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.
Three bones come together to make up the elbow joint. The humerus is the bone in the upper arm. Two bones from the forearm (the radius and the ulna) form the lower part of the elbow. Each of these bones has a very distinct shape. Ligaments connected to the bones keep all of these bones in proper alignment.
The elbow is both a hinge joint and a ball and socket joint. As muscles contract and relax, two unique motions occur at the elbow.
Bending occurs through a hinge joint that allows the elbow to bend and straighten. This is called flexion and extension, respectively.
Rotation occurs though a ball and socket joint that allows the hand to be rotated palm up and palm down. This is called pronation and supination, respectively.
Injuries and dislocations to the elbow can affect either of these motions.
What causes this condition?
Elbow dislocation is often the result of trauma. The most common trauma resulting in an elbow dislocation is a fall onto an outstretched hand and arm. When the hand hits the ground, the force is transmitted through the forearm to the elbow. This force pushes the elbow out of its socket.
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, roller-blading, 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 are the symptoms?
A complete elbow dislocation is extremely painful and very obvious. The arm will look deformed and may have an odd twist at the elbow.
A partial elbow dislocation or subluxation can be harder to detect. Typically, it happens after an accident. Because the elbow is only partially dislocated, the bones can spontaneously relocate and the joint may appear fairly normal. The elbow will usually move fairly well, but there may be pain. There may be bruising on the inside and outside of the elbow where ligaments may have been stretched or torn. Partial dislocations can continue to recur over time if the ligaments never heal.
How do doctors diagnose this condition?
The history and physical examination are probably the most important tools the physician uses to guide his or her diagnosis. Moving the elbow passively is painful, especially extension and supination. The doctor will check for any signs of injury to the nerves or blood vessels.
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.
An elbow dislocation should be considered an emergency injury. The goal of immediate treatment of a dislocated elbow is to return the elbow to its normal alignment. The long- term goal is to restore
What treatment options are available?
Normal alignment after the elbow has been reduced.
The normal alignment of the elbow can usually be restored in an emergency department at the hospital. Before this is done, sedatives and pain medications usually will be given. The act of restoring alignment to the elbow is called a reduction maneuver. It is done gently and slowly. Two people are usually required to perform this maneuver.
Simple elbow dislocations are treated by keeping the elbow immobile in a splint or sling for two to three weeks, followed by early motion exercises. If the elbow is kept immobile for a long time, the ability to move the elbow fully (range of motion) may be affected. Physical therapy can be helpful during this period of recovery.
Some people will never be able to fully open (extend) the arm, even after physical therapy. Fortunately, the elbow can work very well even without full range of motion. Once the elbow's range of motion improves, the doctor or physical therapist may add a strengthening program. X-rays may be taken periodically while the elbow recovers to ensure that the bones of the elbow joint remains well aligned.
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?
What should I expect after treatment?The humerus, ulna and radius function as four distinctive joints. These bones are surrounded by ligaments, muscles and tendons that shape the bone and hold the elbow together. The primary goal of rehabilitation from an elbow fracture is to restore elasticity to the elbow joint and pain free range of motion. Your physician will likely recommend some exercises that prevent muscle atrophy, promote flexion and extension of your elbow as well as pronation and supination of your forearm. These exercise should be performed a minimum of once daily to increase the circulation of blood and nutrients to your elbow joint and increase coordination.
Rehabilitation exercises stretches the muscles, tendons and ligaments in your forearm and upper arm and help restore elasticity and range of motion to your injured elbow.
Perform the wrist flexor stretch by extending your injured arm straight ahead with your palm facing up. Ensuring that your elbow remains straight, place the palm and fingers of your opposite hand across the palm and fingers of the injured, extended hand. Gently draw your injured hand back until you feel a stretch in your forearm. Hold this position for five seconds and then relax. Perform one set of 10 repetitions three times daily.
Begin a pronation and suppination stretch by extending your injured hand forward with your palm facing up. Slowly rotate your hand from a palm up position to a palm down position. Hold this position for five seconds, and rotate your arm to the palm up position. Perform one set of 10 repetitions, three times daily.
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.
ROM elbow braces (with sling) generally utilized to hold the elbow and arm in a stationary position, giving comfortable support and protection to keep the arm stabilized so that healing can occur more rapidly, and that fractured bones or tendon and bursa surgical repairs can heal properly. Hinged elbow braces encourage and help restore range of motion at that stage of the recovery process, but also help maintain protection against further injury.
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. 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.