Posterolateral Rotatory Instability of the Elbow

with Rehab

ExitCare ImagePosteriolateral rotatory instability of the elbow is caused by a tear (sprain) of the lateral ulnar collateral ligament (LUCL) of the elbow. Ligaments are soft tissue structures that attach bones to bones and help maintain proper bone alignment across a joint. The LUCL helps maintain the alignment of the upper arm bone (humerus), and the forearm bones (the ulna, and the radius). Injury to the LUCL often causes the ligament to be stretched, causing the elbow joint to be loose. Injuries to the elbow, such as dislocation, falling on an outstretched hand, or even surgery, may cause damage to the LUCL. Sprains are classified into three categories. Grade 1 sprains cause pain, but the tendon is not lengthened. Grade 2 sprains include a lengthened ligament due to the ligament being stretched or partially ruptured. With grade 2 sprains there is still function, although the function may be diminished. Grade 3 sprains are characterized by a complete tear of the tendon or muscle, and function is usually impaired.

SYMPTOMS

  • Pain, tenderness, and or bruising (contusion) around the elbow.

  • Vague elbow pain.

  • Elbow instability including: clicking, snapping, clunking.

  • Bones become out of alignment, so the joint surfaces do not touch (dislocation), bones become out of alignment, but the joint surfaces still touch (subluxation).

  • Pain that worsens with elbow function.

CAUSES

A sprain occurs when a force is placed on a ligament that is greater than it can withstand. Common mechanisms of injury include:

  • Elbow dislocation.

  • Falling on an outstretched hand.

  • Complication from tennis elbow (lateral epicondylitis) surgery.

RISK INCREASES WITH:

  • Activities in which falling are likely (football or rugby).

  • Previous elbow injury.

  • Poor strength and flexibility

PREVENTION

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Learn and use proper technique when falling. When possible, have a coach correct improper technique.

PROGNOSIS

Posterolateral rotatory instability does not heal naturally. If you begin noticing symptoms, then a brace may help alleviate pain and improve function. Surgery is often necessary to regain complete function that is followed by 6 months of rehabilitation.

RELATED COMPLICATIONS

  • Recurrent symptoms that result in a chronic problem.

  • Prolonged healing time, if improperly treated or re-injured.

  • Risks of surgery: infection, bleeding, nerve damage, or damage to surrounding tissues.

  • Injury to other structures of the elbow (articular cartilage).

  • Arthritis of the elbow.

  • Elbow stiffness with permanent limitation of elbow motion.

  • Prolonged disability.

TREATMENT

Treatment initially involves the use of ice and medication to help reduce pain and inflammation. The use of strengthening and stretching exercises may help reduce pain with activity. These exercises may be performed at home or with referral to a therapist. Your caregiver may recommend that you wear a brace to help reduce symptoms. Surgery is usually recommended to regain full function of the elbow. Surgery involves replacing the ligament with other tissue (reconstructing) the ligament. After surgery the elbow will be immobilized for a period of time to allow for healing. After immobilization it is important to perform strengthening and stretching exercises to help regain strength and a full range of motion.

MEDICATION

  • If pain medication is necessary, then nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication for 7 days before surgery.

  • Prescription pain relievers may be given if deemed necessary by your caregiver. Use only as directed and only as much as you need.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or massage the area with a piece of ice (ice massage).

  • Heat treatment may be used prior to performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or soak the injury in warm water.

SEEK MEDICAL CARE IF:

  • Treatment seems to offer no benefit, or the condition worsens.

  • Any medications produce adverse side effects.

  • Any complications from surgery occur:

  • Pain, numbness, or coldness in the extremity operated upon.

  • Discoloration of the nail beds (they become blue or gray) of the extremity operated upon.

  • Signs of infections (fever, pain, inflammation, redness, or persistent bleeding).

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Posterolateral Rotatory Instability of the Elbow

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

RANGE OF MOTION – Supination, Active-Assisted

  • Sit with your right / left elbow bent 90 degrees and rest your forearm on a table.

  • Keeping your upper body and shoulder in place, roll your forearm so your palm faces upward. When you can go no farther, use your opposite hand to help until you feel a gentle to moderate stretch. Hold for __________ seconds.

  • Slowly release the stretch and return to the starting position.

Repeat __________ times Complete this exercise __________ times per day.

RANGE OF MOTION – Pronation, Active-Assisted

  • Sit with your right / left elbow bent 90 degrees and rest your forearm on a table.

  • Keeping your upper body and shoulder in place, roll your forearm so your palm faces the tabletop. When you can go no farther, use your opposite hand to help until you feel a gentle to moderate stretch. Hold for __________ seconds.

  • Slowly release the stretch and return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image RANGE OF MOTION – Supination, Active

  • Stand or sit with your elbows at your side. Bend your right / left elbow to 90 degrees.

  • Turn your palm upward until you feel a gentle stretch on the inside of your forearm.

  • Hold this position for __________ seconds. Slowly release and return to the starting position.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image RANGE OF MOTION – Pronation, Active

  • Stand or sit with your elbows at your side. Bend your right / left elbow to 90 degrees.

  • Turn your palm downward until you feel a gentle stretch on the top of your forearm.

  • Hold this position for __________ seconds. Slowly release and return to the starting position.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image RANGE OF MOTION – Extension

  • Hold your right / left arm at your side and straighten your elbow as far as you can using your right / left arm muscles.

  • Straighten the right / left elbow farther by gently pushing down on your forearm until you feel a gentle stretch on the inside of your elbow. Hold this position for __________ seconds.

  • Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image RANGE OF MOTION – Flexion

  • Hold your right / left arm at your side and bend your elbow as far as you can using your right / left arm muscles.

  • Bend the right / left elbow farther by gently pushing up on your forearm until you feel a gentle stretch on the outside of your elbow. Hold this position for __________ seconds.

  • Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image RANGE OF MOTION – Elbow Flexion, Supine

  • Lie on your back. Extend your right / left arm into the air, bracing it with your opposite hand. Allow your right / left arm to relax.

  • Let your elbow bend, allowing your hand fall slowly toward your chest.

  • You should feel a gentle stretch along the back of your upper arm and/or elbow. Your physician, physical therapist or athletic trainer may ask you to hold a __________ lbs hand weight to increase the intensity of this stretch.

  • Hold for __________ seconds. Slowly return your right / left arm to the upright position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH – Elbow flexors

  • Lie on a firm bed or countertop on your back. Be sure that you are in a comfortable position which will allow you to relax your arm muscles.

  • Place a folded towel under your upper arm so that your elbow and shoulder are at the same height. Extend your arm; your elbow should not rest on the bed or towel

  • Allow the weight of your hand to straighten your elbow. Keep your arm and chest muscles relaxed. Your caretaker may ask you to increase the intensity of your stretch by adding a small wrist or hand weight.

  • Hold for __________ seconds. You should feel a stretch on the inside of your elbow. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image RANGE OF MOTION – Wrist Flexion, Active-Assisted

  • Extend your right / left elbow with your fingers pointing down.*

  • Gently pull the back of your hand towards you until you feel a gentle stretch on the top of your forearm.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

*If directed by your physician, physical therapist or athletic trainer, complete this stretch with your elbow bent rather than extended.

ExitCare Image RANGE OF MOTION – Wrist Extension, Active-Assisted

  • Extend your right / left elbow and turn your palm upwards.*

  • Gently pull your palm/fingertips back so your wrist extends and your fingers point more toward the ground.

  • You should feel a gentle stretch on the inside of your forearm.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

*If directed by your physician, physical therapist or athletic trainer, complete this stretch with your elbow bent, rather than extended.

STRENGTHENING EXERCISES - Posterolateral Rotatory Instability of the Elbow

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Progress the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does worsen, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your clinician.

ExitCare Image STRENGTH – Elbow Flexors, Supinated

  • With good posture, stand or sit on a firm chair without armrests. Allow your right / left arm to rest at your side with your palm facing forward.

  • Holding a __________ weight or gripping a rubber exercise band/tubing,

  • bring your hand toward your shoulder.

  • Allow your muscles to control the resistance as your hand returns to your side.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Elbow Flexors, Neutral

  • With good posture, stand or sit on a firm chair without armrests. Allow your right / left arm to rest at your side with your thumb facing forward.

  • Holding a __________ weight or gripping a rubber exercise band/tubing, bring your hand toward your shoulder.

  • Allow your muscles to control the resistance as your hand returns to your side.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Elbow Extensors

  • Lie on your back. Extend your right / left elbow into the air, pointing it toward the ceiling. Brace your arm with your opposite hand.*

  • Holding a __________ weight in your hand, slowly straighten your right / left elbow.

  • Allow your muscles to control the weight as your hand returns to its starting position.

Repeat __________ times. Complete this exercise __________ times per day.

*You may also stand with your elbow overhead and pointed toward the ceiling and supported by your opposite hand.

ExitCare Image STRENGTH - Elbow Extensors, Dynamic

  • With good posture, stand or sit on a firm chair without armrests. Keeping your upper arms at your side, bring both hands up to your right / left shoulder while gripping a rubber exercise band/tubing. Your right / left hand should be just below the other hand.

  • Straighten your right / left elbow. Hold for __________ seconds.

  • Allow your muscles to control the rubber exercise band/tubing as your hand returns to your shoulder.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Forearm Supinators

  • Sit with your right / left forearm supported on a table, keeping your elbow below shoulder height. Rest your hand over the edge, palm down.

  • Gently grip a hammer or a soup ladle.

  • Without moving your elbow, slowly turn your palm and hand upward to a "thumbs-up" position.

  • Hold this position for __________ seconds. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Forearm Pronators

  • Sit with your right / left forearm supported on a table, keeping your elbow below shoulder height. Rest your hand over the edge, palm up.

  • Gently grip a hammer or a soup ladle.

  • Without moving your elbow, slowly turn your palm and hand upward to a "thumbs-up" position.

  • Hold this position for __________ seconds. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Wrist Flexors

  • Sit with your right / left forearm palm-up and fully supported. Your elbow should be resting below the height of your shoulder. Allow your wrist to extend over the edge of the surface.

  • Loosely holding a __________ weight or a piece of rubber exercise band/tubing, slowly curl your hand up toward your forearm.

  • Hold this position for __________ seconds. Slowly lower the wrist back to the starting position in a controlled manner.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Wrist Extensors

  • Sit with your right / left forearm palm-down and fully supported. Your elbow should be resting below the height of your shoulder. Allow your wrist to extend over the edge of the surface.

  • Loosely holding a __________ weight or a piece of rubber exercise band/tubing, slowly curl your hand up toward your forearm.

  • Hold this position for __________ seconds. Slowly lower the wrist back to the starting position in a controlled manner.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Ulnar Deviators

  • Stand with a ____________________ weight in your right / left hand or sit holding on to the rubber exercise band/tubing with your opposite arm supported.

  • Move your wrist so that your pinkie travels toward your forearm and your thumb moves away from your forearm.

  • Hold this position for __________ seconds and then slowly lower the wrist back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Radial Deviators

  • Stand with a ____________________ weight in your right / left hand or sit holding on to the rubber exercise band/tubing with your arm supported.

  • Raise your hand upward in front of you or pull up on the rubber tubing.

  • Hold this position for __________ seconds and then slowly lower the wrist back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.