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Elbow Dislocation Treatment & Management

  • Author: Mark E Halstead, MD; Chief Editor: Craig C Young, MD  more...
 
Updated: May 26, 2016
 

Acute Phase

Rehabilitation Program

Physical Therapy

Early ROM exercises in stable, reduced elbow dislocations has been shown to be associated with an improved outcome. However, immobilization of the affected elbow for longer than 3 weeks in patients following an elbow dislocation has been associated with loss of ROM compared with patients who start early ROM exercises.[13]

A study by Iordens et al compared outcomes of early mobilization and plaster immobilization in patients with a simple elbow dislocation. The study found that patients in the early mobilization group recovered faster and returned to work earlier without increasing the complication rate.[16]

Medical Issues/Complications

Brachial artery disruption may be seen in any elbow dislocation and special attention should be made in open dislocations.

Ulnar nerve injury may occur in up to 15% of elbow dislocations. Perform an initial neurovascular assessment and frequent reassessments.

Median nerve injury is frequently seen in conjunction with brachial artery injuries because both of these structures are in close anatomic proximity. The median nerve function should always be assessed with a higher suspicion of injury if a brachial artery injury is known to exist. The median nerve may also be injured or entrapped during a reduction.

Associated fractures for elbow dislocation include those of the radial head or neck (5-10%), medial/lateral epicondyle avulsions (10%), those of the coronoid process (10%), and fractures of the distal radius, ulna, and proximal humerus (10%).

Compartment syndrome may develop in the forearm fascia or biceps tendon due to massive swelling, which may occur in an acute elbow dislocation. Compartment syndrome must be considered in the differential diagnosis in the presence of persistent patient pain, particularly when exacerbations of pain occur with passive finger and wrist extension of the dislocated arm.

Ectopic calcification, primarily around the collateral ligaments, is common after an elbow dislocation, provides no limitations and requires no intervention.

Myositis ossificans may also be seen if significant hemarthrosis developed with the elbow dislocation.

Surgical Intervention

Seek surgical intervention by an orthopedist if any signs of neurovascular compromise, associated fractures, or nonreducible dislocations are present.

Consultations

Obtain orthopedic consultation if any signs of neurovascular compromise, associated fractures, or nonreducible dislocations are present.

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Recovery Phase

Rehabilitation Program

Physical Therapy

Patients with limitations in ROM on follow-up evaluation may benefit from more aggressive physical therapy to regain loss of mobility.

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Maintenance Phase

Rehabilitation Program

Physical Therapy

Depending on the severity of the elbow dislocation, it may take several months for the elbow to fully heal. Muscle-strengthening activities, in addition to the ROM program, are important to improve endurance of the elbow. Incorporate sport-specific training as the athlete progresses through rehabilitation to ensure a safe return to his/her sport.[17]

Surgical Intervention

Surgical intervention may be needed for a functional flexion contracture or for chronic residual instability.[18, 19, 20]

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Contributor Information and Disclosures
Author

Mark E Halstead, MD Associate 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, 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, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Joseph P Garry, MD, FACSM, FAAFP Associate Professor, Department of Family Medicine and Community Health, 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 Medical Society for Sports Medicine, Minnesota Medical Association, American College of Sports Medicine

Disclosure: Nothing to disclose.

References
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  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.

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  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. 1999 Jun. 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. 1999 Nov. 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. 1998 Jul. 102(1):e10. [Medline]. [Full Text].

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  17. 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. 2008 Mar-Apr. 17(2):276-80. [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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