended when instability and pain are not relieved by non-operative treatment. Elbow reconstruction is performed through an incision using a graft to replicate the torn ligament. For acute tears, a repair of the native ligament may be possible, followed by immobilization. Postoperative medication and physical therapy are at your surgeon’s discretion.
Description
A dislocation occurs when the humerus (upper arm bone) no longer articulates with the two bones of the lower arm (radius and ulna). Elbow dislocation is a medical emergency, as the nerves and blood supply to the elbow can be injured at the time of injury.
What are the causes?
Elbow dislocation occurs from trauma (like falling, collisions during sports or from a motor vehicle accident).
What are the symptoms?
Elbow dislocation causes immediate pain and a deformity is present. Patients cannot use the arm. Numbness, tingling and a cold sensation may be felt in the hand if the nerves and blood vessels are compromised during the injury.
How is it diagnosed?
Your surgeon will perform a thorough history and physical exam, aided by X-rays. Range of motion will be greatly reduced, and the elbow will have a visible deformity. X-rays will show the dislocated elbow and any fractures associated with the injury.
How is it treated?
Non-operative
Your surgeon will immediately reduce the elbow with or without pain medication. After the elbow is back in place and stabilized, further diagnostic studies (CT/”CAT” scan, MRI, Blood Flow) will be performed to assess the extent of the damage to the joint and surrounding structures. If the elbow remains stable, your surgeon may prescribe medication and physical therapy.
Operative
Surgery is recommended when the elbow cannot be reduced, a fracture is present, if there are bone fragments in the joint from the injury or the elbow remains unstable secondary to ligament damage. Surgical technique depends on the injuries causing the instability. Postoperative medication and physical therapy are at your surgeon’s discretion.
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