The elbow is an inherently stable joint, due to 1) the congruent and form-fitting nature of the bones, 2) the muscles that cross the joint and tighten it, and 3) the collateral ligaments along the lateral and medial side of the joint that hold the humerus to the forearm.
Despite the stability of the joint, injuries creating instability of the elbow can occur. The elbow is the second most commonly dislocated joint in the human body (behind the shoulder). Elbow dislocations usually occur as the result from a fall onto the hand, or from another person falling onto the outside of the elbow such as during contact sports (see image on right)
Aside from a sudden traumatic event like a dislocation, an elbow joint can also become unstable due to chronic overuse. This can occur from various stresses on the elbow, but is occasionally seen in baseball pitchers that injure their medial collateral ligament and subsequent require “Tommy John surgery”.
Injuries to the soft tissues around the elbow can result in subsequent elbow problems such as weakness, instability, stiffness, or arthritis (see images below)
Other injuries to the collateral ligaments of the elbow may require surgery. Dr. Schreiber has published research on treating unstable elbows with repair of the injured ligaments. For more information, click here.
Complete elbow dislocations are not subtle, and are usually reduced (relocated) either immediately at the time of injury or under sedation in an emergency room. Mild elbow instability can be subtle, and the diagnosis is made from x-rays and from a physical examination.
Acute elbow dislocations can usually be successfully treated non-surgically. During the healing process, specific rehabilitation protocols are used to minimize tension on the injured structures and optimize the chance that the ligaments heal in a normal (and not lengthened or lax) position. An overhead motion protocol can allow early range of motion by placing the elbow in a protected position (see figure below).
By performing range of motion exercises in a supine (lying down) position, the weight of the forearm helps to hold the elbow joint reduced, whereas performing early motion with the arm by your side results in gravity causing distraction across the joint. It also transitions the triceps muscle from a joint distracting force to a joint stabilizing force.
The overhead motion protocol has been shown to produce excellent range of motion outcomes following elbow dislocations. To read more about Dr. Schreiber’s research on the overhead motion protocol and outcomes following elbow injuries, click here
Other injuries to the collateral ligaments of the elbow may require surgery. Dr. Schreiber has published research on treating unstable elbows with repair of the injured ligaments. For more information, click here
Dr. Schreiber is a board certified orthopedic surgeon specializing in hand, wrist, and elbow conditions. Dr. Schreiber practices at the Raleigh Orthopaedic Clinic in Raleigh, North Carolina.