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Arthroscopy and Sport Injuries pp 229–235Cite as

Elbow Instability

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Abstract

The elbow is a trochleoginglymoid joint which configuration makes the elbow a fairly constrained and one of the most congruous and stable joints of the body.

The normal range of motion of the elbow is approximately 0° of extension and 140° of flexion. A functional range of motion for activities of daily living has been described to be of 30–130°, and the functional arc of throwing ranges from 20° to 130°.

Although it is not a weight-bearing joint, it can be subjected to high loads when practicing racket or throwing sports or in gymnastics. As a consequence of these continued sport activities, elbow stability, due to static and dynamic constraints, can be compromised.

The elbow is the second most commonly dislocated major joint, and 15–35 % of elbow dislocations can have residual instability. Elbow dislocations represent 11–28 % of all elbow injuries, with an annual incidence of 6–8 cases per 100,000 people.

The symptoms of the instability in athletes can occur following a single traumatic event or may be due to repetitive stress leading to chronic laxity such as in a throwing athlete. The focus of this chapter will be on elbow instabilities connected to sport activities.

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References

  1. Prasad A, Robertson DD, Sharma GB et al (2003) Elbow: the trochleogingylomoid joint. Semin Musculoskelet Radiol 7(1):19–25

    Article  PubMed  Google Scholar 

  2. Morrey BF, Askew LJ, Chao EY (1981) A biomechanical study of normal functional elbow motion. J Bone Joint Surg Am 63(6):872–877

    CAS  PubMed  Google Scholar 

  3. Safran MR, Baillargeon D (2005) Soft-tissue stabilizers of the elbow. J Shoulder Elbow Surg 14(1 Suppl S):179S–185S

    Article  PubMed  Google Scholar 

  4. Mehlhoff TL, Noble PC, Bennett JB, Tullos HS (1988) Simple dislocation of the elbow in the adult. Results after closed treatment. J Bone Joint Surg Am 70(2):244–249

    CAS  PubMed  Google Scholar 

  5. Murthi AM, Keener JD, Armstrong AD, Getz CL (2011) The recurrent unstable elbow: diagnosis and treatment. Instr Course Lect 60:215–226

    PubMed  Google Scholar 

  6. Hildebrand KA, Patterson SD, King GJ (1999) Acute elbow dislocations simple and complex. Orthop Clin North Am 30:63–79

    Article  CAS  PubMed  Google Scholar 

  7. Morrey BF, An KN (1983) Articular and ligamentous contributions to the stability of the elbow joint. Am J Sports Med 11(5):315–319

    Article  CAS  PubMed  Google Scholar 

  8. Callaway GH, Field LD, Deng XH, Torzilli PA, O’Brien SJ, Altchek DW, Warren RF (1997) Biomechanical evaluation of the medial collateral ligament of the elbow. J Bone Joint Surg Am 79(8):1223–1231

    CAS  PubMed  Google Scholar 

  9. Eygendaal D, Olsen BS, Jensen SL, Seki A, Sojbjerg JO (1999) Kinematics of partial and total ruptures of the medial collateral ligament of the elbow. J Shoulder Elbow Surg 8(6):612–616

    Article  CAS  PubMed  Google Scholar 

  10. Morrey BF, Tanaka S, An KN (1991) Valgus stability of the elbow. A definition of primary and secondary constraints. Clin Orthop Relat Res 265:187–195

    PubMed  Google Scholar 

  11. Morrey BF, An KN (1985) Functional anatomy of the ligaments of the elbow. Clin Orthop 201(Dec):84–90

    PubMed  Google Scholar 

  12. Regan WD, Korinek SL, Morrey BF et al (1991) Biomechanical study of ligaments around the elbow joint. Clin Orthop 271:170–179

    PubMed  Google Scholar 

  13. Miyake J, Moritomo H, Masatomi T et al (2012) In vivo and 3-dimensional functional anatomy of the anterior bundle of the medial collateral ligament of the elbow. J Shoulder Elbow Surg 21(8):1006–1012

    Article  PubMed  Google Scholar 

  14. Floris S, Olsen BS, Dalstra M et al (1998) The medial collateral ligament of the elbow joint: anatomy and kinematics. J Shoulder Elbow Surg 7(4):345–351

    Article  CAS  PubMed  Google Scholar 

  15. Fuss FK (1991) The ulnar collateral ligament of the human elbow joint: anatomy, function and biomechanics. J Anat 175(Apr):203–212

    PubMed Central  CAS  PubMed  Google Scholar 

  16. Ochi N, Ogura T, Hashizume H et al (1999) Anatomic relation between the medial collateral ligament of the elbow and the humero-ulnar joint axis. J Shoulder Elbow Surg 8(1):6–10

    Article  CAS  PubMed  Google Scholar 

  17. Martin BF (1958) The annular ligament of the superior radio-ulnar joint. J Anat 92(3):473–482

    PubMed Central  CAS  PubMed  Google Scholar 

  18. Dunning CE, Zarzour ZD, Patterson SD, Johnson JA, King GJ (2001) Ligamentous stabilizers against posterolateral rotatory instability of the elbow. J Bone Joint Surg Am 83-A(12):1823–1828

    CAS  PubMed  Google Scholar 

  19. McAdams TR, Masters GW, Srivastava S (2005) The effect of arthroscopic sectioning of the lateral ligament complex of the elbow on posterolateral rotator stability. J Shoulder Elbow Surg 14(3):298–301

    Article  PubMed  Google Scholar 

  20. Jensen SL, Olsen BS, Seki A, Ole Sojbjerg J, Sneppen O (2002) Radiohumeral stability to forced translation: an experimental analysis of the bony constraint. J Shoulder Elbow Surg 11(2):158–165

    Article  PubMed  Google Scholar 

  21. Park MC, Ahmad CS (2004) Dynamic contributions of the flexor-pronator mass to elbow valgus stability. J Bone Joint Surg Am 86-A(10):2268–2274

    PubMed  Google Scholar 

  22. Morrey BF (1998) Complex instability of the elbow. Instr Course Lect 47:157–164

    CAS  PubMed  Google Scholar 

  23. O’Driscoll SW, Morrey BF, Korinek S, An KN (1992) Elbow subluxation and dislocation. A spectrum of instability. Clin Orthop Relat Res 280:186–197

    PubMed  Google Scholar 

  24. Sheps DM, Hildebrand KA, Boorman RS (2004) Simple dislocations of the elbow: evaluation and treatment. Hand Clin 20:389–404

    Article  PubMed  Google Scholar 

  25. Lill H, Korner J, Rose T et al (2001) Fractures-dislocations of the elbow joint: strategy for treatment and results. Arch Orthop Trauma Surg 121:31–37

    Article  CAS  PubMed  Google Scholar 

  26. Josefsson PO, Gentz CF, Johnell O et al (1987) Surgical versus non surgical treatment of ligamentous injuries following dislocation of the elbow joint: a prospective randomized study. J Bone Joint Surg Am 69:605–608

    CAS  PubMed  Google Scholar 

  27. Josefsson PO, Gentz CF, Johnell O et al (1989) Dislocations of the elbow and intraarticular fractures. Clin Orthop Relat Res 246:126–130

    PubMed  Google Scholar 

  28. Sojbjerg JO, Helmig P, Kjaersgaard-Andersen P (1989) Dislocation of the elbow: an experimental study of the ligamentous injuries. Orthopedics 12:461–463

    CAS  PubMed  Google Scholar 

  29. Deutch SR, Olsen BS, Jensen SL et al (2003) Ligamentous and capsular restraints to experimental posterior elbow joint dislocation. Scand J Med Sci Sports 13:311–316

    Article  PubMed  Google Scholar 

  30. Deutch SR, Jensen SL, Olsen BS et al (2003) Elbow joint stability in relation to forced external rotation: an experimental study of the osseous constraint. J Shoulder Elbow Surg 12:287–292

    Article  PubMed  Google Scholar 

  31. McKee MD, Schemitsch EH, Sala MJ, O’Driscoll SW (2003) The pathoanatomy of lateral ligamentous disruption in complex elbow instability. J Shoulder Elbow Surg 12(4):391–396

    Article  PubMed  Google Scholar 

  32. O’Driscoll SW, Bell DF, Morrey BF (1991) Posterolateral rotatory instability of the elbow. J Bone Joint Surg Am 73(3):440–446

    PubMed  Google Scholar 

  33. Cohen MS, Hastings H II (1998) Acute elbow dislocation: evaluation and management. J Am Acad Orthop Surg 6:15–23

    CAS  PubMed  Google Scholar 

  34. Jungbluth P, Frangen TM, Arens S et al (2006) The undiagnosed Essex-Lopresti injury. J Bone Joint Surg Br 88:1629–1633

    Article  CAS  PubMed  Google Scholar 

  35. Safran MR (2004) Ulnar collateral ligament injury in the overhead athlete: diagnosis and treatment. Clin Sports Med 23:643–663

    Article  PubMed  Google Scholar 

  36. Safran MR, Caldwell GL, Fu FH (1996) Chronic instability of the elbow. In: Peimer CA (ed) Surgery of the hand and upper extremity. McGraw-Hill, New York, pp 467–490

    Google Scholar 

  37. O’Driscoll SWM, Lawton RL, Smith AM (2005) The moving valgus stress test for medial collateral ligament tears of the elbow. Am J Sports Med 33:231–239

    Article  PubMed  Google Scholar 

  38. Safran MR, Mcgarry MH, Shin S et al (2005) Effects of elbow flexion and forearm rotation on valgus laxity of the elbow. J Bone Joint Surg Am 87:2065–2074

    Article  PubMed  Google Scholar 

  39. Azar FM, Andrews JR, Wilk KE et al (2000) Operative treatment of ulnar collateral ligament injuries of the elbow in athletes. Am J Sports Med 28:16–23

    Article  CAS  PubMed  Google Scholar 

  40. Thompson W (2001) Ulnar collateral ligament reconstruction in athletes: muscle-splitting approach without transposition of the ulnar nerve. J Shoulder Elbow Surg 10:152–157

    Article  CAS  PubMed  Google Scholar 

  41. Timmerman LA, Schwartz ML, Andrews JR (1994) Preoperative evaluation of the ulnar collateral ligament by magnetic resonance imaging and computed tomography arthrography. Evaluation in 25 baseball players with surgical confirmation. Am J Sports Med 32:26–31

    Article  Google Scholar 

  42. Regan W, Lapner PC (2006) Prospective evaluation of two diagnostic apprehension signs for posterolateral instability of the elbow. J Shoulder Elbow Surg 15:344–346

    Article  PubMed  Google Scholar 

  43. Arvind CHV, Hargreaves DG (2006) Tabletop relocation test: a new clinical test for posterolateral rotatory instability of the elbow. J Shoulder Elbow Surg 15:707–708

    Article  PubMed  Google Scholar 

  44. Mehta JA, Bain GI (2004) Posterolateral rotatory instability of the elbow. J Am Acad Orthop Surg 12(6):405–415

    PubMed  Google Scholar 

  45. Potter HG, Weiland AJ, Schatz JA et al (1997) Posterolateral rotatory instability of the elbow: usefulness of MR imaging in diagnosis. Radiology 204:185–189

    Article  CAS  PubMed  Google Scholar 

  46. Deml C, Arora R, Oberladstatter J et al (2007) Functional therapy and the limitations for acute elbow dislocation. Unfallchirurg 110:845–851

    Article  CAS  PubMed  Google Scholar 

  47. Freehill MT, Safran MR (2011) Diagnosis and management of ulnar collateral ligament injuries in throwers. Curr Sports Med Rep 10(5):271–278

    Article  PubMed  Google Scholar 

  48. Rettig AC, Sherrill C, Snead DS, Mendler JC, Mieling P (2001) Nonoperative treatment of ulnar collateral ligament injuries in throwing athletes. Am J Sports Med 29(1):15–17

    CAS  PubMed  Google Scholar 

  49. Jobe FW, Stark H, Lombardo SJ (1986) Reconstruction of the ulnar collateral ligament in athletes. J Bone Joint Surg Am 68(8):1158–1163

    CAS  PubMed  Google Scholar 

  50. Ahmad CS, Lee TQ, ElAttrache NS (2003) Biomechanical evaluation of a new ulnar collateral ligament reconstruction technique with interference screw fixation. Am J Sports Med 31(3):332–337

    PubMed  Google Scholar 

  51. Pederzini L, Prandini M, Tosi M, Nicoletta F (2012) The acute lesions of the medial collateral ligament of the elbow. GIOT 38(Suppl 2):14–18

    Google Scholar 

  52. Cain EL, Andrews JR, Dugas JR et al (2010) Outcome of ulnar collateral ligament reconstruction of the elbow in 1281 athletes: results in 743 athletes with minimum 2-year follow-up. Am J Sports Med 38(12):2426–2434

    Article  PubMed  Google Scholar 

  53. Nestor BJ, O’Driscoll SW, Morrey BF (1992) Ligamentous reconstruction for posterolateral rotator instability of the elbow. J Bone Joint Surg Am 74(8):1235–1241

    CAS  PubMed  Google Scholar 

  54. Savoie FH, Holt MS, Field LD, Ramsey JR (2008) Arthroscopic management of posterior instability: evolution of technique and results. Arthroscopy 24(4):389–396

    Article  PubMed  Google Scholar 

  55. Cheung EV (2008) Chronic lateral elbow instability. Orthop Clin North Am 39(2):221–228, vi–vii

    Article  PubMed  Google Scholar 

  56. Sanchez-Sotelo J, Morrey BF, O’Driscoll SW (2005) Ligamentous repair and reconstruction for posterolateral rotatory instability of the elbow. J Bone Joint Surg Br 87(1):54–61

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Orthopaedic and Arthroscopic Department, New Sassuolo Hospital, via F. Ruini, 2, Sassuolo, Modena, 41049, Italy

    Luigi Adriano Pederzini & Felice Di Palma

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  1. Luigi Adriano Pederzini
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  2. Felice Di Palma
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Correspondence to Luigi Adriano Pederzini .

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Editors and Affiliations

  1. Knee Orthopedics and Sport Traumatology Unit,, Humanitas Clinical Institute IRCCS, Milan, Italy

    Piero Volpi

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Pederzini, L.A., Di Palma, F. (2016). Elbow Instability. In: Volpi, P. (eds) Arthroscopy and Sport Injuries. Springer, Cham. https://doi.org/10.1007/978-3-319-14815-1_29

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  • DOI: https://doi.org/10.1007/978-3-319-14815-1_29

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-14814-4

  • Online ISBN: 978-3-319-14815-1

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