Posterolateral Rotatory Instability of the Elbow

The elbow joint is made up of three bones, including the upper arm bone (humerus) and the inner and outer forearm bones (ulna and radius). Strong bands of tissue (ligaments) attach the bones together. A group of ligaments works together to hold the elbow joint together (LCL complex). Damage to these ligaments makes your elbow move more than normal (instability).

Posterolateral rotatory instability is a type of elbow instability. This type of instability makes your elbow joint feel loose. You may feel or see your radius bone shift backward and outward when you move your arm.

What are the causes?

This condition is caused by damage to the LCL complex ligaments as a result of:

• Dislocating your elbow.
• Breaking one of your forearm bones near your elbow.
• Breaking a fall with your hand.

What increases the risk?

This condition is more likely to develop in people who:

• Have a history of elbow injury or dislocation.
• Play contact sports.
• Have had many cortisone injections in their outer elbow.

What are the signs or symptoms?

Symptoms of this condition include:

• A feeling that your elbow is locking or catching when you move it.
• A popping or clicking feeling or sound in your elbow when you straighten it, especially with your palm up.
• Pain at the outside of your elbow.
• A feeling that your elbow may pop or slide out of place when you put pressure through your hands, such as when you push off from a chair.

How is this diagnosed?

This condition is diagnosed based on your symptoms, medical history, and a physical exam that checks your elbow motion and tests your arm strength. During the exam, your health care provider may move your arm in different directions to check for instability. You may also have imaging studies, such as:

• X-rays to check for fractures, dislocations, or changes in elbow alignment.
• MRI to check for tears in your ligaments, muscles, or tendons.

How is this treated?

Treatment for this condition includes:

• Wearing a splint or brace to support your elbow and keep it still while it heals (immobilization).
• Taking medicine to relieve pain.
• Avoiding activities that cause elbow pain or instability.
• Doing strength and range-of-motion exercises (physical therapy) as told by your health care provider.

You may need surgery if you still have pain or instability after treatment, or if your instability has been going on for a long time (chronic). This may include a procedure to repair or reconstruct damaged ligaments. After surgery, you will have to wear a cast or splint for several weeks and eventually do physical therapy.

Follow these instructions at home:

If You Have a Splint or Brace:

• Wear it as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the splint or brace if your fingers tingle, become numb, or turn cold and blue.
• Do not let your splint or brace get wet if it is not waterproof.
• Keep your splint or brace clean.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves.
• If your splint or brace is not waterproof, protect it with a watertight covering when you take a bath or a shower.

Managing Pain, Stiffness, and Swelling

• If directed, apply ice to the injured area.
  • If you have a removable splint or brace, remove it as told by your health care provider.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag or between your cast and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your toes often to avoid stiffness and to lessen swelling.
• Raise (elevate) the injured area above the level of your heart while you are sitting or lying down.

Driving

• Do not drive or operate heavy machinery while taking prescription pain medicine.
• Ask your health care provider when it is safe to drive if you have a splint or brace on your arm.

Activity

• Gradually return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do exercises as told by your health care provider.
• Be safe and responsible while being active to avoid falls.

General Instructions

• Do not put pressure on any part of the splint until it is fully hardened. This may take several hours.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• Your symptoms do not improve after 2–4 weeks of treatment.

Posterolateral Rotatory Instability of the Elbow Rehab

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your elbow. These exercises also help to relieve pain and stiffness.

Exercise A: Supination, active

1. Stand or sit with your elbows at your sides.
2. Bend your left / right elbow to 90 degrees.
3. Turn your left / right palm upward until you feel a gentle stretch on the inside of your forearm. Do not let your elbow straighten.
4. Hold this position for __________ seconds.
5. Slowly release the stretch.
6. Return to the starting position.

Repeat __________ times. Complete this stretch __________ times a day.

Exercise B: Pronation, active

1. Stand or sit with your elbows at your sides.
2. Bend your left / right elbow to an “L” shape (90 degrees).
3. Turn your left / right palm downward until you feel a gentle stretch on the top of your forearm. Do not let your elbow straighten.
4. Hold this position for __________ seconds.
5. Slowly release the stretch.
6. Return to the starting position.

Repeat __________ times. Complete this stretch __________ times a day.

Strengthening exercises

These exercises build strength and endurance around your elbow. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise C: Elbow flexors, natural

1. Sit on a firm chair without armrests, or stand.
2. Let your left / right arm rest at your side with your palm facing inward.
3. Hold a __________ weight or grip a secured rubber exercise band or tubing with your left / right hand, and bring your hand toward your shoulder with your thumb pointing toward the ceiling.
4. Hold this position for __________ seconds.
5. Slowly return your hand to your side.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Elbow extensors

1. Lie on your back.
2. Raise your left / right elbow up into the air, pointing it toward the ceiling. Brace your arm with your other hand. Or, you may do this exercise by standing with your left / right elbow over your head so it is pointed toward the ceiling and supported by your other hand.
3. Holding a __________ weight in your left / right hand, slowly straighten your elbow.
4. Control the weight as your hand returns to its starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Wrist extensors

1. Sit with your left / right forearm palm-down and supported on a table or other surface. Your elbow should be resting below the height of your shoulder.
2. Let your left / right wrist extend over the edge of the surface.
3. Loosely hold a __________ weight or a piece of rubber exercise band or tubing in your left / right hand, and slowly curl your hand up toward your forearm.
4. Hold this position for __________ seconds.
5. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.