Elbow Instability (Including Posterolateral Rotatory Instability)
What is Elbow Instability?
Elbow instability means the elbow does not stay properly aligned, usually due to ligament injury. Posterolateral rotatory instability is the most common form, where the radius and ulna rotate outward due to lateral ligament damage.
What is This Condition?
Often occurs after an elbow dislocation or ligament injury
Can be subtle, with the elbow “slipping” or feeling unstable during certain movements
What are the Symptoms?
Pain or a sense of giving way when pushing up from a chair or doing a push-up
Clicking, locking, or catching sensations
Recurrent elbow dislocations in some cases
Weakness or loss of trust in the arm during activity
What Causes It?
Elbow dislocations or trauma
Repetitive stress (throwing, weightlifting)
Ligament laxity or prior surgeries that disrupted stability
How is It Diagnosed?
Exam: specific instability tests (pivot shift test)
X-rays/CT: may show subtle changes
MRI: evaluates ligament integrity
How is It Treated?
Non-surgical:
Physical therapy is the cornerstone of treatment. Strengthening the muscles that support the elbow — especially the forearm flexors, extensors, and shoulder stabilizers — can help compensate for stretched or torn ligaments.
Therapy also improves coordination and motion patterns, which reduces painful instability episodes.
Bracing may be used during activities to provide additional support while the muscles are retrained.
Many patients with mild instability or partial ligament injuries can regain good function with a dedicated therapy program alone.
Surgical:
Recommended if instability is severe, recurrent, or does not improve with therapy.
Options include repairing or reconstructing the damaged ligaments, often using tendon grafts.
In complex or recurrent cases, additional bone procedures or grafting may be necessary.
Learn more from AAOS (OrthoInfo):
https://orthoinfo.aaos.org/en/diseases--conditions/recurrent-and-chronic-elbow-instability/