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Wheeless' Textbook of Orthopaedics

Posterolateral Elbow Instability


- Discussion:
    - arises from disruption of the lateral collateral and annular ligaments;
    - associated conditions: elbow dislocation, radial head excision, coronoid fracture
    - diff dx: lateral epicondylitis

    - LCL anatomy:
           -  lateral collateral ligament consists of a ligamentous expansion proceding down from lateral epicondyle to ulna (major expansion
                  which inserts into supinator crest of ulna) and also sends expansions down to annular ligament and radius; 
           - 3 layers:
                  - deep layer = joint capsule = radial collateral ligament;
                  - intermediate layer is the annular ligament;
                  - superficial layer is the LCL:
           - LUCL:
                  - ligament that arises from lateral humeral epicondyle and inserts on the supinator crest of the ulna;
                  - acts as a posterior buttress for the radial head to prevent its subluxation;      

           - ECU tendon and the supinator tendon (the later merges with the LCL) both resist posterolateral instability;
           - greater role with increased flexion
           - lateral ulnar collateral ligament deficiency=Posterolateral rotatory instability
           - additional deficiency of radial collateral ligament=Dislocation 
           - references:
                  - The effect of arthroscopic sectioning of the lateral ligament complex of the elbow on posterolateral rotatory stability. 
                  - Ligamentous stabilizers against posterolateral rotatory instability of the elbow.
                  - Functional anatomy of the lateral collateral ligament complex of the elbow: morphology and strain.
                  - The in Vivo Isometric Point of the Lateral Ligament of the Elbow

- Radiographic Findings:
      -
Magnetic resonance imaging in diagnosis of chronic posterolateral rotatory instability of the elbow.
      - Posterolateral rotatory instability of the elbow: usefulness of MR imaging in diagnosis.

- Non Operative Treatment:
    - forearm should be immobilized in pronation, where as elbow may be allowed free flexion-extension in a hinged brace




Morrey BH. Anatomy of the Elbow Joint.  In:  Morrey BH. The elbow and its disorders. 3rd Ed.

Rotatory instability of the elbow. The anatomy and role of the lateral stabilizers.

Posterolateral rotatory instability of the elbow.

Ligamentous reconstruction for posterolateral rotatory instability of the elbow.  

Table top relocation test—New clinical test for posterolateral rotatory instability of the elbow. 

Posterolateral rotatory instability of the elbow in association with lateral epicondylitis. A report of three cases.

Functional outcomes of surgical reconstruction for posterolateral rotatory instability of the elbow.

Atypical Etiology of Lateral Collateral Ligament Disruption and Instability.




Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, May 28, 2013 8:16 am