Have You Suffered An
Elbow Dislocation?

An elbow dislocation is a serious injury. If you have experienced this elbow injury you’ll want to understand your options. Is surgery necessary? What type of recovery can you expect following this elbow injury?





Elbow Anatomy

The elbow is comprised of three bones: the humerus, ulna, and radius. The ulna and humerus connect to create the hinge joint known as the elbow and allows for the movements of elbow flexion and extension (bending and straightening). The connection of the radius to the ulna and allows for rotation of the forearm (called pronation and supination).

The bones are surrounded by ligaments, tendons, nerves, and arteries that are all vital to the functioning of the elbow, wrist, and hand.


elbow anatomy


What is an Elbow Dislocation?

A dislocation of any joint is when the joint comes out of place. In the case of the elbow, the most common type of dislocation is a posterior dislocation. This occurs when the ulna moves posterior or backwards when compared to the humerus. The most common cause for this type of dislocation is a fall on an outstretched arm.


elbow dislocation


It is not uncommon to sustain a fracture associated with an elbow dislocation. This generally signifies a more significant injury with surgery often necessary in order to realign bones for proper healing.


Another type of dislocation occurs in young children. When a child, usually under the age of 5, is lifted up by the wrist, tension on the elbow can allow the radius to become separated from the rest of the elbow. This type of dislocation is commonly referred to as a pulled elbow.


Pulled Elbow


When the elbow is dislocated, injury to the ligaments around the elbow also occurs. The ligaments function to provide stability to the joint thus when the joint becomes disrupted, so have the ligaments.


Diagnosis

When an elbow dislocates, diagnosis is often made rather quickly secondary to the obvious deformity that occurs. X-rays will be taken to confirm the dislocation, determine the direction of movement, and examine if any fracture has also occurred.

An elbow dislocation is a serious injury and should be evaluated immediately. Dislocation of the joint can also disturb the arteries and nerves that travel trough the elbow. The doctor will do simple tests such as finding a radial pulse and pressing on the nail bed to determine if the circulation is impaired. Sensation and movement tests will help determine if there is any nerve injury involvement.



Typical Treatment

For children with a pulled elbow dislocation, reduction of the dislocation is made easily in the ER with no splinting or immobilization necessary. The use of ice therapy and pain medication may be helpful in the short term but recovery is generally rapid.

For those above the age of 5, the first step following a traumatic elbow dislocation is to reduce or put the elbow back into place. Generally x-rays are repeated after the joint is put back into place to make sure no fractures occurred when reducing the dislocation.

For complex dislocations in which fractures have occurred and are displaced, surgery will be necessary to reconnect the bones and possibly repair ligaments. If significant ligament damage is also suspected and MRI will be ordered after the elbow is put back into place.

After the elbow is put back into joint, the use of a splint and sling are used to immobilize the joint. The elbow has a tendency of becoming stiff with immobilization thus movement is often allowed in just a few weeks following dislocation. The greatest difficulty following dislocation is regaining the ability to fully straighten the elbow. Physical therapy will be an important aspect to achieving this goal.


Physical Therapy

One of the most common issues associated with elbow dislocations is residual elbow stiffness. Research supports the use of early range of motion activities following dislocation of the elbow and reduces the likelihood of a flexion contracture or inability to fully straighten the elbow.

Typical physical therapy will incorporate modalities and soft tissue massage to help reduce the swelling. Manual stretching will also be performed by the therapist with an early emphasis on obtaining elbow extension. As range of motion returns, strengthening exercises for the elbow, wrist, and hand will be incorporated into the overall rehabilitation program.


Long Term Prognosis

The good news is that for those that have a simple dislocation in which no surgery is required, return to normal activity is common. Simple dislocations can require up to three months to obtain full elbow use. More complex dislocations that require surgery can result in long term issues such as elbow pain or limited range of motion. Following the recommendations of the surgeon and physical therapist will increase the likelihood of a more positive outcome.



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References

Open Orthop J. 2010 Feb 17;4:76-9.Dislocation of the elbow: a retrospective multicentre study of 86 patients.de Haan J, Schep NW, Zengerink I, van Buijtenen J, Tuinebreijer WE, den Hartog D.

J Bone Joint Surg Am. 2011 Jul 6;93(13):1220-6.Patient-reported outcomes after simple dislocation of the elbow.Anakwe RE, Middleton SD, Jenkins PJ, McQueen MM, Court-Brown CM.

J Am Acad Orthop Surg. 1998 Jan-Feb;6(1):15-23.Acute elbow dislocation: evaluation and management.Cohen MS, Hastings H 2nd.

Hand Clin. 2004 Nov;20(4):389-404.Simple dislocations of the elbow: evaluation and treatment.Sheps DM, Hildebrand KA, Boorman RS.