Elbow Dislocation

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The elbow is the second most commonly dislocated joint in adults, after shoulder dislocations. Elbow dislocations usually occur after a fall when the elbow and hand are fully extended. Elbow dislocations can be complete or partial. A partial dislocation is referred to as a subluxation. The amount of force needed to cause an elbow dislocation is usually enough to cause a bone fracture simultaneously. These two injuries (dislocation-fracture) often occur together and produce a significant amount of elbow pain. 

Man Holding his Elbow

The Elbow Joint 

The elbow joint is made up of three bones. The bones of the elbow are the humerus (upper arm bone), the ulna (the larger bone of the forearm, on the opposite side of the thumb), and the radius (the smaller bone of the forearm on the same side as the thumb). The elbow itself serves as a hinge joint, meaning it’s function is to bend and straighten like a hinge. However, there is a second joint where the radius (radial head) meets the humerus. This joint is more complicated, and allows the radius to rotate so that you can turn your hand palm up and palm down. Articular cartilage surrounds the ends of all three bones, and allows the joint surfaces to slide against one another without causing any damage. If you want to learn more about injuries to the elbow, go to this Video.

The elbow also has three ligaments. Ligaments are soft tissue structures that connect bones to bones. Two of the most important ligaments in the elbow are the medial collateral ligament and the lateral collateral ligament. Together these two ligaments connect the humerus to the ulna and keep it tightly in place as it slides through the groove of the humerus. These ligaments are the main source of stability for the elbow. They can be torn when there is an injury to or dislocation of the elbow. If they do not heal correctly, the elbow can become too loose or unstable. The third ligament, the annular ligament, wraps around the radial head and holds it tight against the ulna. The annular ligament forms a ring around the radial head as it holds it in place. This ligament can be torn when the entire elbow or just the radial head is dislocated.

How Elbow Dislocations Happen?

Elbow dislocations are not common among the general population. Elbow dislocations typically occur when a person falls on to an outstretched hand. When the hand hits the ground, the force is sent up through the arm into the elbow. Usually there is a rotational motion in this force. This can drive and rotate the elbow out of its socket. Elbow dislocations can also happen in car accidents when the passengers reach forward to cushion the impact. The force that is sent through the arm can dislocate the elbow, just like a fall. The elbow is stable because of the combined stabilizing effects of bone surfaces, ligaments, and muscles. When an elbow dislocates, any or all of these structures can be injured to different degrees. A simple dislocation does not have any major bone injury. A complex dislocation can have severe bone and ligament injuries. In the most severe dislocations, the blood vessels and nerves that travel across the elbow may be injured. If this happens, there is a risk of losing the arm. Some individuals are born with greater laxity or looseness in their ligaments. These individuals are at a greater risk for dislocation. Some people are also born with an ulna that has a shallow groove for the elbow hinge joint. They also have a slightly higher risk for dislocation.

Partial or Complete Dislocation?

A complete elbow dislocation is acute, extremely painful, and very obvious. The arm will look deformed and may have an odd twist at the elbow. A partial dislocation or subluxation can be harder to detect. Typically, they occur after an automobile accident. Due to the fact that the elbow is only partially dislocated, the bones can spontaneously reduce and the joint may appear fairly normal. The elbow will usually move fairly well, but there may be pain. There may be bruising on the inside and outside of the elbow where the ligaments have been stretched or torn. Partial dislocations have a tendency to recur over time if the ligaments never heal.

A Doctor’s Evaluation

During a doctors (MD) evaluation, the doctor will examine the arm and check for tenderness, swelling, and deformity. The MD will evaluate the skin and check your circulation to the arm. Pulses at the neck and the wrist will be checked. If the artery is injured at the time of dislocation, the hand will be cool to touch or have a white/purple hue which is caused by a lack of warm blood reaching the hand. It is also important to check the nerve supply to the hand. If nerves have been injured during the dislocation, some or all of the hand may be numb or have a loss of function. 

 An x-ray will be ordered to determine if there is any bone injury. X-rays can also show the direction of the dislocation. If bone detail is difficult to identify on an x-ray, a computed tomography (CT) scan may be done. It is important to evaluate the ligaments of the elbow, so a magnetic resonance image (MRI) can be helpful. First, the doctor will reduce the elbow without waiting for a CT or MRI. These studies are usually taken after the dislocated elbow has been put in place. An elbow dislocation should be treated as a medical emergency. The goal of immediate treatment of a dislocated elbow is to return the elbow to its normal alignment. The long-term goal is to restore function to the arm.

Non-surgical Treatment

The normal alignment of the elbow can usually be restored in an emergency department at the hospital. Before this is done, sedatives and pain medications usually will be given. The act of restoring alignment to the elbow is called a reduction maneuver. It is done gently and slowly. Two people are usually required to perform this maneuver. Simple elbow dislocations are treated by keeping the elbow immobile in a splint or sling for two to three weeks, followed by early motion exercises. If the elbow is kept immobile for a long time, the ability to move the elbow fully (range of motion) may be affected. Physical therapy can be helpful during this period of recovery. Some people will never be able to fully open (extend) the arm, even after physical therapy. Fortunately, the elbow can work very well even without full range of motion. Once the elbow’s range of motion improves, the doctor or physical therapist may add a strengthening program. X-rays may be taken periodically while the elbow recovers to ensure that the bones of the elbow joint remains well aligned.

Surgical Treatment

In a complex elbow dislocation, surgery may be necessary to restore bone alignment and repair ligaments. It can be difficult to realign a complex elbow dislocation and to keep the joint in line. After surgery, the elbow may be protected with an external hinge. This device protects the elbow from dislocating again. If blood vessels or nerve injuries are associated with the elbow dislocation, additional surgery may be needed to repair them. Late reconstructive surgery can successfully restore motion to some stiff elbows. This surgery removes scar tissue and extra bone growth. It also removes obstacles to movement. Over time, there is an increased risk for arthritis in the elbow joint if the alignment of the bones is not good; the elbow does not move and rotate normally; or the elbow continues to dislocate. 

Related Articles:

Bones in the Elbow and Muscles in the Elbow

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By: Lily Condy, OT, CHT