Elbow instability

The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. Posterolateral rotatory instability, stage 2. Coronal FS PD-weighted MRI showing a complete detachment of the proximal lateral ulnar collateral ligament, the proximal radial collateral ligament proper, and the common extensor tendon (white short arrow), with retraction of the lateral ulnar collateral ligament (white arrowhead) and common extensor tendon (long white arrow). Note the extravasation of the joint fluid through the tear (black asterisk)
insightsimaging.springeropen.com • CC-by-4.0
The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. Posterolateral rotatory instability, stage 3B. Consecutive coronal T1-weighted MRI (a–c), and consecutive coronal FS PD-weighted MRI (d–f) showing an acute proximal full-thickness tear of the lateral ulnar collateral ligament and radial collateral ligament (white arrows) and anterior bundle of the medial collateral ligament complex sprain (white arrowheads)
insightsimaging.springeropen.com • CC-by-4.0
The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. Posterolateral rotatory instability, stage 3B. Consecutive coronal FS T1-weighted direct MR arthrographic images (a–f) showing a proximal partial-thickness tear of the anterior bundle of the medial collateral ligament complex (short arrows), proximal complete tear of the lateral ulnar collateral (long white arrows), and partial-thickness tear of the radial collateral ligament proper (white arrowhead)
insightsimaging.springeropen.com • CC-by-4.0
Laterale
(radiale) Bandinstabilität am Ellenbogen nach Luxation: Intraoperative Kontrolle mit Aufklappbarkeit/Distanzierung des Radiusköpfchens vom Capitulum humeri.
Wikipedia • CC BY-SA 4.0
Overuse-related
instability of the elbow: the role of CT-arthrography. Posterolateral rotatory instability (PLRI) at dynamic US examination. The probe is placed in an axial approach between the lateral epicondyle (LE) and the olecranon (O), as the humero-ulnar joint is visualized. While applying a posterolateral rotatory stress, widening of the humero-ulnar joint is determined (white calipers): a widening greater than 4 mm, from resting (a) to stress (b) conditions, is considered indicative of PLRI
insightsimaging.springeropen.com • CC-by-4.0
The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. A 23-year-old man with pain and medial instability after a fall on the outstretched arm. Coronal FS PD-weighted MRI (a) and coronal T1-weighted MRI (b) showing an acute full-thickness proximal tear of the anterior bundle of the medial collateral ligament complex (yellow arrows), a flexor digitorum superficialis muscle edema (white asterisk), a radial head and posterior capitellar contusions (white arrows), and joint effusion
insightsimaging.springeropen.com • CC-by-4.0
The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. A 32-yer-old man with pain and medial instability after a fall on the outstretched arm. Coronal T1-weighted MRI (a) and coronal FS PD-weighted MRI (b) showing an acute avulsion fracture of the anterior bundle of the medial collateral ligament insertion in the sublime tubercle (white arrows), acute partial-thickness proximal tear of anterior bundle of the medial collateral ligament (blue arrow), flexor digitorum superficialis muscle edema (white asterisk), and radial head contusion (white arrowhead)
insightsimaging.springeropen.com • CC-by-4.0
The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. Two different patients with chronic elbow pain and medial instability. Coronal FS PD-weighted MRI (a) showing a chronically thickened anterior bundle of the medial collateral ligament (white arrowhead). Coronal FS PD-weighted MRI (b) showing a chronically thickened anterior bundle of the medial collateral ligament (white arrow), and a deformity of the sublime tubercle due to malunion of an old fracture (white asterisk)
insightsimaging.springeropen.com • CC-by-4.0
The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. Axial illustrations with superior view demonstrating the progression of the structures injured in the posterolateral rotatory instability
insightsimaging.springeropen.com • CC-by-4.0
The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. Anterior view of the elbow demonstrating the progression of the structures injured in a posterior dislocation, from lateral to medial. a Normal. b Proximal disruption of the lateral ulnar collateral ligament (white asterisk). c Proximal disruption of the lateral ulnar collateral ligament and the radial collateral ligament (black asterisk). d Anterior capsule tear (white arrow). Lateral ulnar collateral ligament (LUCL). Radial collateral ligament (RCL). Annular ligament (AL). Anterior bundle of the medial collateral ligament complex (A-MCL)
insightsimaging.springeropen.com • CC-by-4.0
The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. Posterolateral rotatory instability, stage 1. Coronal FS PD-weighted MRI (a, b) and coronal T1-weighted MRI (c, d) showing an avulsion of the proximal lateral ulnar collateral ligament and retraction of the osseous fragment (white arrows). Bone marrow edema is seen in the capitellum (white arrowheads) and radial head (white asterisks)
insightsimaging.springeropen.com • CC-by-4.0
Laterale
(radiale) Bandinstabilität am Ellenbogen nach Luxation in der intraoperativen Durchleuchtung vor Bandrekonstruktion.
Wikipedia • CC BY-SA 4.0
The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. Posterolateral rotatory instability, stage 3B. Consecutive coronal FS T1-weighted direct MR arthrographic images (a, b), sagittal FS T1-weighted direct MR arthrographic image (c), and consecutive axial FS T1-weighted direct MR arthrographic images (d, e) showing a proximal complete tear of the lateral ulnar collateral ligament and radial collateral ligament proper (white short arrows), diffuse partial-thickness tear of the anterior bundle of the medial collateral ligament complex (white arrowheads), and a non-displaced fracture of the coronoid process (long white arrows)
insightsimaging.springeropen.com • CC-by-4.0
The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. Axial FS PD-weighted MRI (a) showing the measurement of normal ulnohumeral incongruity: the distance between the trochlear joint surface and olecranon joint surface (D1, D2, D3, and D4). Sagittal FS PD-weighted MRI (b) showing the measurement of normal radiocapitellar incongruity (RCI): the distance between CAP and R. Axial FS PD-weighted MRI showing an ulnohumeral incongruity of more 1 mm (c). Sagittal FS PD-weight MRI showing a radiocapitellar incongruity of more 2 mm (d)
insightsimaging.springeropen.com • CC-by-4.0
The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. Normal appearance of reconstructed medial collateral ligament (docking technique). Consecutive coronal T1-weighted MRI (a–c) and coronal FS PD-weighted MRI (d). The intact graft (blue arrows) extends from humeral tunnel (blue arrowheads) to ulnar tunnel (yellow arrowheads)
insightsimaging.springeropen.com • CC-by-4.0
The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. Acute subluxation in a handball player with a history of medial instability treated with arthroscopic repair. Consecutive axial FS PD-weighted MRI (a–c), coronal T1-weighted MRI (d), coronal FS PD-weighted (e), and sagittal FS PD-weighted MRI (f) showing a re-tear of the repaired anterior bundle of the medial collateral ligament (white arrowheads), a complete tear of the common flexor tendon (yellow arrows), and a tear of the posterior bundle of the medial collateral ligament (white arrow)
insightsimaging.springeropen.com • CC-by-4.0
The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. Elbow illustrations demonstrating docking technique (a) and Jobe technique (b) for medial collateral ligament reconstruction
insightsimaging.springeropen.com • CC-by-4.0
The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. Lateral view of the elbow demonstrating the open reconstruction technique for lateral ulnar collateral ligament reconstruction
insightsimaging.springeropen.com • CC-by-4.0
Overuse-related
instability of the elbow: the role of CT-arthrography. Elbow 3D reformatting with ligament illustrations. Medial view (a). The medial collateral ligament (MCL) complex and its components: the anterior bundle of the medial collateral ligament (A-MCL), the posterior bundle of the medial collateral ligament (P-MCL), and the transverse ligament (T-MCL). Lateral view (b). The lateral collateral ligament (LCL) complex and its components: the radial collateral ligament (RCL), the lateral ulnar collateral ligament (LUCL), and the annular ligament (AL)
insightsimaging.springeropen.com • CC-by-4.0
The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. Posterolateral rotatory instability, stage 3C. Consecutive coronal FS T1-weighted direct MR arthrographic images (a–c), and consecutive axial FS T1-weighted direct MR arthrographic images (d–f) demonstrating a full-thickness tear of the anterior bundle of the medial collateral ligament complex (yellow arrow), proximal full-thickness tear of the common flexor tendon (short white arrows), proximal full-thickness tear of the common extensor tendon (white arrowheads), proximal complete tear of the lateral ulnar collateral ligament and radial collateral ligament proper (long white arrows), and a complete tear of the posterior bundle of the medial collateral ligament complex (yellow arrowheads)
insightsimaging.springeropen.com • CC-by-4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Elbow instability refers to as an excessive, usually painful, mobility in the elbow joint, most of the time as a result of a prior traumatic event or overuse and maybe also seen in patients with connective tissue disease .

Classification

Elbow instability can be classified in respect of timing (acute, chronic, recurrent), part of joint involved (ulnohumeral, radiocapitellar, proximal radioulnar), degree and direction of displacement and the coexistence of associated fractures :

  • posterolateral rotatory instability (most common)
  • valgus instability (posttraumatic / repetitive microtrauma)
  • varus instability (elbow dislocations)
  • posteromedial rotatory instability
  • anterior instability (rare)

Clinical presentation

Patients usually complain of a characteristic history of either a fall in acute instability or recurrent pain with snapping, popping, locking, clicking or clunking in chronic instability and/or the direct complain and apprehension of subluxation .

Clinical testing includes assessing the physiological range of motion in the elbow joint, where noticeable problems might already occur as well as clinical tests as the lateral pivot-shift test, posterolateral drawer test and posterolateral rotatory apprehension test, table-top relocation test, gravity-assisted varus stress test, etc. .

Pathology

Usually involves acute, chronic or repetitive osseous and /or soft tissue injury of the following structures :

Etiology

Acute instability, dislocations and subluxations usually result from a fall on the outstretched hand (FOOSH) or other acute traumatic event and the eccentric loading forces which act upon the elbow joint and its stabilizing structures .

Chronic and recurrent instability occurs as a result of previous posttraumatic injuries or repetitive microtrauma e.g. repetitive valgus stress in baseball pitching .

Radiographic features

Plain radiograph

Dislocations, subluxations, misalignment and associated (avulsion-) fractures or other underlying osseous abnormalities and may be seen in routine elbow radiographs .

Increased ulnohumeral distance (≥4mm) on a lateral radiograph following reduction is referred to as “drop sign” and indicates instability.

Stress radiographs may show radial head subluxation or ulnohumeral joint asymmetry

CT

Can characterize bony structures in fracture-dislocations or depict subtle fractures e.g. in posteromedial rotatory instability .

MRI

The main utility of MRI lies in the detection of the underlying ligamentous and soft tissue injuries, especially the medial (ulnar) collateral ligament complex in case of valgus instability and to characterize the extent of ligamentous and muscular injury in posterolateral rotatory instability .

Treatment and prognosis

Depending on the instability pattern the age of the patient and other comorbidities treatment varies.

Acute elbow dislocations, not complicated by fractures are treated with closed reduction and subsequent brief immobilization .

Associated fractures should be treated with open reduction, if the elbow is unstable, especially olecranon fractures, which involve the anterior joint surface and the insertion of the ligaments and radial head fractures as well as coronoid process type II and type III fractures .

Posterolateral rotatory elbow instability is usually managed surgically especially in young patients and athletes .

Older patients with associated comorbidities and osteoarthritis may be managed conservatively.

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Ellenbogeninstabilität:
Ellenbogenluxation
 
Wikipedia • CC BY-SA 4.0
Verletzungen
des lateralen Kollateralbandes am Ellenbogen
Wikipedia • CC BY-SA 4.0
medial
collateral ligament injury elbow
insightsimaging.springeropen.com • CC-by-4.0
Osborne-Cotterill-Läsion
 
Wikipedia • CC BY-SA 4.0
posterolaterale
Rotationsinstabilität des Ellenbogens
insightsimaging.springeropen.com • CC-by-4.0