Selected Instructional Course Lecture   |    
The Recurrent Unstable Elbow: Diagnosis and Treatment
Anand M. Murthi, MD1; Jay D. Keener, MD2; April D. Armstrong, MD3; Charles L. Getz, MD4
1 Shoulder and Elbow Service, Department of Orthopaedic Surgery, Union Memorial Hospital, 3333 North Calvert Street, Suite 400, Baltimore, MD 21218. E-mail address: amurthi@gcoa.net
2 Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110. E-mail address: keenerj@wudosis.wustl.edu
3 Department of Orthopaedics, Penn State University School of Medicine, 500 University Drive, P.O. Box 850, Hershey, PA 17033. E-mail address: aarmstrong@hmc.psu.edu
4 Department of Orthopaedic Surgery, Thomas Jefferson University School of Medicine, Rothman Institute, 1015 Walnut Street, Philadelphia, PA 19107. E-mail address: charlesgetz@hotmail.com
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Zimmer, Inc., and Ascension Orthopedics).

An Instructional Course Lecture, American Academy of Orthopaedic Surgeons
Printed with permission of the American Academy of Orthopaedic Surgeons. This article, as well as other lectures presented at the Academy's Annual Meeting, will be available in February 2011 in Instructional Course Lectures, Volume 60. The complete volume can be ordered online at www.aaos.org, or by calling 800-626-6726 (8 a.m.-5 p.m., Central time).

Copyright ©2010 American Society for Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Jul 21;92(8):1794-1804
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The elbow has always been a difficult joint to manage because of the subtle nuances of pathology, examination, and treatment. Patients experiencing the sequelae of recurrent elbow instability can lose a substantial amount of function in the affected upper extremity. Elbow instability comprises a wide spectrum of disease ranging from valgus instability in the throwing athlete to traumatic recurrent rotatory instability to iatrogenic damage. Our goal in this article is to provide readers with information to guide them in the development of a systematic algorithm for the treatment of a variety of elbow instability problems. First, we will discuss basic elbow biomechanics and their alterations in the unstable elbow. Next, a thorough discussion of the history, physical examination, and imaging studies necessary to diagnose these injury patterns will be presented. Finally, we will discuss the nuances in the treatment of both medial/valgus elbow injuries and posterolateral rotatory instability of the elbow. Cutting-edge advances in surgical reconstruction of the unstable elbow will allow those caring for these difficult injuries to make the proper management decisions.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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