The elbow is formed by the junction of the humerus (upper arm bone), and radius and ulna (forearm bones). These three bones articulate to form the elbow joint, which is held and supported by muscles and strong ligaments called the lateral ligament (on the outer side) and ulnar collateral ligament (on the inner side). Injury to these ligaments cause elbow instability and dislocation of the joint. Ligament injuries of the elbow can often be missed by the non-upper limb surgeon. This can lead to chronic pain, clicking, weakness and feeling of instability around the elbow. Recurrent or chronic elbow instability is characterised by repeated looseness of the joint and feeling that it may move out of place. Other symptoms include catching, clicking or locking of the elbow. It may also be associated with a fracture of the elbow. Recurrent or chronic elbow instability may be caused by trauma, falling on an outstretched arm or repeated stress as seen in sports activities that involve overhead movement of the arm. Acute instability may also be associated with a fracture of the elbow.
Dr Bala would review your medical history, perform a detailed physical exam and order imaging studies (X-ray, Stress x-rays, Ultrasound or MRI or MR arthrogram scan) to diagnose recurrent elbow instability.
Non-surgical treatment with bracing, NSAIDs, activity modification and physiotherapy may be all that you need to manage your instability. However, it is common that the ligaments require surgery, such as repairs the ligament and stabilisation of the elbow fractures with pins or screws. In some cases, a radial head replacement (partial joint replacement) or reconstruction of the damaged ligament with a tissue graft is required.
The most common ligament injured in the elbow is the Medial Collateral Ligament or MCL (also called the Ulnar Collateral ligament or UCL) which is on the inside of the elbow connecting the inner tip of the arm bone to inner forearm bone. The other common ligament injured is the Lateral Collateral Ligament or LCL (also called the Lateral Ulnar Collateral Ligament or LUCL).
Dr Bala uses a tendon graft from the patients’ own forearm to reconstruct the UCL. This procedure is called the Tommy Jones operation. He uses the technique called the Docking technique where tunnels are drilled through both the inner aspect of the arm bones and the inner forearm bone at the anatomic site where the old ligament was and the new ligament is passed through these tunnels and secured onto itself with screws and strong suture material.
In the event you may have a tattoo on the elbow Dr Bala is well versed in suturing tattoos back accurately with absorbable sutures.