Elbow Dislocation

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Physical Therapy Videos - Elbow

Basic Anatomy

The elbow is the joint that links your upper arm to your forearm. The elbow joint allows you to position your hand close to your body or move it away. This is called flexion and extension of your elbow joint. The elbow also is involved in flipping your hand palm-up and palm-down, also called pronation (palm down) and supination (palm up) of your forearm. Because the elbow plays a large role in moving the hand to the desired location in space., preserving elbow motion is a large part of your treatment and recovery plan.

Skeleton model showing the elbow joint and the 3 bones that form the elbow joint
Figure 1: Skeleton model showing the elbow joint and the 3 bones that form the elbow joint.

 

X-rays of a normal elbow showing the elbow joint and the bones that form the joint
Figure 2: X-rays of a normal elbow showing the elbow joint and the bones that form the joint.

Mechanism and Epidemiology

Elbow dislocations are serious injuries that may happen when someone falls onto their outstretched hand. They may also happen if your elbow is straightened past its normal straight position. About half occur during sports activities. You will have immediate pain, your arm will look "crooked," and you won’t be able to bend or straighten your arm. You may have numbness or tingling in your fingers. In rare cases you may have damage to the blood vessels to your arm.

Photograph of a patient with an elbow dislocation, showing the swelling and bruising typically seen after this injury
Figure 3: Photograph of a patient with an elbow dislocation, showing the swelling and bruising typically seen after this injury.

 

X-rays of an elbow dislocation
Figure 4: X-rays of an elbow dislocation. The arm and forearm no longer fit together the way they normally would.

 

X-rays after reduction of the same elbow, now back to normal
Figure 5: X-rays after reduction of the same elbow, now back to normal.

Initial Treatment

Elbow dislocations are serious and need to be treated as soon as possible. You should go to the nearest emergency room. Your doctor will examine your arm to see if the nerves and arteries in your arm are working or not. You will be x-rayed to see if you have a dislocation, broken bones, or both. Once the diagnosis is made, you will need to have your elbow put back in place, or "reduced." Usually this takes place in the emergency room. You will typically get medications to reduce your pain and make you sleepy. Once you are relaxed and sleepy, the doctor will gently pull on your arm and put your elbow back in place. Your arm will then be placed in a splint with your elbow in a bent position. Sometimes, elbow dislocations need surgery.    

General Treatment

Once your elbow is back in place, your elbow will be kept in a splint or cast for 1-3 weeks. The length of time will be determined by your treating doctor, based on factors such as your overall condition and the doctor’s determination of the stability of your elbow joint. Your doctor likely will get a series of x-rays to be sure your elbow stays in a good position.

Post-Reduction Care

After your cast or splint has been removed, an a-ray will confirm that your elbow is still in the right place. Then you will get to start moving your elbow and will likely go to physical therapy. This is important to regain motion and minimize the stiffness that commonly happens after elbow dislocations. Typically, your doctor will limit your activities for 6-12 weeks after a dislocation. They may also restrict how much you can straighten your elbow once you start moving it. This is because the elbow is less likely to dislocate again if it is kept slightly bent. Gradually, you will work on getting back as much motion as possible in your elbow joint.

Long Term

Long-term issues after elbow dislocations can include stiffness or repeat dislocations. Stiffness is very common. People with this injury are usually not able to get their arm completely straight again. Fortunately, you can still function well even if you cannot get your arm all-the-way bent or straight. Diligent therapy and following your doctor’s instructions are the best ways to work on regaining motion. Another dislocation is rare. It usually occurs in the days or weeks following the injury if you are aggressive with your elbow motion. Repeat dislocations almost never happen after your elbow has healed. Patients with elbow dislocations may develop elbow joint arthritis years after their injury.

Physical Therapy Videos - Elbow

More Information

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Christopher Doro, MD
Edited by the OTA Patient Education Committee and Steven Papp, MD (section lead)
All x-rays and pictures taken from the personal collection of Dr. Doro and Christopher Domes, MD