Elbow Dislocation in Emergency Medicine Clinical Presentation

Updated: Jan 21, 2016
  • Author: James E Keany, MD, FACEP; Chief Editor: Trevor John Mills, MD, MPH  more...
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Presentation

History

Obtain history that includes the mechanism of injury, type and location of pain, amount of immediate dysfunction, treatment prior to arrival in the emergency department, timing of effusion appearance, and history of prior elbow injury.

  • Mechanisms - A fall onto an extended, abducted arm (posterior) or a direct blow to a flexed elbow (anterior)
  • Pain - Intense, focused around the elbow joint
  • Extremely limited range of motion
  • Effusion
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Physical

In posterior dislocations, the elbow is flexed, with an exaggerated prominence of the olecranon. On palpation, the olecranon is displaced from the plane of the epicondyles (as opposed to a supracondylar fracture, in which the epicondyles are palpable in the same plane as the olecranon).

In anterior dislocations, the elbow is held in full extension. The upper arm appears shortened, while the forearm is elongated and held in supination.

Neurovascular function should be documented in detail before and after reduction. Continued repeated examination is essential.

Indications for admission with frequent neurovascular assessment include the following:

  • Children
  • Unreliable patients
  • Extensive edema
  • Evidence of neurovascular compromise either before or after reduction
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Complications

Complications of elbow dislocation may include the following:

  • Brachial artery injury [1]
  • Medial nerve injury
  • Ulnar nerve injury
  • Concomitant fractures
  • Avulsion of the triceps mechanism insertion (anterior dislocation only)
  • Entrapment of bone fragments within the joint space
  • Joint stiffness with decreased range of motion (particularly in extension)
  • Myositis ossificans
  • Compartment syndrome
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