Elbow Dislocation Clinical Presentation

  • Author: Mark E Halstead, MD; Chief Editor: Sherwin SW Ho, MD   more...
 
Updated: Dec 2, 2011
 

History

In posterior elbow dislocations, the patient often describes falling on an outstretched hand (ie, the FOOSH injury) as the mechanism of injury. Some clinicians speculate that the elbow is more likely to dislocate when it is slightly abducted and flexed. When compressive forces are directed on to the outstretched hand, the radius and ulna, along with the valgus force at the elbow, suffer the common posterolateral dislocation. These forces also contribute to associated fractures. In addition, hyperextension at the elbow has been seen with elbow dislocations.

Anterior dislocations are usually the result of a direct posterior blow to a flexed elbow. Associated fractures of the olecranon are commonly seen.

Divergent dislocations are very rare injury and are associated with significant high-energy trauma to the elbow.

In children, radial head subluxations often occur when the arm is pulled. The child commonly holds the arm pronated, mildly flexed, and abducted against the body and refuses or fights any manipulation of the affected arm.

Essential elements of the dislocation history include the mechanism of the injury, the time between the injury and presentation, functioning, previous attempts at reduction/manipulation, swelling, location, and the type of pain.

Next

Physical

Neurovascular assessment and documentation of the clinical evaluation are essential in any elbow dislocation because associated brachial artery and ulnar nerve injuries are frequent. Median nerve injuries are also common.

Evaluate the injury for swelling.

Note any deformities that are present.

Posterior elbow dislocations often have a very prominent olecranon and a forearm that appears foreshortened.

Anterior elbow dislocations have the appearance of an elongated forearm, and the arm is held in extension.

Touch sensation of the median and ulnar nerves can be quickly assessed by testing the distal palmar aspect of the first through fifth digits. (The ulnar nerve innervates the medial one half of the fourth digit and the fifth digit, as well as the dorsal side of the same digits.)

Motor function of the median and ulnar nerve can be quickly assessed by evaluating the abduction and adduction strength of the digits (ulnar nerve) and the opposability of the thumb (median nerve).

Previous
Next

Causes

Unlike the shoulder, a previous elbow dislocation does not predispose a patient to future dislocations. Elbow dislocations are commonly caused by a fall on an outstretched hand or by a traumatic event. Radial head subluxations in children are usually caused by pulling or yanking on the child's arm when the child's elbow is extended.

Previous
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Mark E Halstead, MD  Assistant Professor, Departments of Orthopedics and Pediatrics, Washington University School of Medicine; Team Physician, St Louis Rams, Washington University Athletics

Mark E Halstead, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Sports Medicine, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

David T Bernhardt, MD  Director of Adolescent and Sports Medicine Fellowship, Associate Professor, Department of Pediatrics/Ortho and Rehab, Division of Sports Medicine, University of Wisconsin School of Medicine and Public Health

David T Bernhardt, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Sports Medicine, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Joseph P Garry, MD, FACSM, FAAFP  Associate Professor, Sports Medicine Faculty, Department of Family and Community Medicine, University of Minnesota Medical School

Joseph P Garry, MD, FACSM, FAAFP is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Heart Association, American Medical Society for Sports Medicine, and North American Primary Care Research Group

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

Henry T Goitz, MD  Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD  Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Herodicus Society

Disclosure: Breg, Inc. Consulting fee Consulting; Biomet, Inc. Consulting fee Consulting; GMV, Inc. Arthroscopy Simulator Evaluation and teaching; Smith and Nephew Grant/research funds Fellowship funding; DJ Ortho Grant/research funds Course funding; Athletico Physical Therapy Grant/research funds Course, research funding

References

  1. O'Driscoll SW. Elbow dislocations. In: Morrey BF, ed. The Elbow and Its Disorders. 3rd ed. Philadelphia, Pa: WB Saunders; 2000:409-17.

  2. Rockwood CA Jr, Green DP, Bucholz RW, eds. Rockwood and Green's Fractures in Adults. 4th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1996:971-85.

  3. Kuhn MA, Ross G. Acute elbow dislocations. Orthop Clin North Am. Apr 2008;39(2):155-61, v. [Medline].

  4. Ross G. Acute elbow dislocation: on-site treatment. Phys Sportsmed. Feb 1999;27(2):121-2. [Medline]. [Full Text].

  5. Parsons BO, Ramsey ML. Acute elbow dislocations in athletes. Clin Sports Med. Oct 2010;29(4):599-609. [Medline].

  6. Sheps DM, Hildebrand KA, Boorman RS. Simple dislocations of the elbow: evaluation and treatment. Hand Clin. Nov 2004;20(4):389-404. [Medline].

  7. Carter SJ, Germann CA, Dacus AA, Sweeney TW, Perron AD. Orthopedic pitfalls in the ED: neurovascular injury associated with posterior elbow dislocations. Am J Emerg Med. Oct 2010;28(8):960-5. [Medline].

  8. Nelson AJ, Izzi JA, Green A, Weiss AP, Akelman E. Traumatic nerve injuries about the elbow. Orthop Clin North Am. Jan 1999;30(1):91-4. [Medline].

  9. Lee KS, Rosas HG, Craig JG. Musculoskeletal ultrasound: elbow imaging and procedures. Semin Musculoskelet Radiol. Sep 2010;14(4):449-60. [Medline].

  10. Mehta JA, Bain GI. Elbow dislocations in adults and children. Clin Sports Med. Oct 2004;23(4):609-27, ix. [Medline].

  11. Cohen MS, Hastings H 2nd. Acute elbow dislocation: evaluation and management. J Am Acad Orthop Surg. Jan-Feb 1998;6(1):15-23. [Medline].

  12. Ross G, McDevitt ER, Chronister R, Ove PN. Treatment of simple elbow dislocation using an immediate motion protocol. Am J Sports Med. May-Jun 1999;27(3):308-11. [Medline].

  13. Schippinger G, Seibert FJ, Steinböck J, Kucharczyk M. Management of simple elbow dislocations. Does the period of immobilization affect the eventual results?. Langenbecks Arch Surg. Jun 1999;384(3):294-7. [Medline].

  14. Villarin LA Jr, Belk KE, Freid R. Emergency department evaluation and treatment of elbow and forearm injuries. Emerg Med Clin North Am. Nov 1999;17(4):843-58, vi. [Medline].

  15. Macias CG, Bothner J, Wiebe R. A comparison of supination/flexion to hyperpronation in the reduction of radial head subluxations. Pediatrics. Jul 1998;102(1):e10. [Medline]. [Full Text].

  16. Duckworth AD, Kulijdian A, McKee MD, Ring D. Residual subluxation of the elbow after dislocation or fracture-dislocation: treatment with active elbow exercises and avoidance of varus stress. J Shoulder Elbow Surg. Mar-Apr 2008;17(2):276-80. [Medline].

  17. Micic I, Kim SY, Park IH, Kim PT, Jeon IH. Surgical management of unstable elbow dislocation without intra-articular fracture. Int Orthop. Aug 2 2008;epub ahead of print. [Medline].

  18. Jeon IH, Kim SY, Kim PT. Primary ligament repair for elbow dislocation. Keio J Med. Jun 2008;57(2):99-104. [Medline]. [Full Text].

  19. Duckworth AD, Ring D, Kulijdian A, McKee MD. Unstable elbow dislocations. J Shoulder Elbow Surg. Mar-Apr 2008;17(2):281-6. [Medline].

  20. de Haan J, Schep NW, Zengerink I, van Buijtenen J, Tuinebreijer WE, den Hartog D. Dislocation of the elbow: a retrospective multicentre study of 86 patients. Open Orthop J. Feb 17 2010;4:76-9. [Medline]. [Full Text].

  21. Kesmezacar H, Sarikaya IA. The results of conservatively treated simple elbow dislocations. Acta Orthop Traumatol Turc. 2010;44(3):199-205. [Medline].

  22. Burra G, Andrews JR. Acute shoulder and elbow dislocations in the athlete. Orthop Clin North Am. Jul 2002;33(3):479-95. [Medline].

  23. Sano S, Rokkaku T, Imai K, et al. Radial head dislocation with ulnar plastic deformation in children: An osteotomy within the middle third of the ulna. J Shoulder Elbow Surg. Jul 19 2008;epub ahead of print. [Medline].

 
Previous
Next
 
Posterior and lateral dislocation of the left elbow in a soccer goalie. A small avulsion fracture of the olecranon is present.
The preferred method for posterior elbow dislocation reduction is to lay the patient prone with the humerus supported by the exam table. Place one hand around the wrist of the affected arm and apply downward traction, while the other hand stabilizes the humerus and the thumb is placed over the olecranon, with gentle pressure applied to facilitate reduction.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.