Posterolateral Rotatory Instability of the Elbow: Part I. Mechanism of Injury and the Posterolateral Rotatory Drawer Test

Camp, Christopher L.; Smith, Jay; O’Driscoll, Shawn W.

doi:10.1016/j.eats.2016.10.016

Cited by 26 publications

(11 citation statements)

References 10 publications

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“…O’Driscoll et al describes how soft tissues are disrupted in a circular pattern from lateral to medial in posterior dislocations [ 10 - 11 ]. This is described as a “Circle of Horii” injury [ 12 ]. In the case we describe there was extensive soft tissue injury to the medial structures of the elbow, disruption of the anterior capsule, and no clinical or radiographic evidence of injury to the lateral structures.…”

Section: Discussionmentioning

confidence: 99%

An Unusual Case of Anterior Elbow Dislocation Without Bony Injury

Fahey

Gaafar

Bossut

2021

Cureus

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While elbow dislocation is a common occurrence, the vast majority of them dislocate posteriorly and are due to disruption of the elbow stabilizers, which start on the lateral side and proceed medially, disrupting the anterior and posterior stabilizing structures. We present an unusual case of anterior elbow dislocation, with disruption of the medial stabilizing structures and anterior capsule, without any bony injury. A 44-year-old man presented to the ED after being assaulted. While the exact mechanism of injury was unclear, the patient believes he had been struck with a heavy object on the posterior aspect of his elbow. His dislocation was reduced in the ED, but was highly unstable after reduction. Further imaging revealed disruption of his medial collateral ligaments and common flexor origin. He went on to have an open repair of his medial structures with suture anchors. After six weeks of follow-up he was doing well, with no further episodes of instability and a good functional range of movement. Though rare, anterior elbow dislocations have been reported sporadically in the literature. Surgeons and ED doctors dealing with these injuries should be aware that the maneuvers to relocate the elbow will be different compared to the standard maneuvers used for posterior dislocations. Patients should be examined for stability after reduction, especially on valgus stressing. We would advocate for low threshold for performing an examination under anesthesia (EUA), with open repair of the stabilizing structures if persistently unstable after reduction.

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Section: Discussionmentioning

confidence: 99%

An Unusual Case of Anterior Elbow Dislocation Without Bony Injury

Fahey

Gaafar

Bossut

2021

Cureus

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“…MCL injuries are not uncommon in traumatic, complete elbow dislocations with some studies reporting up to 100% of patients (n = 15) having disruption. 27,28 Therefore, a careful preoperative evaluation is warranted to assess for these concomitant injuries.…”

Section: Discussionmentioning

confidence: 99%

Lateral Ulnar Collateral Ligament Reconstruction for Posterolateral Rotatory Instability of the Elbow: A Systematic Review

Fares

Kusnezov

Dunn

2020

Hand (New York, N,Y.)

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Background: Posterolateral rotatory instability (PLRI) is a common form of recurrent elbow instability. The aim of this systematic review is to present the outcomes and complications of lateral ulnar collateral ligament (LUCL) reconstruction surgery for PLRI. Methods: A literature search of LUCL reconstructions was performed, identifying 99 potential papers; 11 of which met inclusion/exclusion criteria, accounting for 148 patients. Papers were included if they reviewed cases of PLRI from 1976 to 2016 with reported outcome measures. Data were pooled and analyzed focusing on patient demographics as well as subjective and objective patient outcomes and complications. Results: The average age of patients was 34 years with a mean follow-up time of 49.8 months. The most common mechanism of injury was a traumatic elbow dislocation (66%), followed by cubitus varus deformity (7%), and unknown mechanisms (7%). Overall, 90% of patients achieved elbow stability and 2.7% experienced a failed reconstruction that necessitated an additional surgery. Furthermore, 93% were satisfied with the outcome of the reconstruction, and 83% reported good to excellent outcomes with 11% reporting moderate to severe persistent pain. Nearly half (45%) of reconstructions were done using a palmaris longus tendon graft, 24% with a triceps tendon graft, and 7% with a synthetic graft. Conclusions: Outcomes following LUCL reconstruction for PLRI are excellent and revision rates are low. LUCL reconstruction is a safe and reliable procedure. Level of Evidence: IV Therapeutic

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“…We performed the varus stress test and posterolateral rotatory drawer test. 15 16) We defined normal as no difference with the other side, mild instability as mild widening (difference of ≤ 10° in varus stress test) with firm endpoint, and severe instability as apparent widening (difference of > 10° in varus stress test) or subluxation (clunk sensation in posterolateral rotatory drawer test) without an endpoint. MRI findings were evaluated in the fat-suppressed T2-weighted image of the coronal plane.…”

Section: Methodsmentioning

confidence: 99%

“…The clinical scores were collected by a hand fellow who was blinded to this study (NHJ). Range of motion (ROM; passive extension and flexion) was measured, and the varus stress test and posterolateral rotatory drawer test 15 16) were performed at regular follow-ups (3, 6, 12, and 24 months postoperatively) by the surgeon who performed the surgery.…”

Section: Methodsmentioning

confidence: 99%

Clinical Outcomes of Arthroscopic Debridement for Lateral Epicondylitis with Partial Injury of the Lateral Collateral Ligament Complex

et al. 2022

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Background Lateral collateral ligament injuries may occur in patients with chronic lateral epicondylitis. The present study aimed to compare the clinical outcomes of arthroscopic debridement between patients with chronic lateral epicondylitis combined with a partial ligament injury and those without a ligament injury. Methods Between 2016 and 2018, patients who underwent arthroscopic debridement for lateral epicondylitis were evaluated. Partial injury to the lateral collateral ligament was defined as discontinuity or thinning with increased signal of the lateral ligament on magnetic resonance imaging and laxity with a firm endpoint in the varus or posterolateral rotatory stress test. Arthroscopic debridement was performed when there was no apparent instability in the stress test under fluoroscopic guidance after anesthesia. Patients with a ligament injury were compared with those without a ligament injury in terms of physical examination (varus stress test and posterolateral rotatory drawer test), pain visual analog scale, Mayo elbow performance score, and quick disabilities of the arm, shoulder and hand score. Results There were 38 patients in the intact ligament group and 15 patients in the partial ligament injury group. There were 23 men and 30 women, and the mean patient age was 50 years (range, 27–77 years). The mean follow-up period was 30 months (range, 24–49 months). Instability was not observed in both groups at the last follow-up, and clinical scores improved significantly after surgery. Postoperative results did not show significant difference between the two groups. One patient in the partial injury group underwent revision open debridement owing to persistent pain. Conclusions The clinical outcomes of arthroscopic debridement for lateral epicondylitis did not show significant differences between patients with a partial ligament injury and those without a ligament injury.

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Posterolateral Rotatory Instability of the Elbow: Part I. Mechanism of Injury and the Posterolateral Rotatory Drawer Test

Cited by 26 publications

References 10 publications

An Unusual Case of Anterior Elbow Dislocation Without Bony Injury

An Unusual Case of Anterior Elbow Dislocation Without Bony Injury

Lateral Ulnar Collateral Ligament Reconstruction for Posterolateral Rotatory Instability of the Elbow: A Systematic Review

Clinical Outcomes of Arthroscopic Debridement for Lateral Epicondylitis with Partial Injury of the Lateral Collateral Ligament Complex

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