APEX Elbow Mastering Surgical Techniques for Clinical Success-LUCL and Lateral Elbow Instability

Video Transcription

Video Summary

The transcript covers diagnosis and treatment of lateral elbow instability, focusing on LUCL injury and posterolateral rotatory instability (PLRI). The speaker reviews elbow stabilizers (ulnohumeral articulation, ligament complexes, radiocapitellar joint, and dynamic flexor/extensor muscles) and explains that PLRI is a 3‑D subluxation of the forearm away from the trochlea, often after dislocation, iatrogenic injury (e.g., tennis elbow surgery), or steroid injections.<br /><br />A case is presented: a 17‑year‑old athlete with recurrent traumatic elbow dislocations, clicking, and apprehension with weight bearing, generalized hyperlaxity (Beighton 9/9), posterolateral tenderness, and a positive chair push-up test; pivot shift is limited by apprehension. Faculty emphasize high suspicion, x-rays mainly to rule out fractures and assess alignment, MRI as confirmatory but often indirect/limited for LUCL visualization, and possible use of fluoroscopy comparing sides.<br /><br />Given chronic recurrent instability and poor tissue quality, the surgeon performs open LUCL reconstruction (Kocher approach) using allograft and a humeral docking technique, tensioned around 40–60° flexion in mid-pronation. Post-op rehab includes splinting, hinged bracing with extension blocks, avoiding shoulder abduction and passive supination early, gradual ROM, strengthening, and return to contact sports around 6 months.

Asset Caption

Moderator: Mandeep S. Virk, M.D.

Keywords

lateral ulnar collateral ligament (LUCL) injury

posterolateral rotatory instability (PLRI)

lateral elbow instability diagnosis

chair push-up test and pivot shift test

open LUCL reconstruction with humeral docking technique

postoperative rehabilitation and return to sport