Recurrent posterolateral rotatory instability of the elbow is an
apparently undescribed clinical condition that is difficult to diagnose. We
treated five patients, ranging in age from five to forty years, who had
such a lesion and in whom the instability could be demonstrated only by
what we call the posterolateral rotatory-instability test. This test
involves supination of the forearm and application of a valgus moment and
an axial compression force to the elbow while it is flexed from full
extension. The elbow is reduced in full extension and must be subluxated as
it is flexed in order to obtain a positive test result (a sudden reduction
of the subluxation). Flexion of more than about 40 degrees produces a
sudden palpable and visible reduction of the radiohumeral joint. The elbow
does not subluxate without provocation. The cause for this condition, we
think, is laxity of the ulnar part of the lateral collateral ligament,
which allows a transient rotatory subluxation of the ulnohumeral joint and
a secondary dislocation of the radiohumeral joint. The annular ligament
remains intact, so the radio-ulnar joint does not dislocate. Operative
repair of the lax ulnar part of the lateral collateral ligament eliminated
the posterolateral rotatory instability, as revealed intraoperatively in
our five patients.