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The mechanism of injury detailed in the stem would lead to posterolateral rotatory instability (PLRI), which results from injury to the lateral ulnar collateral ligament (LUCL), labeled E in Figure A. PLRI typically occurs after a fall on the outstretched hand, generating an axial load, valgus force, and an external rotational moment (supination) about the forearm with respect to the humerus. This initial injury results in the radial head and proximal ulna subluxating posterolaterally away from the humerus in a rotatory fashion and damage to the lateral collateral ligament (LCL) complex, with the LUCL being the most robust of this complex. The other ligaments of the LCL include the radial collateral ligament (RCL), accessory ligament, and annular ligament. Characteristic symptoms of PLRI include clicking and locking with extension and difficulty getting out of a chair or performing tricep arm dips. Camp et al. reviewed the patient presentation and physical examination of PLRI. They reported that the most common cause of PLRI is trauma, but may also be seen with tennis elbow, iatrogenic injury from prior lateral elbow surgery, or tardy PLRI caused by cubitus varus from malunion of a childhood supracondylar humerus fracture. They recommended the posterolateral rotatory drawer test as the most sensitive and reliable method for evaluating PLRI in the awake and anesthetized patient. Fedorka et al. reviewed PLRI. They reported that the diagnosis is often based on clinical examination, using provocative maneuvers such as the posterolateral rotatory instability test, the posterolateral drawer test, and the chair push-up test. They recommended that a repair be performed when the ligamentous tissue is amenable and that reconstruction with autograft is performed otherwise. Figure A is a schematic of the elbow collateral ligaments. Illustration A is the labeled version of Figure A. Incorrect Answers: Answer 1: Label A depicts the annular ligament, which is part of the LCL complex. However, this does not contribute to PLRI like the LUCL. Answer 2-4: Isolated injuries to the anterior, posterior, and transverse medial ulnar collateral ligaments would not result in PLRI.
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