Elbow Dislocation Treatment & Management

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

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]

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.[16]

Surgical Intervention

Surgical intervention may be needed for a functional flexion contracture or for chronic residual instability.[17, 18, 19]

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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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