Elbow Dislocation: Understanding, Treatment, and Recovery

Overview: What is an Elbow Dislocation?

An elbow dislocation is when the bones of the elbow joint are pushed out of their normal alignment. The elbow is made up of three bones: the humerus (upper arm bone), the ulna (the larger bone in the forearm), and the radius (the smaller bone in the forearm). When these bones become displaced due to trauma or injury, it results in a dislocation.

Types of Elbow Dislocations:

Simple Dislocation: This involves the displacement of the bones without any accompanying fractures.
Complex Dislocation: This involves both a dislocation and a fracture of one or more bones in the elbow.

Symptoms of elbow dislocation:

Intense pain in the elbow
Swelling and bruising
Visible deformity (the elbow looks out of place)
Inability to move or bend the elbow
Numbness or tingling in the fingers (if nerves are affected)

Prevalence of Elbow Dislocations

Elbow dislocations are relatively uncommon but are the second most common large joint dislocation after shoulder dislocations. They occur more frequently in adults than children but are still considered rare injuries overall.

General Prevalence:

Elbow dislocations account for 10-25% of all elbow injuries.
The overall incidence is estimated to be 6-8 per 100,000 people per year.

Demographics:

Adults: The majority of elbow dislocations occur in adults, particularly young adults between the ages of 15 and 40, due to higher involvement in physical activities and sports.
Children: Though less frequent, elbow dislocations in children often involve the radial head, a condition known as nursemaid’s elbow or pulled elbow or radial head subluxation.

Gender Differences:

Elbow dislocations are slightly more common in males, likely due to higher participation in contact sports and physical labour.

Sports and Activity-Related Prevalence:

Elbow dislocations are common in high-energy activities like gymnastics, wrestling, football, and basketball due to the risk of falls and impacts on an outstretched arm.

Occupational Incidence:

Jobs with a higher risk of falls or physical impacts, such as construction or manual labour, also contribute to a higher incidence of elbow dislocations in certain groups.

Proper treatment and rehabilitation are critical to restoring full function and preventing chronic instability in the joint. Access Ortho offers urgent care for acute elbow injuries.

Symptoms and Causes

Symptoms of Elbow Dislocations:

Severe Pain: Immediate and intense pain in the elbow.
Visible Deformity: The elbow may appear visibly out of place or bent unnaturally.
Swelling and Bruising: Rapid swelling and bruising around the elbow.
Inability to Move the Elbow: Limited or no range of motion, especially bending or straightening the arm.
Numbness or Tingling: These sensations can occur in the hand or fingers if nerves are pinched or damaged.
Weakness in the Arm: A loss of strength or grip in the affected arm.
Coldness or Pale Skin: These signs may suggest compromised blood flow due to vascular damage.

What Causes Elbow Dislocations?

The most common cause of an elbow dislocation is trauma or injury that forces the bones of the elbow joint out of alignment. Common causes include:

Falling on an Outstretched Arm: This is the most typical mechanism, especially during a fall where someone instinctively puts their hand out to catch themselves.
Direct Blows or Impact: High-energy trauma, such as from a car accident or contact sports like football, can lead to a dislocation.
Twisting Injuries: A sudden twist or forceful motion can also result in dislocation, though this is less common.
Sports Injuries: Activities like gymnastics, wrestling, or skateboarding, where the elbow is placed under extreme pressure or stress, increase the risk of dislocation.

Risk Factors for Elbow Dislocations:

Certain factors can increase the likelihood of elbow dislocations:

Participation in High-Risk Sports: Activities that involve high-impact forces, jumping, or falling (e.g., football, basketball, gymnastics) increase the risk.
Previous Elbow Dislocation: If you have had an elbow dislocation before, you are at a higher risk of it occurring again.
Poor Joint Stability or Weakness: Weak muscles or unstable ligaments around the elbow joint can increase susceptibility.
Occupational Hazards: Jobs with a high risk of falls or physical demands, such as construction, increase the chance of elbow injuries.
Age and Gender: Young adults and males are more prone to dislocations due to greater involvement in sports and physical activities.

Complications of Elbow Dislocations:

If not treated promptly and properly, elbow dislocations can lead to several complications, including:

Joint Instability: The elbow may become unstable and prone to future dislocations if the ligaments are severely damaged.
Chronic Pain and Stiffness: Limited range of motion and persistent pain, particularly if the joint or ligaments do not heal correctly.
Nerve Injury: The ulnar or median nerve may be stretched or pinched, leading to numbness, tingling, or weakness in the hand and fingers.
Blood Vessel Damage: If blood vessels are compressed or torn during dislocation, it can lead to poor circulation in the arm, requiring urgent medical attention.
Osteoarthritis: Over time, damage to the joint and cartilage can lead to degenerative joint disease (osteoarthritis).
Fractures: In complex dislocations, the bones of the elbow may fracture, complicating treatment and recovery.
Compartment Syndrome: Swelling within the muscles of the forearm can cause increased pressure and decreased blood flow. This is a medical emergency.

Rapid diagnosis and treatment are important in preventing long-term complications from an elbow dislocation. Access Ortho offers rapid appointments and specialist orthopaedic care for acute musculoskeletal injuries.

Diagnosis and Tests

How Are Elbow Dislocations Diagnosed?

Elbow dislocations are typically diagnosed based on physical examination, patient history, and imaging tests. The healthcare provider assesses the elbow’s position, looks for deformity, swelling, and bruising, and evaluates the patient’s ability to move the joint. A thorough examination is also done to check for any signs of nerve or vascular damage, such as numbness, weakness, or impaired blood flow.

Which Tests Do Providers Use to Confirm Elbow Dislocations?

Physical Examination:

The medical team will visually inspect the elbow for abnormal positioning or deformity.
The range of motion will be tested, though it’s often very limited in a dislocation.
The provider may check for areas of tenderness, swelling, and bruising.
Neurovascular exam: The medical team will assess blood flow and nerve function by checking pulses and sensations in the hand and fingers.
X-rays:

X-rays are the most common and essential imaging test used to confirm an elbow dislocation. They can clearly show if the bones in the elbow joint are out of alignment.
X-rays are also used to identify any fractures that may have occurred with the dislocation (complex dislocation).
CT Scan (Computed Tomography):

A CT scan is sometimes used to get a more detailed view of the bones and joint if the X-ray images are unclear or if a fracture is suspected.
CT is particularly useful in complex dislocations to assess the extent of bone damage or for preoperative planning.
MRI (Magnetic Resonance Imaging):

An MRI may be ordered if soft tissue damage, such as ligament tears or nerve injuries are suspected.
MRIs provide a detailed image of the muscles, tendons, ligaments, and nerves around the elbow, helping to evaluate the full extent of the injury.
Ultrasound:

Ultrasound is sometimes used to check for vascular injuries. If the provider suspects damage to blood vessels (based on symptoms like coldness or loss of colour in the hand), an ultrasound can assess blood flow to the area.
It is less common but can be useful in the diagnosis of certain soft tissue injuries.
Nerve Conduction Studies:
If there are signs of nerve injury, such as numbness or weakness in the hand or fingers, nerve conduction studies or EMG (electromyography) may be recommended to evaluate the extent of nerve damage.

These diagnostic methods allow the provider to confirm the dislocation, assess any associated damage (such as fractures, ligament tears, or nerve involvement), and determine the appropriate course of treatment. Access Ortho can provide early and accurate diagnosis, which is important to prevent complications and ensure optimal recovery.

Specific Considerations for Elbow Dislocations

Elbow dislocations are complex injuries, and certain considerations must be considered to ensure proper diagnosis, treatment, and recovery. Two key areas of concern are associated ligament injuries and neurovascular complications, both of which can significantly impact outcomes. Access Ortho specialises in orthopaedic injuries, ensuring your assessment and treatment are based on expert knowledge.

1. Associated Ligament Injuries:

Elbow stability is heavily reliant on the integrity of the surrounding ligaments, and ligament damage is common with dislocations. Depending on the severity, ligament injuries can lead to long-term instability or impaired function.

Types of Ligament Injuries:

Lateral Collateral Ligament (LCL) Injury: The LCL stabilises the outside of the elbow and is frequently damaged in elbow dislocations. If not treated, rupture of the LCL can result in chronic elbow instability.
Medial Collateral Ligament (MCL) Injury: The MCL stabilises the inner side of the elbow and may also be injured during dislocation, although less commonly than the LCL.
Anterior Capsule Injury: The anterior part of the joint capsule is often stretched or torn during the dislocation, contributing to joint instability.

Treatment Considerations:

Partial Ligament Tears: These injuries may heal with conservative treatment, such as immobilisation and physiotherapy.
Complete Ligament Tears: In severe cases, particularly with complex dislocations, surgery may be needed to repair or reconstruct damaged ligaments to restore joint stability.

Without addressing ligament damage, patients may experience chronic elbow instability or recurrent dislocations, especially during physical activities that place stress on the joint.

2. Neurovascular Complications:

Elbow dislocations can lead to injuries to the nerves and blood vessels surrounding the joint. Neurovascular complications can cause long-term functional deficits and are medical emergencies that require immediate attention.

Nerve Injuries:

Ulnar Nerve Injury: The ulnar nerve runs close to the inner side of the elbow and is the most commonly affected nerve during elbow dislocations. Injury to the ulnar nerve can cause:
- Numbness or pins and needles in the ring and little fingers
- Weakness in grip strength
- Difficulty with fine motor skills, for example, doing up buttons
Median Nerve Injury: The median nerve can also be damaged, leading to symptoms such as:
- Numbness or pins and needles felt in the thumb, index, and middle fingers
- Weakness in the forearm or hand muscles
- Difficulty with thumb movements
Radial Nerve Injury: The radial nerve is at risk of being stretched or pinched during dislocation, resulting in:
- Numbness on the back of the hand and forearm
- Weakness in extending the wrist or fingers

Blood Vessel Injuries:

Brachial Artery Injury: The brachial artery runs close to the elbow joint and is vulnerable to injury during dislocations. Damage to this artery can lead to:
- Loss of blood flow to the forearm and hand
- Coldness or pale skin in the hand or fingers
- Weak or absent pulses in the wrist
- This is a medical emergency; surgical intervention may be required to restore circulation.

Treatment Considerations:

Nerve Damage: If nerve injury is suspected, treatment may involve observation, physiotherapy, or, in severe cases, surgical repair.
Vascular Damage: Any sign of compromised blood flow (e.g., cold or pale hand, weak pulse) demands urgent intervention to prevent permanent tissue damage. Surgery may be required to repair torn or compressed blood vessels.

Timely diagnosis, proper imaging, and multidisciplinary treatment approaches (including orthopaedic and vascular or nerve specialists) are essential for preventing complications and ensuring a successful recovery. Access Ortho specialises in treating acute musculoskeletal injuries and offers specialist orthopaedic care.

Management and Treatment

How are Elbow Dislocations Treated?

The treatment of an elbow dislocation depends on the severity of the injury, the presence of fractures, and whether any neurovascular or ligament damage is involved. The primary goal is to restore normal joint alignment, ensure the elbow remains stable, and minimise the risk of complications.

1. Immediate Management (Reduction):

The first step in treating an elbow dislocation is to relocate or “reduce” the joint. This process restores the normal alignment of the bones.

Closed Reduction: In most cases, the bones can be manually repositioned without the need for surgery. This is known as closed reduction.
- The doctor will apply gentle traction and manipulation to move the dislocated bones back into place.
- This procedure is typically done under sedation or local anaesthesia to reduce pain in an emergency department.
- After the reduction, the doctor will confirm the correct alignment through X-rays.
Open Reduction (Surgery): If the dislocation cannot be corrected with closed reduction or if there is associated damage to blood vessels, nerves, or bones, open reduction may be required. This is a surgical procedure in which the joint is realigned under direct visualisation.

2. Immobilisation and Rest:

Once the joint has been reduced, the elbow is usually immobilised to allow the ligaments and soft tissues to heal.

Splinting or Sling: Depending on the severity of the injury, a splint or sling keeps the elbow in a stable position for several days to a few weeks. The immobilisation time is typically shorter (1-3 weeks) to avoid stiffness.
Gradual Movement: Early motion is encouraged to prevent long-term stiffness. After initial immobilisation, the doctor will gradually introduce movement exercises.

3. Physiotherapy and Rehabilitation:

Rehabilitation is a critical part of recovery from an elbow dislocation. After immobilisation, physiotherapy helps restore range of motion, strength, and joint stability.

Range of Motion Exercises: Early mobilisation exercises aim to restore the normal bending and straightening of the elbow.
Strengthening Exercises: As healing progresses, exercises to strengthen the muscles around the elbow (forearm, upper arm, and shoulder) are introduced.
Stability Exercises: Special exercises to improve joint stability and prevent future dislocations are also included in the rehabilitation plan.

4. Surgical Treatment:

Surgery may be required in cases of complex dislocations, where there are fractures, severe ligament damage, or neurovascular complications.

Types of Surgical Interventions:

Ligament Repair: Surgical repair may be needed to restore elbow stability if the ligaments are torn. This is particularly common with complete lateral collateral ligament tears (LCL).
Fracture Fixation: If the dislocation involves a fracture (complex dislocation), the surgeon may need to fix the broken bones with plates, screws, or pins.
Nerve or Vascular Repair: If nerves or blood vessels are damaged, surgical repair is performed to restore function and blood flow. Prompt intervention is crucial to avoid permanent damage.
Elbow Reconstruction: In severe or repeated dislocations, reconstructive surgery may be needed to rebuild the joint.

5. Medications:

Pain Relief: Over-the-counter pain relievers, such as panadol or ibuprofen, are often recommended to manage pain and reduce inflammation.
Muscle Relaxants: Sometimes prescribed to ease muscle spasms after the dislocation.
Anti-inflammatory Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce swelling and pain during healing.

6. Follow-Up and Long-Term Management:

Follow-up appointments with the doctor are required to monitor healing progress and ensure the elbow remains stable and functional.

X-rays and Imaging: Follow-up X-rays or MRIs may be taken to assess bone healing and check for complications such as joint instability or arthritis.
Prevention of Recurrent Dislocations: If the dislocation is due to weak ligaments or joint instability, a brace during physical activities may be recommended to prevent further dislocations.

Complications to Watch For:

Even with proper treatment, some complications can arise from elbow dislocations. These include:

Stiffness and decreased movement: This is a common issue, especially if early mobilisation is delayed.
Chronic Instability: In cases of severe ligament damage, the elbow may become unstable and prone to future dislocations.
Nerve or Vascular Damage: If not properly addressed, nerve or blood vessel damage can cause long-term functional deficits or circulation problems.
Post-Traumatic Arthritis: Over time, damage to the cartilage or bone during the dislocation can result in osteoarthritis of the elbow joint.

Proper and timely treatment, combined with a structured rehabilitation plan, is crucial for a full recovery and the prevention of long-term problems. Relocation is best done in an emergency department. Access Ortho offers follow-up care post-relocation. If you have concerns following an elbow injury, Access Ortho can assess and determine the best course of treatment.

Prevention

How Can I Prevent Elbow Dislocations?

While it’s not always possible to completely avoid injuries, especially in high-risk activities, several strategies can help reduce the risk of elbow dislocations. Prevention focuses on improving joint stability and strength and practicing safe techniques in sports and physical activities.

Outlook / Prognosis

What Can I Expect After an Elbow Dislocation?

The recovery process after an elbow dislocation can vary depending on the injury’s severity, complications like fractures or ligament damage, and the treatment received. Recovery typically involves immobilisation, rehabilitation, and, in some cases, surgery. Here’s what you can generally expect:

1. Immediate Post-Injury Phase:

Pain and Swelling: After the dislocation is reduced (repositioned), you may still experience pain, swelling, and bruising around the elbow joint. This is normal and can be managed with rest, ice, and pain relievers.
Immobilisation: Depending on how severe the injury is, your doctor may place your elbow in a splint or sling for a few days to weeks. This prevents further damage and allows the initial healing process to begin. Immobilisation is typically brief to avoid joint stiffness.

2. Early Recovery Phase:

Rehabilitation Begins Early: While your elbow may be immobilised, doctors usually encourage early range-of-motion exercises to prevent the joint from becoming stiff. This phase focuses on gentle movements like bending and straightening the elbow.
Continued Monitoring: Follow-up appointments are essential to monitor healing progress. X-rays or other imaging tests may be done to ensure that the elbow joint is properly aligned. Access Ortho offers follow-up care for dislocations that have been reduced in an Emergency Department or Urgent care setting.

3. Pain Management:

Over-the-counter pain relievers such as panadol or ibuprofen may be prescribed in order to reduce pain and inflammation.
If you experience severe pain or complications, your doctor may prescribe stronger pain medication.

Recovery Time from Elbow Dislocations

Recovery Time for simple elbow dislocations is generally 6 to 12 weeks, but full recovery can take 3 to 6 months.

For complex dislocations, recovery may take 6 months to a year, particularly if surgery is required.
Rehabilitation plays an important role in restoring strength, flexibility, and range of motion, and proper physiotherapy is essential for a full recovery.

When Should I Seek Medical Attention?

Signs that Require Immediate Care

Severe Pain: Intense or worsening pain not relieved by medication could indicate complications like a fracture or nerve damage.
Numbness or Tingling: Persistent numbness, tingling, or weakness in the hand or fingers may suggest nerve injury.
Cold or Pale Hand: If the hand or fingers become cold or pale, it could indicate compromised blood flow, which requires urgent attention.
Inability to Move: If you cannot move your elbow or the movement is severely restricted, it may signal joint or soft tissue damage.
Visible Deformity: Any unusual bulging or changes in the shape of the elbow could indicate complications or misalignment that needs immediate evaluation.
Swelling or Bruising: Excessive swelling or bruising that worsens over time could be a sign of internal injury or complications.
Loss of Pulses: Weak or absent pulses in the wrist may indicate a vascular injury requiring immediate surgical intervention.
Severe Functional Impairment: Difficulty with basic functions like gripping or lifting objects could be due to significant joint or nerve damage.

Immediate medical evaluation is crucial for these signs to avoid long-term complications and ensure proper treatment. If you are concerned your elbow is dislocated, attend your nearest emergency department immediately. If you have had a recent dislocation and require orthopaedic care, contact Access Ortho for an appointment.

Understanding Fracture and Dislocation Clinics

Role of Specialised Clinics such as Access Ortho in Elbow Dislocation Management

Access Ortho is an acute orthopaedics injury clinic and plays a crucial role in managing elbow dislocations as we offer specialist orthopaedic care. Here’s how they contribute to effective treatment and recovery:

1. Accurate Diagnosis

Comprehensive Evaluation: Offers a detailed assessment of the joint, surrounding tissues, and neurovascular status to tailor the treatment plan.

2. Effective Treatment

Access Ortho provides orthopaedic care for elbow dislocations. If surgery is required, a referral will be made to an appropriate surgeon.

4. Rehabilitation and Recovery

Access Ortho coordinates with physiotherapists to design and oversee rehabilitation programs to restore range of motion, strength, and stability.
Follow-up care: Access Ortho provides guidance on recovery and preventive strategies to avoid future dislocations or complications.

In summary, Access Ortho ensures a thorough, expert approach to managing elbow dislocations. Their expertise helps achieve optimal recovery and minimise the risk of complications. If you have symptoms indicating your elbow is still dislocated, attend your nearest emergency department immediately.

Frequently Asked Questions About Elbow Dislocations

What are the main symptoms of an elbow dislocation?

The main symptoms experienced following an elbow dislocation are:

Pain: Intense pain around the elbow joint.
Swelling: Noticeable swelling and bruising.
Deformity: The elbow may appear visibly out of place or misshapen.
Limited Movement: Difficulty or inability to move the elbow or arm.
Numbness or Tingling: This may be felt in the hand or fingers if nerves are involved.

How is an elbow dislocation different from an elbow fracture?

A dislocation occurs when the bones that form the elbow joint are pushed out of their normal position, often resulting in joint misalignment.
A fracture involves a break in one or more of the bones forming the elbow joint. Fractures may or may not occur with a dislocation. X-rays are typically needed to differentiate between them.

Can you pop a dislocated elbow back in yourself?

No, you should not attempt to reduce (pop back) a dislocated elbow yourself. Relocation should be done by a medical professional to avoid further injury and complications. Incorrect reduction can cause additional damage to the joint, nerves, or blood vessels. You should go to your nearest emergency department immediately.

What imaging studies are used to diagnose elbow dislocations?

X-rays: Primary imaging method to confirm the dislocation and check for associated fractures.
CT Scans: Used for detailed views, especially if fractures are suspected.
MRI: This may be recommended in order to assess soft tissue injuries, such as ligament or cartilage damage.

How long does it typically take to recover from an elbow dislocation?

Simple Dislocations: Typically, it takes 6 to 12 weeks for most people to return to normal function.
Complex Dislocations: Recovery may take 6 months to a year, especially if surgery is required.

Will I need surgery for my elbow dislocation?

Surgery may be needed for an elbow dislocation if fractures are present, if there is severe ligament damage, or a complex dislocation. Your doctor will determine the need for surgery based on the severity of the injury and the response to initial treatments.

What is the “terrible triad” of the elbow?

The “terrible triad” refers to a severe elbow injury involving:

Elbow Dislocation
Radial Head Fracture (a fracture of the radial bone near the elbow)
Coronoid Process Fracture (a fracture of the coronoid process of the ulna bone)

How does an elbow dislocation affect arm function?

An elbow dislocation can impair the ability to bend and straighten the elbow, grip objects, and perform everyday tasks. Full recovery usually involves regaining strength, range of motion, and stability.

When can I return to sports after an elbow dislocation?

Return to sports following an elbow dislocation depends on the severity of the dislocation and progress in recovery. Return to sports may be possible within 3 to 6 months for simple dislocations, but you should follow your doctor’s advice. For complex cases, a longer recovery period is required.

What exercises help in recovering from an elbow dislocation?

Range of Motion Exercises: Gentle bending and straightening of the elbow to restore flexibility.
Strengthening Exercises: Bicep curls, tricep extensions, and forearm exercises to build muscle strength around the elbow.
Stability Exercises: Exercises such as isometric holds to enhance joint stability.
Stretching: To improve flexibility and reduce stiffness in the elbow and surrounding muscles.

You must always consult with your medical team before starting an exercise program to ensure it’s appropriate for your specific recovery needs.