eMedicine Specialties > Sports Medicine > Upper Limb
Elbow Dislocation: Follow-up
Updated: Aug 12, 2008
Follow-up
Return to Play
A follow-up examination before the patient's return to play is necessary to reassess motion of the formerly dislocated elbow following the immobilization and early ROM period. Most individuals can return to play 3-6 weeks following an elbow dislocation.
In sports in which an elbow dislocation occurs in a player's nondominant arm, return to play may occur at the earlier end of the rehabilitation spectrum — as long as motion is back to a level that is suitable to the physician and athlete. For elbow dislocations that occur in a player's dominant arm, return to play may take a longer time period. Throwing sports, such as baseball, may require the patient to undergo periods of rest up to 3 months following a dislocation, followed by a strengthening rehabilitative program once full motion is achieved.
Complications
Complications of elbow dislocation primarily include neurovascular compromise, compartment syndrome, and loss of ROM. Chronic regional pain syndrome may occur. Close attention to the neurologic examination pre- and postreduction as well as at the follow-up visit may alert the physician to potential neurologic problems.
Prevention
Elbow dislocations in children due to radial head subluxation (nursemaid's elbow) are often preventable. A child should not be forcibly pulled, lifted, or swung in the air by the hand or wrist. Always lift a small child from under the arms, rather than by the hand or wrist. Athletes who participate in high-risk sports, where falling on an outstretched arm is common, may be advised to wear protective gear to prevent elbow injuries.
Prognosis
Approximately 50% of patients with dislocated elbows achieve a full recovery, including full ROM. One third of patients experience some limitation of motion at the elbow, usually less than 10° of compromised motion. The remaining 10-15% of patients have more significant losses in function, primarily related to limited ROM. Some correlation exists between the severity of the initial injury and the likelihood of having significant motion limitations further in time from the injury occurrence.
Miscellaneous
Medicolegal Pitfalls
- Neurovascular compromise is the most crucial potential complication of elbow dislocations and can be quickly and easily assessed. Perform frequent neurovascular assessments and document the patient's neurovascular function, both pre- and postreduction. The higher occurrence of associated injuries to the median and ulnar nerves and brachial artery necessitate these evaluations.
- Elbows may spontaneously reduce before clinical evaluation or any treatment. The clinician should be aware of this and suspect a reduced dislocation if swelling is noted and the mechanism of injury corresponds with a dislocation.
- In-field reduction without a radiograph might invite legal inquiry, particularly if a postreduction radiograph demonstrates evidence of a fracture. Despite this, clinician comfort and judgment (ie, time delay to reducing the injury if awaiting a prereduction radiograph) must be exercised for each suspected injury.
Related Medscape topics:
Resource Center Exercise and Sports Medicine
Resource Center Joint Disorders
Resource Center Medical Malpractice and Legal Issues
Resource Center Trauma
Specialty Site Orthopaedics
More on Elbow Dislocation |
| Overview: Elbow Dislocation |
| Differential Diagnoses & Workup: Elbow Dislocation |
| Treatment & Medication: Elbow Dislocation |
 Follow-up: Elbow Dislocation |
| Multimedia: Elbow Dislocation |
| References |
| « Previous Page | Next Page » |
References
O'Driscoll SW. Elbow dislocations. In: Morrey BF, ed. The Elbow and Its Disorders. 3rd ed. Philadelphia, Pa: WB Saunders; 2000:409-17.
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.
Kuhn MA, Ross G. Acute elbow dislocations. Orthop Clin North Am. Apr 2008;39(2):155-61, v. [Medline].
Ross G. Acute elbow dislocation: on-site treatment. Phys Sportsmed. Feb 1999;27(2):121-2. [Full Text].
Sheps DM, Hildebrand KA, Boorman RS. Simple dislocations of the elbow: evaluation and treatment. Hand Clin. Nov 2004;20(4):389-404. [Medline].
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].
Mehta JA, Bain GI. Elbow dislocations in adults and children. Clin Sports Med. Oct 2004;23(4):609-27, ix. [Medline].
Cohen MS, Hastings H 2nd. Acute elbow dislocation: evaluation and management. J Am Acad Orthop Surg. Jan-Feb 1998;6(1):15-23. [Medline].
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].
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].
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].
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].
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].
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].
Jeon IH, Kim SY, Kim PT. Primary ligament repair for elbow dislocation. Keio J Med. Jun 2008;57(2):99-104. [Medline]. [Full Text].
Duckworth AD, Ring D, Kulijdian A, McKee MD. Unstable elbow dislocations. J Shoulder Elbow Surg. Mar-Apr 2008;17(2):281-6. [Medline].
Burra G, Andrews JR. Acute shoulder and elbow dislocations in the athlete. Orthop Clin North Am. Jul 2002;33(3):479-95. [Medline].
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].
Further Reading
Keywords
elbow dislocation, dislocation of elbow, dislocated elbow, radial head dislocation, ulnar dislocation, radial head subluxation, FOOSH injury, falling on an outstretched hand, nursemaid's elbow, elbow injury, elbow trauma
