Elbow Dislocation: Causes, Diagnosis and Treatment
In spite of the elbow being a very stable joint, elbow dislocation is still very common. It usually occurs in the second decade of life, frequently as a result of sports injuries. Common mechanism of injury is a fall on the wrist or hand with the elbow in extension.
Once the dislocation has occurred it is a medical emergency and one should quickly reach the nearest hospital.
Symptoms of elbow dislocation include
- severe pain in the elbow region
- elbow area appears to have become widened
- swelling appears quickly
- slight attempt to move the elbow elicits severe pain (due to this the injured person holds his hand or forearm of the injured side)
On reaching the hospital
- you will be examined gently
- you will be asked to describe the exact mechanism of injury
- a pain killer injection will be administered
- your elbow will be x rayed to confirm the diagnosis
- once the diagnosis is confirmed the doctor will attempt to reduce (relocate) your dislocated elbow
Classification depends on the direction that the forearm bones have taken during the dislocation. It can be
- Posterior (forearm bones go behind the arm bone)
- Anterior (forearm bones go in front of the arm bone)
- Medial (forearm bones go inwards relative to the arm bone)
- Lateral (forearm bones go outward relative to the arm bone)
- Divergent (forearm bones go in opposite directions relative to the arm bone)
Posterior type is the most common.
Treatment is by closed reduction (aligning the bones by manipulation without any surgery). After giving light anaesthesia (to reduce pain and relax the muscles) your doctor will manipulate and reduce the dislocation.
During manipulation your doctor will apply traction to the forearm while a assistant holds your upper arm. Gradually the doctor will flex your forearm and at the same time pull it upwards, with the assistant applying downward pressure on the arm. The elbow will re-locate and it will be possible to flex it beyond 90 degrees.
Another method is to first gently bring the elbow to 80 to 90 degrees flexion, then apply a upward pull on the forearm with the assistant applying a downward force on the arm.
A light splint will be applied at 90 degrees flexion.
You may be required to stay in the hospital for 24 hours so the doctor can watch for the development of any complications. A repeat x ray will be done to assess the adequacy of the reduction.
Complications of elbow dislocation include
- injury to brachial artery (main blood supply of the forearm and hand)
- injury to the nerves (commonly the median nerve that innervates the muscles of the forearm and hand)
- fractures of the head of radius bone and coronoid process
- fracture and entrapment of medial epicondyle (this prevents reduction)
- heterotropic ossification (formation of bone where it is usually not seen as in muscles and fascia). It is more common with head injury, burns and multiple fractures. It can result in severe limitation of elbow movement.
These x rays are of a 65 year old lady who sustained a left elbow dislocation (upper x ray) along with a fracture of the radial head. The dislocation was reduced (lower x ray). After reduction the fractured radial head remained displaced. As the lady was not doing any heavy work and had regained 40 to 110 degrees movement in her elbow, hence the fractured radial head was left as such. It was not surgically removed.
Removing the head might have given her more movement of the elbow joint, but she was satisfied and not eager for surgery.
This is a x ray of a 24 year old male who sustained a elbow dislocation 1 month back. After injury his elbow was manipulated by country side bone setters. He came to me 1 month post injury. Clinically the elbow appeared dislocated and this was confirmed by a x ray of the elbow joint.
This is a photo of the same patient showing loss of normal convexity of the triceps muscle and prominence of the olecranon process.
I advised surgery to reduce the dislocation. During surgery a lot of calcification was seen around the elbow joint. This was all removed. The olecranon and coronoid fossa were cleared and the triceps tendon was lengthened. The joint was realigned and held with a steel pin. Below you can see the post-operative x ray with the steel pin.
These are the photographs of the same patient above showing the range of motion of the elbow 6 weeks after surgery (three weeks after pin removal). He has movement of 110 degrees.
This is a x ray of a 40 year old male with a 5 month old medial elbow dislocation. In the photo below you can see that the radius and ulna have moved in the direction of the green arrow. Under normal conditions the yellow spot which is the radial head should be in line with the red spot that is the capitullum of humerus.
This x ray of the same patient shows the excessive calcification (black arrows) around the elbow joint. All this has to be removed during surgery to allow satisfactory movement.
Frequently Asked Questions
How long will I have to wear the splint?
For 7 to 10 days in the absence of any complications. You will require physiotherapy to regain movement of your elbow joint. You can do some simple physiotherapy at home. Like, you can place a bicycle upside down and turn it's pedal with your hand. You can play darts with the injured hand. You may practise these exercises at home, but still you should see a therapist. He can give you helpful advice on how to recover faster and better.
How long will it take to completely recover after elbow dislocation?
Any where between 3 to 6 months. You may develop permanent loss of up to 10 to 15 degrees of elbow movement.
What treatment will be undertaken in case of arterial injury?
Surgery to reconstruct your artery will be required immediately. This is the only way to save your limb.
Although I had one patient who had sustained an elbow dislocation in which the bone had protruded out through the skin after severing his brachial artery and injuring the median nerve. He came to me a day after injury. Apart from loss of radial pulse and median nerve palsy his forearm and hand had good blood circulation. This was due to the presence of collateral blood vessels around the elbow joint.
What treatment will be undertaken in case of nerve injury?
If nerve injury is present before the dislocation is reduced then after reduction the treating doctor will watch for signs of recovery for three to four weeks. If no recovery is observed then surgical exploration of the nerve will be done.
If the injury develops the during the reduction or after it, then surgical exploration will be done immediately because now the nerve is probably entrapped within the joint.
What can be done if I develop heterotropic ossification?
Chances of heterotropic ossification can be prevented by
- avoiding any type of massage
- avoiding forceful passive mobilization of the elbow
- using the drug Indomethacin
Once the heterotropic ossification has developed and consolidated (may take a few months) then it is surgically excised.
I hope the information provided was helpful. If you have any query you can ask me at the contact me page.
This page was last updated on 16th September 2010.
Other causes of elbow pain...
Radial Head Fracture
Little League Elbow
Lateral Condyle Fracture
Elbow Joint Anatomy
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