Elbow locking and loose bodies

Small fragments of cartilage or bone may come loose following trauma or occur  spontaneously in the

elbow joint.

 They then float around inside the joint.

 This leads to episodes of clicking, clunking and locking of the elbow joint.

 As a patient you will have episodes where the elbow jams/ locks so you can't bend or straighten it.

 Often by wiggling or shaking the joint it will then unlock itself as the loose body floats into another part of

the joint.

 Arthritis and osteochondritis dissecans often lead to loose body formation.

 The diagnosis of loose bodies is often made mostly on the history of episodic locking.

 A few rare conditions can simulate locking eg. PLRI - PosteroLateral Rotatory Instability - This is where part of the elbow partially dislocates

 X rays may show the loose bodies, however because of the overlapping shadows of 2 dimensional imaging they are not always seen.

 CT and MRI scans can miss loose bodies.

 The best test to see a loose body is to inject the joint with contrast and then do an MRI or CT.

 This is often not necessary, as if the history is typical for a loose body, an examination under anaesthetic and arthroscopy can be diagnostic and

therapeutic.

Treatment

Loose bodies sometimes will float away from the joint and stick down on the side wall and never cause problems again.

 The mere presence of a loose body does not mandate treatment, treatment is based on symptoms.

 If things do not resolve spontaneously and the symptoms of locking and pain are severe enough the loose bodies are best removed.

 This is most often undertaken as an arthroscopic (keyhole) procedure.

 This can be performed as a day case, as no muscles or ligaments are cut with the arthroscopic procedure.

 Rehabilitation and recovery times are significantly reduced.