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Posterolateral Rotatory Instability
- PLRI
Posterolateral rotatory instability (PLRI) is a rare condition where the elbow keeps giving way or nearly
giving way.
The elbow may feel loose or slide out of joint, particularly when pushing up from an arm chair.
Recurrent painful clicking, snapping, clunking, or locking of the elbow are common complaints.
PLRI is most common after previous dislocations of the elbow if the ligaments don't heal properly. It
may happen spontaneously in some patients who's ligaments are very lax and hypermobile.
It may also be a complication of some types of surgery on the lateral aspect (outside) of the elbow.
The underlying problem is the lateral collateral ligaments either stretch out or don't heal down properly, this allows the radial head to rotate
out under the capitellum and the elbow may partially or totally dislocate.
Normal x ray of elbow
Radial head
Capitellum
Diagnosis
The diagnosis may not be clear initially. Physical examination may be normal. Muscle tone and pain often limits simulating the dislocation in
clinic. X rays are often normal.
Some provocation tests may be done in the clinic.
•
Doing a push up with the arms wide apart and hands supinated (hands pointing to sides)
•
Doing a one arm push up on the side of a table
•
Sitting up from the chair pushing up with your arms hands supinated (hands pointing backwards)
An MRI scan may be requested to exclude other causes of lateral sided (outer side) elbow pain.
The definitive diagnosis may only be made during an examination under anaesthetic where the muscles are fully relaxed. An arthroscopy may
also be performed to see the state of the joint surface. Dynamic examination while taking x rays may also demonstrate injury to other
ligamentous structures around the elbow.
Treatment
Non operative
Activity modification, avoid activities that lead to episodes of subluxation. The elbow is most at rest when it is fully straight and the forearm/
hand supinated. It is best to perform stressful activities with the elbow bent. Elbow braces themselves are unlikely to help prevent
subluxation, short of reminding you to avoid risky positions.
Operative
Surgery is indicated if non operative treatment fails. Surgery involves repair and tightening of the lateral ligament ligament if enough good
quality tissue is present. If not suitable for direct repair then reconstruction with a tendon graft may be required.
References
Janak A. Mehta and Gregory I. Bain; Posterolateral Rotatory Instability of the Elbow; J. Am. Acad. Ortho. Surg., November/December 2004; 12:
405 - 415
Charalambous CP, Stanley JK; Posterolateral rotatory instability of the elbow; J Bone Joint Surg Br. 2008 Mar;90(3):272-9.
© Cambridge Orthopaedics - Cambridge; United Kingdom
Posterolateral Rotatory
Instability - PLRI
Posterolateral rotatory instability (PLRI) is a rare condition where the
elbow keeps giving way or nearly giving way.
The elbow may feel loose or
slide out of joint, particularly
when pushing up from an arm
chair.
Recurrent painful clicking,
snapping, clunking, or locking
of the elbow are common
complaints.
PLRI is most common after
previous dislocations of the
elbow if the ligaments don't
heal properly. It may happen
spontaneously in some
patients who's ligaments are very lax and hypermobile.
It may also be a complication of some types of surgery on the lateral
aspect (outside) of the elbow.
The underlying problem is the lateral collateral ligaments either stretch
out or don't heal down properly, this allows the radial head to rotate out
under the capitellum and the elbow may partially or totally dislocate.
Normal x ray of elbow
Radial head
Capitellum
Diagnosis
The diagnosis may not be clear initially. Physical examination may be
normal. Muscle tone and pain often limits simulating the dislocation in
clinic. X rays are often normal.
Some provocation tests may be done in the clinic.
•
Doing a push up with the arms wide apart and hands supinated
(hands pointing to sides)
•
Doing a one arm push up on the side of a table
•
Sitting up from the chair pushing up with your arms hands
supinated (hands pointing backwards)
An MRI scan may be requested to exclude other causes of lateral sided
(outer side) elbow pain.
The definitive diagnosis may only be made during an examination under
anaesthetic where the muscles are fully relaxed. An arthroscopy may
also be performed to see the state of the joint surface. Dynamic
examination while taking x rays may also demonstrate injury to other
ligamentous structures around the elbow.
Treatment
Non operative
Activity modification, avoid activities that lead to episodes of
subluxation. The elbow is most at rest when it is fully straight and the
forearm/ hand supinated. It is best to perform stressful activities with
the elbow bent. Elbow braces themselves are unlikely to help prevent
subluxation, short of reminding you to avoid risky positions.
Operative
Surgery is indicated if non operative treatment fails. Surgery involves
repair and tightening of the lateral ligament ligament if enough good
quality tissue is present. If not suitable for direct repair then
reconstruction with a tendon graft may be required.
References
Janak A. Mehta and Gregory I. Bain; Posterolateral Rotatory Instability of
the Elbow; J. Am. Acad. Ortho. Surg., November/December 2004; 12: 405
- 415
Charalambous CP, Stanley JK; Posterolateral rotatory instability of the
elbow; J Bone Joint Surg Br. 2008 Mar;90(3):272-9.
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