الفهرس 
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Abstract
Aim of the work
The aim of this essay is to
Describe different types of elbow instability and early diagnosis and treatment of the elbow instability.
Summary and conclusion
The elbow is a hinge joint with rotation in a single constrained plane, it is composed of three joints, the ulno-humeral joint which is the primary determinant of the bony elbow stability, the radio-capitellar joint which affords secondary valgus stress resistance to compressive loads across the joint and the radio-ulnar joint. The elbow has two major ligaments, medial and lateral collateral ligaments which are play an important role in elbow stability. The medial collateral ligament consists of three basic components and anterior oblique, a posterior oblique and a small transverse non- functioning band. The anterior band is the primary constraint to valgus instability. The lateral collateral ligament’s components are the lateral ulnar collateral ligament which is the significantly important component, the radial collateral ligament, the accessory ligament and the quadrate ligament (283).
The three prerequisite for the stability of the ulno-humeral articulation are an intact joint surface, the anterior medial collateral ligament and the ulnar part of the lateral collateral ligament. Although chronic valgus instability is rarely a debilitating complication of elbow dislocation. Recent studies of the anatomy and cytology of injury have fostered an awareness of its role in high performance athletes. The overuse of the upper extremity may result in micro rupture of the soft tissues such as the medial collateral ligament and tendons. Micro tears within the ligaments and tendons can lead to frank disruption of these structures if the offending activity is continued (284).
The diagnosis of MCL insufficiency is based on detailed history and physical examination. Postero-lateral ratatory instability of the elbow is a clinical entity that can be distinguished from dislocation of the elbow. It can be diagnosed by lateral pivot shift test. The causes appear to be insufficiency (laxity or detachment of the origin of the ulnar part of the lateral collateral ligament. Recurrent instability is usually due to insufficiency of the lateral ulnar collateral ligament with attenuation of the other secondary soft tissue constraint on the lateral side (285).
A rational approach to the management of complex instability recognizes both the articular and the soft tissue contributions, it should be simplified by stating that the presence of normal articular architecture, the anterior band of the MCL and the ulnar part of the LCL are all that is acquired for a stable elbow. The principle of reconstruction is to restore the functional integrity of these two bands which are analogous to each other, this is currently done using palmaris longus tendon reconstructions in treating valgus instability in throwing athletes and postero-lateral rotatory instability. The anatomic placement of the origins is critical to the success of each surgery. Also external and internal fixation of associated fractures and radial head arthroplasty has an important role in elbow stability (286).