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Posterolateral Rotatory Instability of the Elbow: Part II. Supplementary Examination and Dynamic Imaging Techniques.

ABSTRACT: Currently, a number of examination and imaging techniques exist for diagnosing posterolateral rotatory instability of the elbow. Although the posterolateral rotatory drawer is the primary examination maneuver, other special tests include the lateral pivot-shift test, prone push-up test, chair push-up test, and tabletop push-up test. In addition, posterolateral rotatory instability can be evaluated using radiography, magnetic resonance imaging, dynamic fluoroscopy, or dynamic ultrasound. In this Technical Note, each of these tests is described in detail. Video instruction is also provided to further explain the techniques and provide examples of positive tests.

SUBMITTER: Camp CL

PROVIDER: S-EPMC5442982 | biostudies-literature |

REPOSITORIES: biostudies-literature

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

Project description:Posterolateral rotatory instability (PLRI) is the most commonly encountered pattern of elbow instability. It is the result of disruption of the lateral collateral ligament complex leading to a posterolateral rotatory subluxation of the ulna and radial head. A number of examination maneuvers have been described to assist in clinical identification of PLRI. Despite this, some inconsistency in the description of these techniques remains in the orthopaedic literature. This Technical Note details the mechanism of injury and patient presentation, and emphasizes the primacy of the posterolateral rotatory drawer test in the assessment of PLRI while providing video instruction on how it should be performed.

| S-EPMC5443138 | biostudies-literature

Arthroscopic Diagnosis of Posterolateral Rotatory Instability of the Elbow.

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Arthroscopic Lateral Collateral Ligament Complex Reconstruction for Posterolateral Rotatory Instability of the Elbow, the Operative Technique.

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| S-EPMC8719306 | biostudies-literature

Lateral Ulnar Collateral Ligament Reconstruction for Posterolateral Rotatory Instability of the Elbow.

Project description:Reconstruction of the lateral ulnar collateral ligament of the elbow is the primary treatment for recurrent symptomatic posterolateral rotatory instability. Although a number of lateral ulnar collateral ligament reconstruction techniques have been described, the docking technique has received general acceptance. In this technique, the graft is passed through a tunnel on the ulnar side and the 2 free limbs are docked into the humerus at the isometric point on the lateral condyle. Advantages of this method of reconstruction include reduced bone removal, decreased soft tissue damage, and precise control of graft tensioning. When precise surgical steps are followed, this technique can be performed in a reliable, efficient, and reproducible manner for patients with posterolateral rotatory instability of the elbow.

| S-EPMC5621830 | biostudies-other

Engaging Posterior Capitellum Fracture and Elbow Posterolateral Rotatory Instability: Is It Always Necessary to Treat the Bone Defect?

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Arthroscopic Reinsertion of Lateral Collateral Ligament, Anterior Capsular Plication, and Coronoid Tunneling Technique for Chronic Elbow Posterolateral Rotatory Instability.

Project description:Posterolateral rotatory instability (PLRI) of the elbow is a chronic condition that results from lateral collateral ligament complex injury and presents with pain, clicking, and subluxation within the flexion and extension arcs of elbow motion. The primary cause involves a lesion of the lateral collateral ligament complex and its avulsion from the lateral epicondyle. In most cases, it is the result of trauma such as a fall on an outstretched hand or any other mechanism that imparts axial compression, valgus force, and supination. Several surgical techniques have been described for the treatment of PLRI, but there is no consensus regarding the ideal surgical treatment. The advantages of an arthroscopic approach for the treatment of PLRI are first diagnostic. Arthroscopy allows for visualization and diagnosis of every compartment of the elbow. The main steps of the surgical procedure consist of reinsertion of the lateral collateral ligament, anterior capsular plication, and coronoid tunneling. By use of this technique, it is possible to perform an anatomic repair and provide stability of the elbow.

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Intraoperative arthroscopic classification tool for posterolateral elbow instability.

Project description:Introducing and implementing an arthroscopic classification tool for posterolateral elbow instability. Thirty arthroscopies were performed on 30 patients, and all recordings were collected, blinded, and labeled. Three orthopedic surgeons reviewed and scored all 30 recordings three times with a period of at least seven days in between to analyze the intraobserver and interobserver reliability. The classification consisted of five different grades. Indications for elbow arthroscopy included impingement (n = 7), osteochondritis dissecans (n = 5), pain (n = 7), osteoarthritis (n = 6), and other (n = 5). The kappa value for intrarater reliability was 0.71, indicating good reliability, while the kappa value for inter-rater reliability was 0.38 indicating fair reliability. This new classification is a tool for an arthroscopic assessment of PLRI and can be used as a standardized grading system for further research and communication between orthopedic surgeons. We demonstrated good intrarater reliability (k = 0.71) with fair inter-rater reliability (k = 0.38). However, further research is necessary to study the clinical significance.

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Occult posterolateral rotatory dislocation of the elbow with olecranon fracture in a child: a case report.

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| S-EPMC3470946 | biostudies-literature

Anconeus-Sparing Minimally Invasive Approach for Lateral Ulnar Collateral Ligament Reconstruction in Posterolateral Elbow Instability.

Project description:Posterolateral elbow instability with an insufficiency of the lateral ulnar collateral ligament commonly results from elbow trauma. However, other etiologies such as iatrogenic injuries after primary surgical treatment for lateral epicondylitis or repetitive corticosteroid injections also may lead to a lateral ulnar collateral ligament insufficiency. In these cases, surgical treatment can help to restore posterolateral stability of the elbow. Besides the stabilizing effect of the ligamentous structures, the anconeus muscle is the most import active stabilizer against posterolateral elbow instability. Therefore, the aim of the present technique is to present an anconeus-sparing, minimally invasive approach to restore posterolateral stability. This technique may serve as an alternative for typically used all open access.

| S-EPMC7093701 | biostudies-literature

Description of the posterolateral rotatory drawer maneuver for the identification of posterolateral corner injury.

Project description:Injury to the posterolateral corner (PLC) is difficult to diagnose; most lesions of this type are included within the context of complex knee injuries. Study of the posterolateral complex is growing in importance because of the complex instability generated by these injuries. Although various physical examination tests are described for the diagnosis of PLC lesions, in 72% of cases these lesions are not identified at their initial presentation, which shows the difficulty in both performing these tests and interpreting the results. The maneuver described in this report is performed by executing external rotation of the leg. With the thumb of the proximally positioned hand, the examiner evaluates the positioning of the lateral tibial plateau in relation to the femoral condyle. With this maneuver, in lesions of the PLC and particularly lesions of its external rotation-restricting structures, we observe external rotation of the tibia and posterior subluxation of the lateral tibial plateau that cause the anterior edge of the tibial plateau to be posteriorized in relation to the anterior edge of the lateral femoral condyle. The idea behind this maneuver is not to eliminate the use of other tests but, rather, to add it to a diagnostic arsenal that still has interpretation flaws.

| S-EPMC4044506 | biostudies-literature

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