Elbow instability in Vienna
The elbow feels insecure when you push up on it, it snaps or gives way — often after a dislocation, sometimes creeping in over years. I clarify which ligament has given way and discuss with you whether training is enough or whether a ligament reconstruction is sensible.
In short
The term elbow instability is used when the ligaments no longer guide the joint securely and the ulna and radius give way under load. Usually it is the outer ligament complex with the LUCL that is affected — after a dislocation or through years of loading from pushing up on the arm; less often the medial collateral ligament in throwing sports. Typical signs are insecurity when pushing up, snapping, and pain on one side of the joint. I examine clinically and with ultrasound; where needed, an X-ray or MRI follows, and if the findings stay unclear, arthroscopy shows the instability. Treatment is conservative first — if the joint stays insecure, I reconstruct the ligament.
What is elbow instability?
The elbow is a hinge with a rotational function: the bony surfaces of the humerus, ulna and radius interlock, guided by two ligament complexes — on the outside by the LUCL (lateral ulnar collateral ligament), on the inside by the medial collateral ligament. If one of these loses its tension, the joint gives way under load. The trigger is often a single event: a fall onto the outstretched arm or an elbow dislocation, in which the outer ligament complex usually tears and the radial head not infrequently breaks along with it.
The second form comes on gradually: repeated pushing up on the arm, throwing and striking loads or recurring states of irritation at the outer tendon attachment stretch the ligaments over years. Symptoms on the outer side are then easily confused with a tennis elbow (epicondylitis lateralis). In medical terms, a distinction is made between posterolateral rotatory instability (giving way towards the back and outside) and medial instability with gapping on the inner side. An overview is given on the page about elbow surgery in Vienna.
Typical symptoms
- Insecurity when pushing up — the arm gives way when getting up from a chair or during a press-up
- Snapping and clicking — above all with the arm almost straight and the hand turned outwards
- Pain on the outer side — depending on load, often with an irritated tendon attachment
- Pain on the inner side — when throwing, striking or lifting, at times with a loss of strength
- Tingling in the ring and little finger — when the ulnar nerve is irritated as well, see cubital tunnel syndrome
- Loss of extension — the arm can no longer be straightened fully, see stiff elbow
How I make the diagnosis
At the beginning there is a detailed conversation: when did it happen, what brings on the giving way? I then examine clinically, test the collateral ligaments under varus and valgus stress and check the rotational stability with pushing movements. Ultrasound is available in the practice: with it I assess ligaments, tendon attachment and effusion and make the gapping visible in comparison with the other side. Where needed I arrange an X-ray for bony avulsions or an MRI for ligaments and cartilage. If the findings stay unclear, elbow arthroscopy shows the instability under direct view.
Treatment: conservative first
Not every instability has to be operated on. The muscles around the elbow can compensate in part for missing ligament tension if they are trained in a targeted way. I therefore begin with physiotherapy and exercise therapy — both in the same building at the Orthozentrum Döbling — and with an adjusted load at work and in training.
I treat accompanying irritation in the practice: shockwave therapy, focused and radial, for an irritated tendon attachment; an ultrasound-guided injection when pain blocks the exercise therapy; PRP therapy for a stubbornly irritated tendon attachment; and magnetic field therapy in addition. The aim is to relieve the pain and to make the arm able to carry load again — the damage to the ligament itself is not repaired by these methods.
When an operation is necessary
If the elbow stays insecure despite consistent training, or if it gives way in everyday life, reconstruction of the ligament is sensible. Fresh injuries can often be treated by reattaching the torn ligament complex. In chronic instability I replace the stretched ligament: on the outside as an LUCL reconstruction, on the inside as a medial ligament reconstruction, using a tendon from your own body placed in bone tunnels.
Beforehand I look inside the joint in many cases: arthroscopy shows how far the elbow gaps open and makes it possible to remove loose bodies or to release scarring (arthrolysis). I carry out necessary procedures at the ATOMOS Klinik Währing, the Privatklinik Döbling or the Rudolfinerhaus, and I accompany you from planning through the procedure to aftercare.
A guided build-up with physiotherapy follows; I prepare athletes step by step for loads from pushing up, throwing and striking — more on this under sports orthopaedics in Vienna. Whether an operation takes place depends on the findings; we make the decision together as soon as the examination and imaging are available.
Frequently asked
Frequently asked questions about elbow instability
A typical sign is a feeling of insecurity when pushing up on the hand: when getting up from a chair or during a press-up. It is accompanied by snapping, clicking or brief giving way, mostly with the arm almost straight. If these signs appear after a dislocation or a fall, have the elbow assessed.
No. If the elbow gives way only with certain movements, I begin with targeted training of the stabilising muscles and with an adjusted load. Whether an operation is sensible depends on which ligament is affected, on accompanying damage to bone and cartilage, and on what you ask of the arm. The decision is made together, as soon as all findings are available.
LUCL stands for the lateral ulnar collateral ligament, the outer ligament that secures the elbow against rotating out towards the back and outside. If it is torn off or stretched, I replace it with a tendon from your own body, which I anchor in bone tunnels. With fresh injuries, reattaching it is often enough.
The medial collateral ligament is loaded above all in throwing and striking movements, for instance in the javelin or in handball. If it tears or becomes stretched, pain on the inner side and a loss of strength when throwing follow. If the elbow stays unstable despite training, I reconstruct the ligament with a tendon from your own body and, where needed, free the ulnar nerve.
Not inevitably. After a simple dislocation the ligaments often heal if the arm is moved early and under guidance. A residual instability is more likely to remain if bone was injured as well, for instance the radial head or the coronoid process of the ulna. Get in touch if the joint stays insecure or can no longer be straightened fully.
The instability often only shows itself when the elbow is relaxed and tested under direct view. In arthroscopy I introduce a camera through small entry points, test the gapping and assess cartilage, capsule and the ligament attachments. In this way I recognise accompanying damage and can treat it in the same procedure.
My practice is a private practice, in Austria a Wahlarztordination. I do not settle directly with any public health insurer; you receive an invoice and submit it to your insurer — on request I take care of the submission for you. For an operation, direct settlement with a supplementary private insurance is possible; for an appointment you do not need a referral.
Dr. med. Martin Eigenschink
Specialist in Orthopaedics and Traumatology · Specialist in elbow, shoulder and hand surgery
Surgical and conservative treatment of the elbow, shoulder and hand, preferably minimally invasive. Practice at the Orthozentrum Döbling, 1190 Vienna. More about my background
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You can reach me on 01 2080145, Monday to Friday from 9:00 to 16:00; consultations are by arrangement. How billing in a private practice works is described on its own page.
Medical notice: The contents of this page serve as general information. They do not replace a medical examination, diagnosis or individual advice. Medicine is a constantly evolving field — despite careful research, no guarantee can be given that the content is fully up to date.