Elbow Dislocation Clinical Presentation

Updated: Sep 26, 2017
  • Author: Mark E Halstead, MD; Chief Editor: Craig C Young, MD  more...
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Presentation

History

In posterior elbow dislocations, the patient often describes falling on an outstretched hand (ie, the FOOSH injury) as the mechanism of injury. Some clinicians speculate that the elbow is more likely to dislocate when it is slightly abducted and flexed. When compressive forces are directed on to the outstretched hand, the radius and ulna, along with the valgus force at the elbow, suffer the common posterolateral dislocation. These forces also contribute to associated fractures. In addition, hyperextension at the elbow has been seen with elbow dislocations.

Anterior dislocations are usually the result of a direct posterior blow to a flexed elbow. Associated fractures of the olecranon are commonly seen.

Divergent dislocations are very rare injury and are associated with significant high-energy trauma to the elbow.

In children, radial head subluxations often occur when the arm is pulled. The child commonly holds the arm pronated, mildly flexed, and abducted against the body and refuses or fights any manipulation of the affected arm.

Essential elements of the dislocation history include the mechanism of the injury, the time between the injury and presentation, functioning, previous attempts at reduction/manipulation, swelling, location, and the type of pain.

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Physical

Neurovascular assessment and documentation of the clinical evaluation are essential in any elbow dislocation because associated brachial artery and ulnar nerve injuries are frequent. Median nerve injuries are also common.

Evaluate the injury for swelling.

Note any deformities that are present.

Posterior elbow dislocations often have a very prominent olecranon and a forearm that appears foreshortened.

Anterior elbow dislocations have the appearance of an elongated forearm, and the arm is held in extension.

Touch sensation of the median and ulnar nerves can be quickly assessed by testing the distal palmar aspect of the first through fifth digits. (The ulnar nerve innervates the medial one half of the fourth digit and the fifth digit, as well as the dorsal side of the same digits.)

Motor function of the median and ulnar nerve can be quickly assessed by evaluating the abduction and adduction strength of the digits (ulnar nerve) and the opposability of the thumb (median nerve).

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Causes

Unlike the shoulder, a previous elbow dislocation does not predispose a patient to future dislocations. Elbow dislocations are commonly caused by a fall on an outstretched hand or by a traumatic event. Radial head subluxations in children are usually caused by pulling or yanking on the child's arm when the child's elbow is extended.

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