Knowledge that empowers
What is it?
An elbow dislocation is an injury where the two bones of the forearm, the radius and ulna, are separated from the upper arm (humerus) bone.
Often the forearm bones are displaced posteriorly (behind) the humerus. Elbow dislocations typically occur due to a fall onto an outstretched hand (FOOSH injury).
Elbow dislocations are typically categorised as either simple or complex. A simple dislocation involves complete tearing of either the lateral and/or medial ligaments, and the capsule of the elbow. A complex dislocation typically refers to an elbow dislocation where there is complete tearing of the ligaments and capsule, however there is also the presence of one or more fractures of the bone. One commonly seen complex dislocation is known as a terrible triad injury – this refers to elbow dislocation with associated fractures of the coronoid and radial head.
It is also possible to partially dislocate your elbow; this is known as subluxation or may even be referred to as a perched elbow.
Who is affected?
As elbow dislocations require a significant amount of force, it is common to see these injuries in people who participate in sports and activities such as martial arts, olympic weightlifting, snowsports and skateboarding. It is perhaps more common to see these injuries in areas of the world more affected by wintery conditions – a common story to hear is of someone slipping and falling on ice or snowmelt.
What are the symptoms?
Those unlucky enough to have dislocated their elbow may describe the elbow slipping out of place and not being able to be put back in (locked dislocation). It is typically a very painful injury and there is usually obvious deformity seen at the elbow with almost complete impairment to move the elbow. A large amount of swelling and bruising is common after an elbow dislocation, result of the soft tissue and bone damage.
What is the prognosis?
The outcomes after elbow dislocation are favourable in the majority of cases if early diagnosis is made, and there is timely referral for physiotherapy or surgical treatment of the elbow.
Generally speaking, patient satisfaction is high once the elbow becomes stable and it can be used for activities of daily life. Although most of the patients recover full range of motion, some patients are experience residual stiffness.
These are normally able to bend the elbow from approximately 30° of flexion >= 130° and are also able to rotate the forearm enough to complete tasks such as feeding yourself and keyboard or mouse use for work.
It must be said that a satisfactory outcome after elbow dislocation or surgery for a complex dislocation is never guaranteed. A small percentage of patients will continue to experience instability after simple elbow dislocation and may require surgery.
It is, however, far more common to develop elbow stiffness as opposed to suffering from further instability or recurrent dislocation.
The exact cause of stiffness can be due to a number of different reasons; some of these include development of thick scar tissue in the ligaments and capsule of the elbow joint, heterotopic ossification – a process where abnormal amounts of bone develop in the soft tissues outside of the elbow joint and reduced mobility of the ulnar nerve as it passes the injured elbow to supply the hand.
Thankfully though, the rate of re-dislocation of the elbow is extremely low as compared to the shoulder joint, something that many patients may fear as they return to normal life, recreation and work.
It is for these reasons that it is critical to seek expert care following an elbow dislocation. A/Prof. Raniga and members of our physiotherapy team have specialist training in the management of simple and complex elbow dislocations. We also share a close working relationship with Orthopaedic Surgeons and Therapists at the Roth MacFarlane Hand and Upper Limb Centre in Canada, a world-renowned centre for management of elbow injuries. You can expect an expert level of care from all members of our team following elbow dislocation.
How is the diagnosis made?
Diagnosis of a dislocated elbow may be suspected after taking a thorough history and completing a detailed physical examination.
Although diagnosis is confirmed by taking a series of x-rays of the elbow. Once diagnosed, the joint needs to be urgently reduced by an orthopaedic specialist doctor to avoid neurovascular complications.
After joint reduction, some complex fractures may also require further examination by way of a computed tomography (CT) scan. This gives your surgeon a chance to see the fracture pattern in 3D and assists greatly with planning surgery, should that be necessary.
Non surgical treatment
Simple elbow dislocations do not often require surgery and will recover well under the guidance of an experienced physiotherapist.
Your rehabilitation, in most circumstances, will be closely supervised over the course of 3-4 months to ensure the elbow regains its stability and range of motion for use in day to day life.
Elbow dislocations are, however, notoriously difficult to rehabilitate as treatment requires finely balancing protected range of motion and splinting to achieve stability, but also allowing the patient to complete early range of motion exercises to prevent excessive stiffness.
Patients with complex elbow fracture-dislocations or persistent chronic elbow instability often require surgery to achieve structural stability of the elbow joint.
Depending on the specific type of injury, surgery may involve fracture fixation, repair or reconstruction of associated ligament injuries and even replacement of the radial head with a prosthesis. Only in very extreme circumstances of severe fracture-dislocations would the entire elbow joint need replacement.
For the same reasons as described previously, physiotherapy is critical following surgery for a complex dislocation to achieve the best outcome for your elbow. Physiotherapy after surgery often includes customised splinting, protective range of motion exercises for the elbow, shoulder, wrist and hand. Once the elbow has healed sufficiently and is stable, physiotherapy may involve stretching and static progressive splinting to ensure the elbow has sufficient range of motion for day to day tasks.