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Elbow

LUCL Injury: the elbow that clicks and gives way.

Injury to the lateral ulnar collateral ligament, the main stabilizer on the outside of the elbow, leads to posterolateral rotatory instability. Dr. Lee reconstructs these injuries using anchor and internal-brace constructs he helped design.

Written bySteven J. Lee, MD · Chief of Hand and Upper Extremity Surgery, Lenox Hill Hospital
Last reviewed · May 2026

The lateral ulnar collateral ligament (LUCL) is the key stabilizer on the outer side of the elbow. When it is torn or stretched, the joint can rotate and shift abnormally, a pattern called posterolateral rotatory instability (PLRI). It often follows an elbow dislocation, a fall, or, occasionally, prior surgery or repeated cortisone injections at the outer elbow.

Patients describe clicking, clunking, or a feeling that the elbow is about to give way, usually when pushing up from a chair or with the arm extended and the palm up. The symptoms can be subtle, and the diagnosis is often missed until instability is specifically tested for.

Symptoms

Common findings include:

  • Clicking, clunking, or catching on the outer elbow
  • A sense the elbow may slip or give way, especially pushing up with the palm up
  • Pain and apprehension at the outer elbow
  • A history of elbow dislocation or injury

How it is diagnosed

The diagnosis rests on specific instability tests on examination, supported by MRI and sometimes an examination under anesthesia. Because routine imaging can look normal, an exam by a surgeon who tests for this pattern is what makes the diagnosis.

Dr. Lee's approach

The first step is recognizing the instability, which is frequently overlooked. Dr. Lee tests specifically for posterolateral rotatory instability and confirms it with imaging.

When the ligament is repairable, it is reattached to the bone with suture anchors. When the tissue is insufficient, the ligament is reconstructed with a tendon graft. In both cases an internal brace tape protects the repair during healing and allows earlier motion. Dr. Lee helped design the anchor and internal-brace constructs used in this reconstruction.

Repair

When the ligament tissue is good, often in a more acute injury, it is reattached to the bone with suture anchors and protected with an internal brace tape, which supports the repair while it heals.

Reconstruction

When the ligament cannot be repaired, it is reconstructed with a tendon graft, again augmented with an internal brace. The construct restores the outer-side stability the elbow depends on.

Recovery timeline

Recovery protects the reconstruction while restoring motion:

  1. Weeks 0 to 2
    Hinged brace, protecting the repaired ligament. Begin guided motion within a safe arc. Hand and shoulder motion encouraged.
  2. Weeks 2 to 6
    Progressive motion in the brace. Avoid positions that stress the repair.
  3. Weeks 6 to 16
    Strengthening and a graded return to activity and sport, guided by stability and strength.

What patients commonly misunderstand

What tends to get overlooked:

  • It is often missed. Posterolateral rotatory instability can be subtle and is frequently overlooked, sometimes mislabeled as tennis elbow. A targeted instability exam is what uncovers it.
  • Repeated cortisone at the outer elbow can contribute. Multiple steroid injections into the outer elbow can weaken the ligament. This is one reason injections for outer-elbow pain are used judiciously.

This page is general educational content authored by Dr. Lee. It is not a substitute for individual medical advice. Every patient's case is different, book a consultation to discuss yours.

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Patient questions

LUCL injury and elbow instability, answered.

  • What does a LUCL injury feel like?

    Most people notice clicking, clunking, or a feeling that the elbow might slip or give way, often when pushing up from a chair with the palm turned up, or with the arm extended. There is usually pain and apprehension on the outer side of the elbow, frequently after a previous dislocation or injury.

  • Why was it missed before?

    Posterolateral rotatory instability can be subtle, and routine X-rays often look normal. It is diagnosed with specific instability tests on examination, supported by MRI. An evaluation by a surgeon who tests for this pattern is what typically makes the diagnosis.

  • How is it fixed?

    If the ligament tissue is good, it is reattached to the bone with suture anchors and protected with an internal brace tape. If the tissue is insufficient, it is reconstructed with a tendon graft, also augmented with an internal brace. Dr. Lee helped design the anchor and internal-brace constructs used for this reconstruction.

Next step

Elbow that clicks, catches, or feels unstable? The fix starts with the right diagnosis.

Lateral elbow instability is treatable, but it has to be recognized first. Dr. Lee tests specifically for posterolateral rotatory instability and reconstructs it with anchor and internal-brace techniques he helped design.

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