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Elbow Dislocation

Treatment of a Dislocated Elbow

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Updated May 23, 2011

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An elbow dislocation occurs when the upper arm and forearm get separated from their normal position. The bone of the upper arm (humerus) normally touching the bones of the forearm (the radius and ulna). When an elbow dislocation occurs, these bones are separated from their normal alignment. Elbow dislocations are the second most common joint dislocation, following shoulder dislocations.

There are two basic types of elbow dislocations:

  • Simple Elbow Dislocation
    A simple elbow dislocation means there is no fracture of the bones around the elbow joint. The prognosis of a simple elbow dislocation is better, as often surgery is not required for treatment.
  • Complex Elbow Dislocation
    A complex elbow dislocation means that there is a fracture, usually of the forearm, that has occurred along with the elbow dislocation. In a complex elbow dislocation, surgery is often needed to fix the broken bone in order to maintain the elbow joint in a normal position.

Assessment of a Dislocated Elbow

If someone has injured their elbow, a dislocated elbow joint should be considered as a possible cause of elbow pain. Symptoms of a dislocated elbow include pain, swelling and inability to bend the elbow. In some elbow dislocations, nerve or blood vessel damage can occur. All elbow dislocations require prompt medical attention, but those with nerve or vascular (blood vessel) injury require special attention.

Prior to putting the elbow back into position (called "reducing" the elbow), an x-ray should be done to view the position of the elbow dislocation, and look for any associated fractures.

Treatment of an Elbow Dislocation

An elbow dislocation is treated by repositioning the bones. Most often the reduction is performed under anesthesia, however, if the patient is able to relax, the reduction may be performed without anesthesia. Often the elbow joint will simply, "pop" back into position, however there can be difficulty achieving normal alignment in more complex injuries. After reducing the elbow, another x-ray must be done to ensure appropriate alignment of the joint.

If a simple elbow dislocation has occurred, after the joint is reduced, the examiner should determine the stability of the elbow joint. If the elbow will not stay in position, and continually pops back out, surgery will likely be necessary. In most cases, the elbow can be immobilized in a position where the joint is stable. The position of most stability is with the elbow bent, and the hand turned palm down.

Immobilization is limited, as prolonged immobilization can cause significant stiffness of the joint. Patients are started with early elbow motion, usually within days or a week after the injury. Mobility is started in a range where the elbow was stable, and gradually increased. Patients with simple elbow dislocations generally achieve return to full activity within 6 to 12 weeks of the injury.

Surgery for Elbow Dislocations

Surgery is seldom required for a simple elbow dislocation. Surgery is only necessary after a simple elbow dislocation when the elbow will not stay in joint (about 1-2% of elbow dislocations). Numerous studies have shown no benefit from ligament repair after a stable simple elbow dislocation.

Surgery is usually necessary when there is an associated fracture with the elbow dislocation. Without surgical stabilization of the fracture, it is usually difficult to maintain the alignment of the elbow joint. Surgery usually requires placing plates and screws on the fractured bones to restore their alignment.

Sources:

Cohen MS, Hastings H. "Acute elbow dislocation: evaluation and management" J. Am. Acad. Orthop. Surg., Jan 1998; 6: 15 - 23.

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