Elbow Dislocation in Emergency Medicine Clinical Presentation

  • Author: James E Keany, MD, FACEP; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Jul 20, 2011
 

History

Obtain history that includes the mechanism of injury, type and location of pain, amount of immediate dysfunction, treatment prior to arrival in the emergency department, timing of effusion appearance, and history of prior elbow injury.

  • Mechanisms - A fall onto an extended, abducted arm (posterior) or a direct blow to a flexed elbow (anterior)
  • Pain - Intense, focused around the elbow joint
  • Extremely limited range of motion
  • Effusion
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Physical

  • Posterior dislocations: Elbow is flexed, with an exaggerated prominence of the olecranon. On palpation, the olecranon is displaced from the plane of the epicondyles (as opposed to a supracondylar fracture, in which the epicondyles are palpable in the same plane as the olecranon).
  • Anterior dislocations: The elbow is held in full extension. The upper arm appears shortened, while the forearm is elongated and held in supination.
  • Neurovascular function should be documented in detail before and after reduction. Continued repeated examination is essential.
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Contributor Information and Disclosures
Author

James E Keany, MD, FACEP  Medical Director, TravelMDAssist; Staff Physician, Department of Emergency Services, Mission Hospital Regional Medical Center

James E Keany, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, and California Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Dekker McKeever, DPM  Chief Podiatric Surgery Resident Physician, Trauma and Reconstruction Specialist, Mission Hospital Regional Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Joseph J Sachter, MD, FACEP  Consulting Staff, Department of Emergency Medicine, Muhlenberg Regional Medical Center

Joseph J Sachter, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

David B Levy, DO, FACEP, FAAEM  Chairman, Department of Emergency Medicine, St Elizabeth Health Center; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine

David B Levy, DO, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Informatics Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

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  3. Ayel JE, Bonnevialle N, Lafosse JM, Pidhorz L, Al Homsy M, Mansat P, et al. Acute elbow dislocation with arterial rupture. Analysis of nine cases. Orthop Traumatol Surg Res. Sep 2009;95(5):343-51. [Medline].

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  14. Ring D, Jupiter JB. Fracture-dislocation of the elbow. J Bone Joint Surg Am. Apr 1998;80(4):566-80. [Medline].

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  16. Seijas R, Ares-Rodriguez O, Orellana A, Albareda D, Collado D, Llusa M. Terrible triad of the elbow. J Orthop Surg (Hong Kong). Dec 2009;17(3):335-9. [Medline]. [Full Text].

  17. Shearman CM, el-Khoury GY. Pitfalls in the radiologic evaluation of extremity trauma: Part I. The upper extremity. Am Fam Physician. Mar 1 1998;57(5):995-1002. [Medline].

  18. Sugimoto M, Yoshida T, Kitano K, Hosoya T, Tada K. Voluntary dislocation of the radial head. J Shoulder Elbow Surg. May-Jun 1996;5(3):228-30. [Medline].

 
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Anteroposterior radiograph of the elbow demonstrates the normal anatomy.
Lateral radiograph of the elbow demonstrates the normal anatomy.
Lateral view of the elbow demonstrates a posterior dislocation of the elbow. The patient also had a nondisplaced radial head fracture.
 
 
 
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