1. What Are Cubitus Varus & Cubitus Valgus?
The normal arm has a natural angle between the upper arm and forearm when the elbow is fully extended. This is known as the carrying angle.
When this alignment becomes abnormal, the condition may be classified as:
Cubitus Varus
Cubitus varus is an inward angulation of the arm at the elbow.
It is often referred to as a gunstock deformity because of the characteristic appearance of the arm.
Cubitus Valgus
Cubitus valgus is an excessive outward angulation of the forearm relative to the upper arm.
Both conditions may result from congenital abnormalities, growth disturbances, or previous fractures.
2. What Is Gunstock Deformity?
Gunstock deformity is a commonly used term for cubitus varus.
It frequently develops after a childhood elbow fracture, particularly when a supracondylar humerus fracture heals with abnormal alignment.
The deformity may involve more than simple sideways angulation.
There may also be:
✔ Rotation
✔ Flexion or extension deformity
✔ Three-dimensional bone malalignment
For this reason, correction should be planned according to the complete three-dimensional deformity rather than the visible angle alone.
3. Causes of a Crooked Arm
Possible causes include:
✔ Childhood elbow fractures
✔ Supracondylar humerus fracture malunion
✔ Growth plate abnormalities
✔ Congenital bone deformities
✔ Previous trauma
✔ Abnormal bone healing
✔ Previous surgery
✔ Developmental abnormalities
A history of childhood fracture is particularly important in adults who have had a crooked elbow for many years.
4. Symptoms of Cubitus Varus & Cubitus Valgus
Patients may notice:
✔ Arm bending inward or outward
✔ Different carrying angles between the two arms
✔ Visible asymmetry
✔ Difficulty fully bending or straightening the elbow
✔ Elbow discomfort
✔ Joint instability
✔ Fatigue with prolonged arm use
✔ Functional limitations
✔ Cosmetic concerns
Some patients have little pain but are concerned about significant asymmetry.
Others may develop functional or neurological problems depending on the type and severity of deformity.
5. Long-Standing Crooked Arm Deformity
Some adults have lived with cubitus varus or cubitus valgus since childhood.
A deformity that has been present for several decades does not automatically mean that correction is impossible.
However, long-standing deformities require careful evaluation of:
✔ Bone anatomy
✔ Elbow joint condition
✔ Range of motion
✔ Rotation
✔ Muscle and tendon balance
✔ Nerve function
✔ Previous fracture or surgery
✔ Patient age and bone quality
Corrective surgery is considered only after evaluating the expected benefits and limitations for the individual patient.
6. Diagnosis
Evaluation may include:
✔ Physical examination
✔ Measurement of the carrying angle
✔ Comparison with the opposite arm
✔ Range-of-motion testing
✔ Evaluation of rotational deformity
✔ Nerve examination
✔ X-rays
✔ Additional imaging when necessary
Surgical planning should evaluate the deformity in multiple planes rather than relying only on the visible elbow angle.
7. Non-Surgical Treatment
Mild deformities without significant symptoms may not require surgery.
Conservative treatment may include:
✔ Observation
✔ Physical therapy
✔ Range-of-motion exercises
✔ Strengthening
✔ Treatment of associated pain
However, exercises or physical therapy cannot substantially change a fixed structural bone deformity.