Elbow Dislocation: Symptoms, First Aid, Medical Treatment, and Rehabilitation

What to do for a dislocated elbow?

An elbow dislocation is a medical emergency requiring immediate professional attention to properly realign the bones and prevent further damage. Following reduction, a structured rehabilitation program guided by a healthcare professional is crucial for restoring full function and preventing re-injury.

Understanding the Elbow Joint and Dislocation

The elbow is a complex hinge joint formed by the articulation of three bones: the humerus (upper arm bone), and the radius and ulna (forearm bones). Ligaments and a joint capsule provide stability, allowing for flexion, extension, pronation, and supination. An elbow dislocation occurs when the bones of the forearm (radius and ulna) are forced out of alignment with the humerus. This typically results from a significant traumatic event, such as a fall onto an outstretched hand, a direct blow to the elbow, or a hyperextension injury during sports.

Recognizing the Signs and Symptoms

Identifying an elbow dislocation quickly is vital for prompt treatment. Key indicators include:

• Immediate and Severe Pain: Often described as excruciating at the time of injury.
• Obvious Deformity: The elbow may appear significantly misshapen, with the arm appearing shorter or bent at an unnatural angle. The olecranon (the bony tip of the elbow) may be displaced.
• Swelling and Bruising: Rapid onset of swelling around the joint due to internal bleeding and fluid accumulation. Bruising may develop over time.
• Inability to Move the Arm: The individual will experience extreme difficulty or complete inability to bend, straighten, or rotate the forearm.
• Numbness or Tingling: In some cases, nerve compression or damage can lead to numbness, tingling, or weakness in the hand or fingers. This is a serious symptom requiring immediate attention.

Immediate First Aid: What to Do (and Not Do)

If you suspect an elbow dislocation, immediate action is critical:

• Seek Medical Attention Immediately: An elbow dislocation is an emergency. Call emergency services (e.g., 911 in the US) or go to the nearest emergency room without delay.
• Immobilize the Arm: Try to keep the arm as still as possible in the position it was found. You can fashion a makeshift sling using a scarf, towel, or shirt to support the arm and prevent movement. Do not try to force the arm into a "normal" position.
• Apply Ice: Gently apply an ice pack (wrapped in a cloth) to the affected area to help reduce swelling and pain. Do not apply ice directly to the skin.
• Elevate the Arm: If possible and comfortable, try to elevate the arm above heart level to further minimize swelling.
• Do NOT Attempt to Relocate: Never try to "pop" the elbow back into place yourself or allow an untrained person to do so. This can cause severe damage to nerves, blood vessels, ligaments, and potentially lead to fractures.
• Do NOT Give Food or Drink: If medical professionals determine that sedation or surgery is required, it's safer if the individual has an empty stomach.

Medical Diagnosis and Treatment

Upon arrival at a medical facility, the following steps will typically occur:

• Physical Examination: A doctor will assess the injury, check for nerve or blood vessel damage, and evaluate the range of motion (though limited).
• Imaging:
  • X-rays: Crucial for confirming the dislocation, identifying its type, and ruling out associated fractures (which are common with dislocations).
  • MRI (Magnetic Resonance Imaging): May be ordered if soft tissue damage (ligaments, tendons) or cartilage injuries are suspected after reduction.
• Reduction: The process of manually realigning the bones back into their proper position.
  • Non-Surgical Reduction: Most elbow dislocations can be reduced manually by a trained medical professional using specific maneuvers, often under sedation or general anesthesia to relax muscles and minimize pain.
  • Surgical Reduction: Surgery may be required for complex dislocations, those accompanied by significant fractures, or if the dislocation cannot be reduced manually.
• Post-Reduction Immobilization: After successful reduction, the elbow will be immobilized in a splint or cast for a specific period, typically 1-3 weeks, to allow initial healing of the joint capsule and ligaments. The duration depends on the severity of the injury and any associated damage.

Rehabilitation: The Road to Recovery

Rehabilitation is a critical phase following an elbow dislocation to restore full function, prevent stiffness, and reduce the risk of re-dislocation. This process is best guided by a physical therapist or occupational therapist.

• Initial Phase (Immobilization):
  • Focus on pain and swelling management.
  • Gentle, controlled movements of the hand and wrist may be encouraged if permitted by the doctor.
• Early Mobilization Phase:
  • Once the splint is removed (or as directed by the doctor), the focus shifts to regaining range of motion (ROM).
  • Range of Motion (ROM) Exercises: Gentle, progressive exercises to restore elbow flexion, extension, pronation, and supination. These may start with passive or active-assisted movements.
  • Pain Management: Continued use of ice, elevation, and pain medication as needed.
• Strengthening Phase:
  • As ROM improves and pain subsides, strengthening exercises are introduced gradually.
  • Gradual Resistance: Beginning with isometric contractions, then progressing to light resistance exercises using bands, light weights, or bodyweight.
  • Targeted Muscles: Strengthening of the muscles surrounding the elbow (biceps, triceps, forearm flexors and extensors) and the shoulder girdle (rotator cuff, scapular stabilizers) is crucial for joint stability.
  • Proprioceptive Training: Exercises to improve joint awareness and control, such as balance and coordination drills.
• Return to Activity Phase:
  • This final phase involves gradually reintroducing functional movements and sport-specific activities.
  • Sport-Specific Drills: Mimicking movements required for work, daily life, or sports, with increasing intensity and resistance.
  • Criteria for Return: Full, pain-free range of motion, comparable strength to the uninjured arm, and confidence in the joint's stability are typically required before returning to full activity.

Potential Complications and Long-Term Considerations

While most elbow dislocations heal well with proper treatment and rehabilitation, some complications can occur:

• Stiffness and Loss of Range of Motion: This is the most common complication, especially loss of full extension. Consistent rehabilitation is key to minimizing this.
• Recurrent Dislocation: If ligaments were severely damaged or rehabilitation is incomplete, there's a higher risk of re-dislocation.
• Nerve or Blood Vessel Damage: Although rare, these can occur during the initial injury or during reduction.
• Heterotopic Ossification: The abnormal formation of bone in soft tissues around the joint, which can severely limit motion.
• Arthritis: Long-term risk of developing post-traumatic osteoarthritis in the elbow joint.

Prevention Strategies

While not all dislocations can be prevented, certain strategies can reduce the risk:

• Strengthening and Flexibility: Maintain good overall upper body strength and flexibility, particularly around the elbow and shoulder.
• Proper Technique: Use correct technique during sports and physical activities to avoid awkward falls or hyperextension.
• Protective Gear: Wear appropriate protective equipment (e.g., elbow pads) during high-risk sports or activities.
• Fall Prevention: Be mindful of slippery surfaces, cluttered environments, and ensure good balance, especially for older adults.