Postero-lateral Elbow Instability

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Definition/Description

Posterolateral rotatory instability (PLRI) of the elbow was first described in 1991 by O’Driscoll et al. as a condition that is part of a spectrum of instability caused by persistent insufficiency of the lateral collateral ligament (LCL) complex, most notably the lateral ulnar collateral ligament (LUCL). (Sanchez-Sotelo-2005, O’Driscoll-1992) In 2008, Charalambous et al. reported, “PLRI is the most common type of symptomatic chronic instability of the elbow.” In PLRI, the proximal radius and ulna externally rotate together as a unit in relation to the humerus, causing posterior subluxation or dislocation of the radial head relative to the capitellum, without associated instability of the proximal radioulnar joint. (Charalambous-2008, Dunning-2001). 

Characteristics/Clinical Presentation

Patients with PLRI may present with a spectrum of different symptoms ranging from vague pain in the elbow to recurrent posterolateral dislocations. The most common patient complaints/symptoms are recurrent popping, clicking, clunking, or locking, accompanied by a sense of instability in the elbow. These symptoms occur during the act of extension and supination, especially when an axial load is applied through the upper extremity. (hickey 2006) (Bell 2008)(Eygendaal 2004) (Charalambous 2008) (Odriscoll 1999) (Murthi 2010) (Mueller 2010) Other symptoms consist of subluxation, a sense of weakness, and functional disability. (Muller 2010)(Bell 2008)Recurrent complete dislocations are rare. (Bell 2008) Pushing down with the upper extremity to rise from a seated position, performing press-up/push-up exercises, and pushing heavy objects with an extended arm are common activities that patients with PLRI report that reproduce their symptoms. (Hickey 2006) (Charalambous 2008)(Murthi 2010)

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