Elbow Dislocation Medication

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

Medication Summary

Use of medication for elbow dislocations is beneficial in the acute setting when reduction of the dislocation is to take place. Choosing both an anxiolytic and a pain medication is ideal for a conscious sedation to facilitate reduction. Once reduction has occurred, pain may still be an issue, and it would be reasonable to provide the patient with oral pain medication to use in the outpatient setting.

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Anxiolytics

Class Summary

Anxiolytics allow for relaxation and mild sedation when reduction of a dislocated elbow is attempted. These agents also allow for a lower dose of analgesics to be used.

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Midazolam (Versed)

 

DOC for anxiolytics. Shorter-acting benzodiazepine sedative-hypnotic that is useful in patients requiring acute and/or short-term sedation. Midazolam is also useful for its amnestic effects.

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Lorazepam (Ativan)

 

Sedative hypnotic with short onset of effects and a relatively long half-life. By increasing the action of gamma-aminobutyric acid (GABA), which is a major inhibitory neurotransmitter in the brain, this agent may depress all levels of CNS, including the limbic and reticular formation. When the patient needs to be sedated for longer than a 24-hour period, this medication is excellent.

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Diazepam (Valium)

 

Depresses all levels of the CNS (eg, limbic and reticular formation), possibly by increasing the activity of GABA. Individualize the dosage and increase cautiously to avoid adverse effects.

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Analgesics

Class Summary

Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who have sustained trauma or who have sustained injuries.

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Morphine (Duramorph, Astramorph, MS Contin)

 

Indicated for moderate to severe acute and chronic pain.

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Fentanyl (Duragesic, Sublimaze)

 

Potent narcotic analgesic with a much shorter half-life than morphine sulfate. DOC for conscious sedation analgesia. Ideal for analgesic action of short duration during anesthesia and immediate postoperative period.

Excellent choice for pain management and sedation with short duration (30-60 min) and easy to titrate. Easily and quickly reversed by naloxone. After initial dose, the subsequent doses should not be titrated more frequently than q3h or q6h thereafter.

When using the transdermal dosage form, most patients are controlled with 72 h dosing intervals. However, some patients require dosing intervals of 48 h.

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Oxycodone and acetaminophen (Percocet, Roxicet)

 

Drug combination indicated for the relief of moderate to severe pain.

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Acetaminophen and codeine (Tylenol with codeine, Tylenol #3)

 

Indicated for the treatment of mild to moderate pain.

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Acetaminophen and hydrocodone (Vicodin, Hydrocet, Lorcet)

 

Drug combination indicated for moderate to severe pain.

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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].

 
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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.
 
 
 
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