Why Your Elbow Keeps Giving Out

An elbow that keeps giving out, buckling, clicking, or feeling unstable during activity is a sign of elbow instability. This is not a vague description of elbow pain. It is a specific structural problem where the ligaments, bones, or soft tissues that hold the elbow joint in place have been damaged or weakened to the point where the joint cannot maintain normal position under load. Left unaddressed, elbow instability does not resolve on its own. It typically worsens, expands into surrounding structures, and limits function in ways that progressively affect daily life and sports activities. If you’re still wondering why your elbow keeps giving out, this guide answers it all.

What Is Elbow Instability?

The elbow joint is a hinge joint formed by three bones: the humerus, which is the upper arm bone, and the two bones of the forearm, the radius and ulna. These three bones are held together and stabilized by a network of ligaments, tendons, and soft tissues on both the inner side and outer side of the elbow. The joint allows the arm to bend, straighten, and rotate at the wrist and forearm with a high degree of precision.

Elbow instability occurs when one or more of these stabilizing structures fail. The result is a joint that moves abnormally, catching, clicking, slipping, or giving way during activity. Patients describe the sensation differently: some say the elbow feels loose, others describe a sudden giving out during pushing or lifting movements, and others report a reproducible click or clunk when extending the arm.

Elbow instability is distinct from general elbow pain. Many patients with overuse injuries such as tennis elbow, golfer’s elbow, or biceps tendon irritation have significant elbow pain but a structurally stable joint. Instability means the joint mechanics themselves are compromised. Accurate diagnosis of which problem is present, or whether both are present, determines the appropriate treatment path.

Types of Elbow Instability

Elbow instability is not a single condition. There are several distinct types, each defined by which structures are involved and how the joint fails. Identifying the correct type is essential for building effective treatment plans.

Posterolateral rotatory instability is the most commonly diagnosed form of elbow instability in clinical practice. It involves failure of the lateral collateral ligament complex on the outer side of the elbow, allowing the forearm bones to rotate and sublux away from the upper arm bone during certain movements, particularly when the arm is extended and loaded. Patients with posterolateral rotatory instability often report a clicking or giving out sensation when pushing up from a chair or performing overhead movements.

Medial instability, also called valgus instability, is the type most commonly seen in overhead throwing athletes, particularly baseball pitchers. Repetitive valgus stress from throwing places enormous load on the medial collateral ligament on the inner side of the elbow, leading to progressive stretching, partial tearing, or complete rupture of the ligament over time. This is the injury pattern that leads to UCL reconstruction, commonly known as Tommy John surgery, in competitive throwers.

Common Causes of Elbow Instability and Elbow Pain

Elbow instability and the elbow pain that accompanies it arise from a range of causes. Understanding what caused the problem helps determine which structures are involved and what treatment is likely to work.

Elbow Dislocation and Traumatic Injury

A dislocated elbow is one of the most common causes of elbow instability. When the elbow joint is forcibly displaced, the ligaments on one or both sides are torn, the joint capsule is damaged, and in some cases the radial head or other bones sustain fractures. Most patients who experience a dislocated elbow are treated with closed reduction and immobilization, but the torn ligaments that allowed the dislocation to occur do not always heal with full tensile strength. The result is residual elbow instability that may not become symptomatic until the patient returns to loading the arm in sports activities or physical work.

Overuse Injuries and Repetitive Motion

Repetitive motion is one of the most common causes of elbow injuries in both athletes and working adults. Overuse injuries develop when the tendons, ligaments, and soft tissues of the elbow are subjected to repetitive stress without adequate recovery. Tennis elbow, formally called lateral epicondylitis, affects the tendons on the outer side of the elbow and causes pain with gripping, wrist extension, and repetitive movements. Golfer’s elbow, formally called medial epicondylitis, affects the tendons on the inner side and causes pain with gripping, flexion, and forearm rotation. Both conditions cause persistent pain that worsens with repetitive use and can, over time, contribute to structural changes that affect elbow stability.

Biceps Tendon Injury

The biceps tendon attaches at the radial head and plays an important role in elbow flexion and forearm rotation. A distal biceps tendon rupture, which typically occurs during a sudden eccentric load such as catching a heavy object, causes sudden pain at the front of the elbow, weakness, and sometimes a visible deformity in the upper arm where the biceps muscle retracts. Partial biceps tendon tears cause chronic pain and weakness without complete rupture. Both injuries affect elbow mechanics and require evaluation by an orthopedic surgeon.

Cubital Tunnel Syndrome

Cubital tunnel syndrome involves compression of the ulnar nerve as it passes through the cubital tunnel on the inner side of the elbow. It causes pain, numbness, and tingling along the inner forearm and into the ring and small fingers. While not an instability condition per se, cubital tunnel syndrome is closely associated with medial elbow pain and instability in patients who have chronic valgus stress to the elbow, and it is frequently present alongside medial collateral ligament injuries in throwing athletes.

Other Common Causes of Elbow Pain and Instability

Other common causes include rheumatoid arthritis and other inflammatory joint conditions that damage the soft tissues and articular surfaces of the elbow joint, olecranon bursitis involving the fluid filled sac at the back of the elbow that becomes inflamed with trauma or repetitive pressure, broken bone injuries to the radial head or coronoid process that disrupt the bony architecture of the joint, and prior elbow surgery that inadvertently destabilized one of the ligament complexes. Each of these conditions presents with its own pattern of elbow pain and functional limitation that requires individual assessment.

How Elbow Instability Is Diagnosed

Accurate diagnosis of elbow instability requires combining the patient’s history with a targeted physical examination and appropriate imaging tests. No single test tells the whole story, and the clinical picture has to be assembled carefully.

Medical History

The orthopedic specialist will take a thorough medical history focused on how the elbow problem started, whether there was a traumatic injury or elbow dislocation, the pattern of symptoms including when the elbow gives out or hurts most, what activities provoke symptoms, and what prior treatment or surgery the patient has undergone. In throwing athletes, the history includes pitch count, mechanics changes, and onset of symptoms relative to activity. This context shapes which structures the physical examination focuses on.

Physical Examination

The physical examination for elbow instability includes assessment of range of motion, palpation of specific anatomical landmarks, and provocative stress tests designed to reproduce the instability. The lateral pivot shift test is the primary clinical test for posterolateral rotatory instability and involves applying a specific rotational force to the extended elbow to reproduce the subluxation. The moving valgus stress test is used to identify medial collateral ligament injury by reproducing pain on the inner side of the elbow during a simulated throwing motion. These tests require examiner experience to perform and interpret accurately.

Imaging Tests

X rays are obtained first to assess bone alignment, joint space, and the presence of any fracture, loose body, or degenerative change. X rays cannot directly visualize ligaments but provide essential structural context. MRI is the primary imaging test for evaluating the ligaments, tendons, and soft tissues of the elbow. An MRI with contrast or MRI arthrogram improves the ability to detect partial ligament tears and cartilage damage that standard MRI may underestimate. Ultrasound is sometimes used to evaluate the biceps tendon or other superficial structures in real time during movement.

Treatment Options for Elbow Instability and Elbow Pain

Treatment of elbow instability depends on the type and severity of the instability, the underlying cause, the patient’s activity demands, and whether prior treatment has been attempted. The table below provides a structured overview of available treatment options.

Non-Surgical Treatment

Non-surgical treatment is the appropriate first-line approach for most elbow conditions that do not involve complete ligament rupture or acute trauma requiring immediate surgical intervention. Rest and activity modification reduce stress on injured ligaments and tendons and allow the healing process to start. Over the counter medications such as NSAIDs help reduce swelling and manage persistent pain during the early phase. Physical therapy is central to non-surgical management and focuses on restoring range of motion, strengthening the forearm muscles and muscles surrounding the elbow joint, and correcting movement patterns that contribute to repetitive stress.

For overuse injuries such as tennis elbow, golfer’s elbow, and partial biceps tendon injuries, platelet rich plasma injection is an evidence-supported option that promotes tissue healing in the tendons and soft tissues. Studies show platelet rich plasma improves outcomes in chronic lateral epicondylitis compared to corticosteroid injection at six to twelve month follow-up, with lower rates of recurrence. Physical therapy following injection optimizes the healing response.

When Surgery Is Required

Surgery becomes necessary when conservative treatment fails to resolve the instability, when the ligament damage is too severe for non-surgical healing, or when the patient’s demands require a level of elbow stability that physical therapy alone cannot restore.

Ligament reconstruction is the primary surgical treatment for elbow instability. For medial instability, UCL reconstruction using a tendon graft restores the medial collateral ligament and is the procedure that returns most high-level throwing athletes to sport. For posterolateral rotatory instability, reconstruction of the lateral collateral ligament complex restores the outer-side stabilizers of the elbow joint. Both procedures require a structured rehabilitation program of six to twelve months before return to full sport activity.

In severe cases involving a dislocated elbow with associated fractures, combined surgical repair of the bones and ligaments is performed acutely to restore the joint architecture and allow early controlled movement. Delayed or inadequate treatment of complex elbow dislocation injuries significantly worsens long-term outcomes and increases the likelihood of requiring more surgery.

How Dr. Thornton Approaches Elbow Instability

Steven J. Thornton, MD evaluates every elbow patient with the same standard: a full clinical picture before any recommendation is made. Elbow pain and instability are not treated based on imaging findings alone. The history, physical examination, activity demands, and prior treatment history all factor into the diagnosis and the plan.

Dr. Thornton treats the full spectrum of elbow conditions, from overuse injuries and cubital tunnel syndrome to complex ligament reconstruction and post-dislocation instability. For patients who require surgery, Dr. Thornton performs ligament reconstruction using modern arthroscopic-assisted and open techniques, with rehabilitation protocols designed around each patient’s specific sport or occupational demands.

If your elbow keeps giving out, catches or clicks during movement, or causes persistent pain that has not responded to rest and basic treatment, that is the signal to seek care from an orthopedic specialist with specific experience in elbow conditions. Waiting does not improve elbow instability. Early, accurate diagnosis and an effective treatment plan give the best outcome.

Frequently Asked Questions

Why does my elbow keep giving out?

An elbow that gives out is most commonly caused by elbow instability, where the ligaments that hold the elbow joint in position have been damaged or weakened. The most frequent culprit is posterolateral rotatory instability involving the lateral collateral ligament, though medial instability from throwing sports and instability following a dislocated elbow are also common causes. Accurate diagnosis requires a physical examination and imaging to identify which structures are involved.

Can elbow instability be treated without surgery?

Yes, in many cases. Mild to moderate elbow instability, particularly in patients without complete ligament rupture, often responds well to physical therapy, activity modification, and bracing. Physical therapy strengthens the forearm muscles and dynamic stabilizers around the elbow joint to compensate for ligament laxity. Surgery is indicated when conservative treatment fails, when the ligament is completely torn, or when the patient’s demands require a level of stability that rehabilitation alone cannot provide.

What is posterolateral rotatory instability of the elbow?

Posterolateral rotatory instability is the most common form of elbow instability. It occurs when the lateral collateral ligament complex on the outer side of the elbow fails, allowing the forearm bones to rotate away from the upper arm bone during certain movements. Patients typically describe a clicking or giving out sensation when pushing up from a chair, performing push-ups, or extending the arm under load. It is often caused by a prior dislocated elbow or repeated trauma to the outer side of the joint.

What is the difference between tennis elbow and elbow instability?

Tennis elbow, or lateral epicondylitis, is an overuse injury affecting the tendons on the outer side of the elbow. It causes pain with gripping and repetitive movements but does not involve structural instability of the joint. Elbow instability means the joint mechanics themselves are abnormal and the elbow shifts out of its normal position under load. Both conditions cause elbow pain, but they have different causes, different examination findings, and different treatment pathways. Some patients have both conditions simultaneously.

When should I seek medical attention for elbow pain?

Seek care from an orthopedic specialist if your elbow gives out, clicks, or buckles during activity; if elbow pain is persistent and has not improved with rest after two to four weeks; if you have experienced a dislocated elbow or traumatic injury; if you have significant weakness or numbness in the forearm or wrist; or if pain is interfering with daily life or sports activities. Early evaluation produces better outcomes than waiting for symptoms to worsen.

The Bottom Line

An elbow that keeps giving out is telling you something specific: the structural stability of the joint has been compromised. Whether the cause is a prior dislocated elbow, torn ligaments from throwing sports, overuse injuries that have progressed to structural damage, or a chronic condition affecting the soft tissues and bones of the elbow joint, the underlying problem requires accurate diagnosis and appropriate treatment, not just rest and time.

Most patients with elbow instability can be treated effectively without surgery when the condition is identified early and the right physical therapy program is put in place. Patients with complete ligament tears, failed conservative treatment, or activity demands that require full joint stability are well served by ligament reconstruction, which has a strong track record of returning athletes and active patients to full function.

The worst outcome is continuing to load an unstable elbow without understanding what is wrong. That leads to progressive damage to the joint, the tendons, and the surrounding structures, and it narrows the treatment options over time.

To schedule an evaluation with Dr. Steven J. Thornton, MD for elbow pain or instability, contact online now.

Written by:

Dr. Steven J. Thornton, MD is a board-certified orthopedic surgeon and sports medicine specialist serving patients across the Dallas and Fort Worth metroplex. Fellowship-trained at the Hospital for Special Surgery affiliated with Weill Cornell Medicine, Dr. Thornton specializes in minimally invasive shoulder, knee, hip, and elbow procedures. To schedule a consultation, contact the practice today.