Elbow Dislocation: Understanding Causes, Symptoms, Treatment, and Recovery

What is a dislocated bone in the elbow?

An elbow dislocation occurs when the bones of the forearm (radius and ulna) are completely separated from the bone of the upper arm (humerus) at the elbow joint, resulting in a visible deformity, severe pain, and an inability to move the arm.

Anatomy of the Elbow Joint

To understand an elbow dislocation, it's essential to first grasp the basic anatomy of this complex joint. The elbow is a hinge joint formed by the articulation of three bones:

• Humerus: The long bone of the upper arm.
• Ulna: The larger bone of the forearm, located on the pinky finger side. Its olecranon process forms the bony prominence at the back of the elbow.
• Radius: The smaller bone of the forearm, located on the thumb side.

These bones are held together and stabilized by a network of strong ligaments and a joint capsule:

• Medial Collateral Ligament (MCL) / Ulnar Collateral Ligament (UCL): Provides stability on the inner (medial) side of the elbow.
• Lateral Collateral Ligament (LCL) / Radial Collateral Ligament (RCL): Provides stability on the outer (lateral) side of the elbow.
• Annular Ligament: Encircles the head of the radius, holding it firmly against the ulna.
• Joint Capsule: A fibrous sac that encloses the joint, containing synovial fluid for lubrication.

The intricate design of these bones and soft tissues allows for flexion and extension of the arm, as well as pronation and supination of the forearm (turning the palm up and down).

What is an Elbow Dislocation?

An elbow dislocation refers to the complete separation of the articular (joint) surfaces of the humerus, ulna, and radius. This means the bones that normally meet to form the joint are no longer in their proper alignment. It is distinct from a subluxation, which is a partial or incomplete dislocation where the joint surfaces are still partially in contact.

Elbow dislocations are broadly categorized:

• Simple Dislocation: Involves only the dislocation of the bones, with no associated fractures. While "simple" in name, it still involves significant ligamentous and soft tissue damage.
• Complex Dislocation: Involves the dislocation of the bones along with one or more fractures of the humerus, ulna, or radius. These are typically more severe, require more complex treatment, and have a longer recovery period.

Dislocations are also described by the direction of displacement of the ulna and radius relative to the humerus:

• Posterior Dislocation: The most common type, where the forearm bones are displaced backward relative to the humerus.
• Anterior, Lateral, Medial, or Divergent Dislocations: Less common types, describing displacement in other directions.

Common Causes of Elbow Dislocation

Elbow dislocations are typically the result of significant trauma, often involving a fall or direct impact.

• Fall onto an Outstretched Hand (FOOSH): This is the most frequent mechanism. When falling, an individual extends their arm to break the fall, transferring a large force through the arm to the elbow joint, often causing hyperextension and rotation that tears the stabilizing ligaments.
• Sports Injuries: High-impact sports, gymnastics, wrestling, and contact sports carry a higher risk.
• Motor Vehicle Accidents: Direct impact to the elbow or forces transmitted through the arm can cause dislocation.
• Direct Blow to the Elbow: A forceful impact directly on the joint can cause the bones to displace.

Signs and Symptoms

The signs and symptoms of an elbow dislocation are usually immediate and unmistakable:

• Severe and Immediate Pain: Intense pain at the elbow joint.
• Obvious Deformity: The elbow will appear visibly out of place, often with a prominent bony lump or an unnatural angle.
• Swelling and Bruising: Rapid onset of swelling and discoloration around the joint.
• Inability to Move the Arm: The individual will be unable to bend or straighten the elbow.
• Numbness or Tingling: Due to potential nerve compression (ulnar, median, or radial nerves), there may be a loss of sensation or tingling in the hand or fingers.
• Weakness or Coldness in the Hand: This is a critical sign of potential vascular injury (damage to blood vessels) and requires immediate medical attention.

Diagnosis

A medical professional will diagnose an elbow dislocation through a combination of physical examination and imaging studies.

• Clinical Examination: The doctor will visually inspect the arm for deformity, palpate the area for tenderness and bony misalignment, and carefully assess nerve and blood vessel function (checking sensation, pulse, and capillary refill in the hand).
• X-rays: Essential to confirm the dislocation, determine the direction of displacement, and rule out any associated fractures (which would indicate a complex dislocation).
• MRI (Magnetic Resonance Imaging): May be used after reduction to assess the extent of soft tissue damage, such as ligament tears, cartilage damage, or joint capsule injuries.
• CT Scan (Computed Tomography): Sometimes used for complex dislocations, especially when multiple fractures are suspected, to get a more detailed view of the bone fragments.

Treatment and Management

Prompt medical attention is crucial for an elbow dislocation to minimize complications and facilitate proper healing.

• Immediate Medical Attention: Do not attempt to pop the elbow back into place yourself, as this can cause further damage to nerves, blood vessels, or surrounding tissues.
• Reduction: The primary treatment is reduction, which involves gently manipulating the bones back into their correct anatomical position. This is typically performed under sedation or general anesthesia to relax the muscles and minimize pain.
  • Closed Reduction: The most common method, where the bones are repositioned externally without surgery.
  • Open Reduction: Required for complex dislocations where bone fragments or soft tissues prevent successful closed reduction, or if there are associated fractures that need surgical repair.
• Pain Management: Analgesics are administered to manage the severe pain.
• Immobilization: After reduction, the elbow is typically immobilized in a splint or cast for a short period (usually 1-3 weeks) to protect the healing ligaments and joint capsule. Prolonged immobilization is generally avoided to prevent stiffness.
• Surgical Intervention: Necessary for complex dislocations involving significant fractures, severe ligamentous instability, or if the joint cannot be reduced non-surgically. Surgery may involve repairing ligaments, fixing bone fragments with plates and screws, or removing bone chips.

Recovery and Rehabilitation

Recovery from an elbow dislocation is a multi-stage process focused on restoring range of motion, strength, and stability.

• Early Motion: A critical component of rehabilitation. Once stable, gentle, controlled active range of motion exercises are initiated as early as possible (often within days of reduction) to prevent chronic stiffness, which is a common complication.
• Physical Therapy: A structured rehabilitation program guided by a physical therapist is essential. This typically includes:
  • Range of Motion (ROM) Exercises: Gradually increasing the ability to bend and straighten the elbow, as well as pronate and supinate the forearm.
  • Strengthening Exercises: Progressively building strength in the muscles surrounding the elbow and shoulder to enhance joint stability. This may start with isometric exercises and advance to resistance training.
  • Proprioception and Stability Drills: Exercises designed to improve the joint's awareness of its position in space and enhance dynamic stability.
• Expected Timeline: Full recovery can vary widely depending on the severity of the dislocation, presence of fractures, and individual factors. Simple dislocations may take 6-12 weeks for functional recovery, while complex cases can take several months to a year or more for maximum improvement.
• Potential Complications:
  • Stiffness (Contracture): The most common complication, especially if immobilization is prolonged or rehabilitation is not consistent.
  • Re-dislocation: A risk if the initial injury was severe or if rehabilitation is not completed.
  • Nerve or Vascular Damage: Though rare, these can occur during the injury or reduction.
  • Post-traumatic Arthritis: Long-term risk, especially with complex dislocations or repeated injuries.
  • Heterotopic Ossification: Abnormal bone growth around the joint, which can limit motion.

Prevention Strategies

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

• Proper Technique in Sports: Learning and practicing correct falling techniques in sports like gymnastics or martial arts can help.
• Strength and Conditioning: Maintaining strong muscles around the elbow, shoulder, and core can improve overall joint stability.
• Fall Prevention: For older adults or individuals with balance issues, addressing hazards in the home and improving balance can reduce the risk of falls.
• Protective Gear: In high-risk sports, appropriate padding or protective equipment may offer some protection.

When to Seek Medical Attention

If you suspect an elbow dislocation or experience any of the following after an injury, seek immediate medical attention:

• Sudden, severe pain in the elbow.
• Visible deformity or misalignment of the elbow joint.
• Inability to move the arm or elbow.
• Numbness, tingling, or weakness in the hand or fingers.
• Coldness or pallor (paleness) of the hand.

Early and appropriate management of an elbow dislocation is critical for optimal recovery and to minimize the risk of long-term complications.