When the joint surfaces of an elbow are forced apart, the elbow is dislocated. The elbow is the second most commonly dislocated joint in adults (after shoulder dislocation). Elbow dislocations can be complete or partial. A partial dislocation is referred to as a subluxation. The amount of force needed to cause an elbow dislocation is enough to cause a bone fracture at the same time. These two injuries (dislocation-fracture) often occur together.
This guide will help you understand
- How the problem develops
- How doctors diagnose the condition
- What treatment options are available
What part of the elbow is affected?
The bones of the elbow are the humerus (the upper arm bone), the ulna (the larger bone of the forearm, on the opposite side of the thumb), and the radius (the smaller bone of the forearm on the same side as the thumb).
What can cause this condition?
This can also result in a fracture/dislocation. About half of all elbow dislocations in teens and young adults occur as a result of a sports activity. The most common elbow dislocations are associated with sports such as gymnastics, cycling, rollerblading, or skateboarding.
Dislocation can also occur from a sideswipe injury. This type of injury occurs when the driver of an automobile has the elbow out the open window during a car accident. The force of the impact causes a severe fracture-dislocation of the elbow.
What does this condition feel like?
If ligaments or other soft tissues are torn, there can be swelling and bruising around the elbow. Bruising is not immediately obvious but appears several days after the injury. Injury to any of the three nerves that cross the elbow (median, ulnar, radial nerves) can cause neurologic symptoms such as numbness, tingling, and/or weakness of the forearm, wrist, and hand. If a bone fracture is also involved the fracture can cut or damage a nerve causing temporary or permanent paralysis.
Pain and an inability to straighten the elbow or pain when turning the hand the palm up (supination) is typical. There is often tenderness along the lateral aspect of the elbow (side of the elbow away from the body).
How do doctors diagnose elbow dislocation?
X-ray is the best way to look for dislocation or fracture-dislocation.
After the joint is relocated, other imaging studies may be ordered to look for damage to the joint cartilage, bone, ligaments, and other soft tissues. If bone detail is difficult to identify on an X-ray, a computed tomography (CT) scan may be done. If it is important to evaluate the ligaments, a magnetic resonance image (MRI) can be helpful.
What treatment options are available?
It is possible for the elbow to relocate by itself. This is more likely when there is a subluxation, rather than a complete dislocation. Sometimes the elbow can be reduced or put back in place by a trained medical person applying a quick motion to the forearm. There are several different methods used for manual (closed) reduction. Closed reduction refers to the fact that the elbow can be put back in joint without surgery. An open incision is not needed.
Manual reduction can be done in an emergency on site (e.g., at an athletic event or car accident) by a trained medical person but usually the procedure is done in a clinic or hospital setting. You would be given medications first to help with the pain.
People who need normal arm strength get best results with surgery to reconnect the tendon right away. Surgery is needed to avoid tendon retraction. When the tendon has been completely ruptured, contraction of the biceps muscle pulls the tendon further up the arm. When the tendon recoils from its original attachment and remains there for a very long time, the surgery becomes harder, and the results of surgery are not as good.
If there is too much swelling, it may be necessary to delay surgery for a few days up to a week. The elbow will be reduced right away and the arm immobilized while waiting for the swelling to subside.
If there has been damage to the bones and/or ligaments, surgery may be needed to restore alignment and function. The type of surgery depends on the extent of the damage. Wires, pins, or even an external fixation device may be needed to hold everything together until healing occurs.
What should I expect after treatment?
Simple elbow dislocations heal well with few (if any) problems. You may notice a slight loss of elbow motion, especially when trying to straighten the arm. This should not affect your overall motion and function. X-rays may be taken while the elbow heals. This will show if the bones of the elbow joint are healing in a reduced position with good alignment.
The arm may be immobilized for 10 to 14 days to allow the ligament to heal. Gentle range of motion may be allowed during that time but you should rely on your physician to advise you. Type of activities and movements allowed are determined according to the type of injury that’s present.
After immobilization, physical therapy may begin. The goal is to restore normal motion, joint proprioception (sense of position), and motor control. The program will progress to include strengthening.
Rehabilitation for the athlete includes sport-specific training is part of the rehab program. Your physical therapist will guide you through this process. Most athletes can resume sports participation three to six weeks after an elbow dislocation. The timing of return to sports depends on the type of sport (e.g., throwing sports may require a longer rehab). Dislocation of the dominant hand may require longer rehab before full motion and strength are restored.
Some athletes continue to wear a protective splint and/or use taping to stabilize the joint during the transition back into action. This can help protect the joint during motion and activity during the final phase of healing.
It’s best to avoid any further traction on the elbow until healing has occurred. Pulling a heavy door open, carrying a heavy purse, or lifting a heavy backpack are a few examples of activities and movements that put a traction force through the elbow. These kinds of movements should be avoided until healing occurs.
Post-operative immobilization is often required, especially for complex injuries. This could be a cast, dynamic splint, or postoperative range-of-motion (ROM) brace. The adjustable ROM brace is used to improve elbow motion gradually while allowing soft tissue healing. It helps minimize scar tissue formation and may contribute to fewer complications (such as arthritis) later on.
After immobilization, physical therapy may begin. The goals are the same as for conservative (nonoperative) care: restore normal motion, joint proprioception (sense of position), and motor control. The program will progress to include strengthening. Rely on your doctor and therapist to guide you through the healing process.
As in conservative care, some athletes continue to wear a protective splint and/or use taping to stabilize the joint during the transition back into action. This can help protect the joint during motion and activity during the final phase of healing.
It’s best to avoid any further traction on the elbow until healing has occurred. Pulling a heavy door open, carrying a heavy purse, or lifting a heavy backpack are a few examples of activities and movements that put a traction force through the elbow. These kinds of movements should be avoided until healing occurs. Your doctor and/or therapist will advise you as you progress through the healing process.
Scar tissue can cause a stiff elbow. Recurrent dislocation is also possible. If either of these problems develops, additional reconstructive surgery may be needed. For some patients, arthritis is a long-term result of elbow injury. This is more likely if there is a history of recurrent elbow dislocations.