Elbow instability

What is an elbow instability?

An elbow instability is a condition caused by damage, overstretching, or hyperlaxity of the ligaments in the elbow joint. This can be caused by injury or overuse of the elbow and can lead to pain and restricted movement. The instability can cause the bones involved (humerus, ulna, radius) to move out of their correct position during certain movements or activities, which can cause pain and further injury.

Medical explanation

A dislocation (luxation) of the elbow can occur, especially in the context of falls where the body is caught by the arm. This almost always tears soft tissue structures (tendons, ligaments, capsule) that are important for the stability of the joint. In addition, fractures of the bones involved may occur. In most cases, a “simple” dislocation without bone involvement heals without consequences, even with conservative measures. Severe damage involving the dynamic and static stabilizers can lead to persistent instability. In this case, surgical stabilization is necessary.
Surgical stabilization of the joint is also necessary in cases of chronic instability of the elbow with regular dislocations or painful instability.

Our surgical techniques

Acute

First, diagnostic arthroscopy (joint endoscopy) is performed to rule out further damage to the joint (e.g., cartilage damage). Then, the capsule-ligament apparatus and tendons are exposed through a small incision in the skin. After an acute dislocation, the torn ligament and tendon structures are reattached to the bone in order to restore the stability of the joint. This is done using small bone anchors or a transosseous technique. Depending on the type and severity of the dislocation, additional fractures of the elbow may need to be treated using osteosynthesis procedures.

Chronically

In cases of chronic elbow instability, the above-mentioned procedure with direct refixation of the soft tissues is no longer effective. In such cases, medial and/or lateral ligament reconstruction is necessary, depending on the location of the instability. The patient’s own tendons (triceps, gracilis, palmaris longus) or foreign tendons can be used for this purpose. The grafts are fixed in place using bone tunnels and anchor screws and replace the insufficient ligaments of the joint.

In-patient stay

2-3 days

Follow-up treatment

As a rule, an elbow brace with limited range of motion must be worn for 6 weeks. During this time, the joint is slowly mobilized under the guidance of a physical therapist and strength is carefully built up. Patients can return to light physical work after 4 weeks and to heavy work after 3 months at the earliest. Strenuous sports are only permitted after 6 months.

Comprehensive information on other shoulder and elbow conditions and treatment options can be found in the complete range of treatments offered by Prof. Dr. med. Frank Martetschläger.