Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Elbow Dislocation Workup

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

Imaging Studies

Before reduction of the injury, obtain anteroposterior and lateral radiographs of the elbow (see the image below). If clinicians feel comfortable trying a reduction in the field, they may do so before obtaining radiographs; however, postreduction films should be obtained and the affected limb's neurovascular status should be documented pre- and postreduction.

Posterior and lateral dislocation of the left elbo Posterior and lateral dislocation of the left elbow in a soccer goalie. A small avulsion fracture of the olecranon is present.

Postreduction films are also necessary to ensure adequate reduction and to evaluate for fractures. The recreation of a normal radiocapitellar line (the line drawn through the shaft of the radius through the center of the capitellum) should be evident on all radiographic views.

Ultrasound is also used to diagnose elbow pathology by presenting real-time, high-resolution imaging of tendons, ligaments, and nerves.[9]

CT scanning may be useful in the evaluation for the full extent and location of fractures that may occur with a complex elbow dislocation.

MRI has little use in an acute elbow dislocation.

Next

Other Tests

A role may exist for angiography in the evaluation of a suspected associated arterial injury; however, if angiography would significantly delay vascular repair, the operating room may be a more appropriate setting for its use.

Previous
Next

Procedures

Several methods for reducing a posterior elbow dislocation have been suggested.[1, 2, 3, 4, 10, 11, 12, 13, 14] Before reduction, adequate patient analgesia and sedation are necessary not only for patient comfort but also for the reduction. Radial head subluxations in children (ie, nursemaid's elbow) can generally be reduced without the need for sedation or analgesia. The 2 most commonly used techniques for the posterior dislocation are as follows:

  • The author's preferred method is to place the patient in a prone position with the affected elbow flexed at 90° and the humerus supported by the table (see the image below). The hand of the affected arm should be pointing toward the ground. Apply downward traction to the forearm, which is held in slight pronation, while using the other hand to grasp the humerus, and apply pressure to the olecranon in a downward motion to facilitate reduction.
    The preferred method for posterior elbow dislocati 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.
  • A second method involves the patient lying supine with the affected arm extended to the side in slight flexion. An assistant applies traction to the humerus toward the patient's body, while a second individual applies in-line traction to the forearm, the latter of which is held slightly flexed and supinated to facilitate reduction.

Perform anterior elbow dislocation reductions by grasping the humerus with 2 hands to apply countertraction, while an assistant provides in-line traction to the forearm. Orthopedic assistance may be beneficial given the infrequency of anterior dislocations.

Treat radial head subluxations in children by supporting the child's affected arm with your nondominant hand, with moderate pressure placed on the radial head. With your dominant hand on the child's wrist, apply gentle traction to the arm, and in 1 motion, supinate and fully flex the affected elbow. You can palpate for a click over the radial head with your nondominant hand.

Some studies have suggested that hyperpronation may be a more effective way to reduce the subluxation.[15] The hyperpronation method also may be attempted if a subluxation cannot be reduced by the more commonly used supination and flexion method.

Postreduction

Place the elbow through gentle ROM testing. ( NOTE:  Extending the elbow beyond 20° from full extension may cause the elbow to redislocate and is not recommended.) Inability to move the elbow smoothly through ROM following reduction should raise the suspicion of a trapped medial epicondyle fracture. Reexamination for neurovascular integrity should take place postreduction, followed by follow-up elbow radiographs. The elbow joint is expected to be unstable following a dislocation. ( NOTE: Assessment for stability following reduction is likely to be painful for the patient and does not provide further information for the management of this condition.)

If near-full ROM is present in the affected elbow without associated fractures, the elbow may be splinted using a posterior splint, with the forearm in slight pronation and the elbow flexed at 90°.

If there are any concerns regarding potential neurovascular compromise or excessive swelling, or the risk of compartment syndrome exists, it would be beneficial to admit the patient to a hospital for a 24-hour period of observation following the injury.

For on-site reductions, such as at a game or in a training room where radiographs may not be readily available, a physician who feels comfortable reducing an elbow may do so, provided the physician performs and documents a complete neurovascular examination before and after the reduction.[4] Because of the high association of fractures with elbow dislocations, the patient should be advised to obtain radiographs of the elbow soon after the reduction.

Previous
 
 
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
  1. O'Driscoll SW. Elbow dislocations. 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. 2008 Apr. 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. 2010 Oct. 29(4):599-609. [Medline].

  6. Sheps DM, Hildebrand KA, Boorman RS. Simple dislocations of the elbow: evaluation and treatment. Hand Clin. 2004 Nov. 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. 2010 Oct. 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. 1999 Jan. 30(1):91-4. [Medline].

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

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

  11. Cohen MS, Hastings H 2nd. Acute elbow dislocation: evaluation and management. J Am Acad Orthop Surg. 1998 Jan-Feb. 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. 1999 May-Jun. 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. 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].

  16. Iordens GI, Van Lieshout EM, Schep NW, De Haan J, Tuinebreijer WE, Eygendaal D, et al. Early mobilisation versus plaster immobilisation of simple elbow dislocations: results of the FuncSiE multicentre randomised clinical trial. Br J Sports Med. 2015 Jul 14 [Epub ahead of print]. [Medline].

  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].

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

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

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

  21. 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. 2010 Feb 17. 4:76-9. [Medline]. [Full Text].

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

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

  24. Englert C, Zellner J, Koller M, Nerlich M, Lenich A. Elbow Dislocations : A Review Ranging from Soft Tissue Injuries to Complex Elbow Fracture Dislocations. Adv Orthop. Epub 2013 Oct 21. [Medline].

  25. 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. 2008 Jul 19. epub ahead of print. [Medline].

  26. Schreiber JJ, Potter HG, Warren RF, Hotchkiss RN, Daluiski A. Magnetic resonance imaging findings in acute elbow dislocation: insight into mechanism. J Hand Surg Am. 2014 Feb. 39(2):199-205. [Medline].

  27. Bruinsma WE, Guitton T, Ring D. Radiographic loss of contact between radial head fracture fragments is moderately reliable. Clin Orthop Relat Res. 2014 Jul. 472(7):2113-9. [Medline]. [Full Text].

  28. Sormaala MJ, Sormaala A, Mattila VM, Koskinen SK. MDCT findings after elbow dislocation: a retrospective study of 140 patients. Skeletal Radiol. 2014 Apr. 43(4):507-12. [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 © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.