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Significant rotatory instability found with cutting the humeral origin of the LCL
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BOSTON — At the American Shoulder and Elbow Surgeons Open Symposium, Hill Hastings II, MD, discussed how posterolateral rotatory instability occurs in the elbow and how the understanding of this is critical for repair.
“Posterolateral rotatory instability is most common with trauma,” Hastings said. “It is the first stage developed with dislocation. Its understanding is critical for repair. When there is good tissue, then just primary tissue reconstruction will suffice most of the time.”
Hastings noted patients mainly experience significant posterolateral rotatory instability after the humeral origin of the lateral collateral ligament (LCL) is cut and not from the cutting away of the extensor carpal nerve or the annular ligament. Significant instability also results when the rest of the annular ligament is cut.
“I used to think that attachment to the ulna was important, but we found that by transecting it proximal to distal, and then even further distal, you could see we created little instability,” Hastings said. “It was only when you cut the muscular origin and then the more coalesced fibers proximally, you created a significant instability.”
According to Hastings, posterior lateral rotatory instability can be indicated by a lateral popping, clicking pain experienced by patients, administration of more than three steroid injections, a failed lateral epicondylectomy, a fistula or effusion after tennis elbow surgery, or apprehension to perform push-ups. – by Casey Tingle
Reference:
Hastings 2nd, H. LCL instability/reconstruction. Presented at: American Shoulder and Elbow Surgeons Open Symposium; Oct. 6, 2016; Boston.
Disclosure: Hastings reports no relevant financial disclosures.