O'Driscoll's 1991 paper defines posterolateral rotatory instability (PLRI) of the elbow as a previously undescribed clinical entity. It identifies insufficiency of the ulnar part of the lateral collateral ligament (LUCL) as the causative lesion. Five patients are presented, and the PLRI test is introduced as the only reliable diagnostic maneuver.
Patients with episodic elbow instability after dislocation were routinely misdiagnosed with recurrent ulnohumeral or proximal radio-ulnar joint dislocation before this paper. No reproducible test existed, and the LUCL's role in preventing ulnohumeral axial rotation was not widely recognized.
When a patient describes the elbow giving way only in extension with the forearm supinated, perform the PLRI test — not a standard valgus stress test, which will be negative. When assessing valgus stability after elbow dislocation, pronate the forearm first. Laxity in supination does not confirm MCL injury; it may reflect LUCL insufficiency. Only laxity in pronation isolates the anterior MCL.
After acute dislocation with intact medial structures, apply a hinged brace with the forearm in full pronation. This reduces the lateral side and allows the torn LUCL to approximate and heal without surgery.
This paper directly enabled subsequent LUCL reconstruction techniques and established iatrogenic PLRI. After lateral epicondylitis release or radial head excision. As a distinct complication to counsel patients about.
O'Driscoll's 1991 paper defines posterolateral rotatory instability (PLRI) of the elbow as a previously undescribed clinical entity. It identifies insufficiency of the ulnar part of the lateral collateral ligament (LUCL) as the causative lesion. Five patients are presented, and the PLRI test is introduced as the only reliable diagnostic maneuver.
Patients with episodic elbow instability after dislocation were routinely misdiagnosed with recurrent ulnohumeral or proximal radio-ulnar joint dislocation before this paper. No reproducible test existed, and the LUCL's role in preventing ulnohumeral axial rotation was not widely recognized.
When a patient describes the elbow giving way only in extension with the forearm supinated, perform the PLRI test — not a standard valgus stress test, which will be negative. When assessing valgus stability after elbow dislocation, pronate the forearm first. Laxity in supination does not confirm MCL injury; it may reflect LUCL insufficiency. Only laxity in pronation isolates the anterior MCL.
After acute dislocation with intact medial structures, apply a hinged brace with the forearm in full pronation. This reduces the lateral side and allows the torn LUCL to approximate and heal without surgery.
This paper directly enabled subsequent LUCL reconstruction techniques and established iatrogenic PLRI. After lateral epicondylitis release or radial head excision. As a distinct complication to counsel patients about.