Elbow Dislocation: Treatment, Rehabilitation, and Complications

How to treat an elbow dislocation?

Treating an elbow dislocation primarily involves prompt medical intervention for reduction, followed by a structured rehabilitation program focusing on pain management, restoring range of motion, and progressive strengthening to regain full function and prevent recurrence.

Understanding Elbow Dislocation

An elbow dislocation occurs when the bones of the forearm (radius and ulna) are completely displaced from their normal alignment with the upper arm bone (humerus) at the elbow joint. It is a common upper extremity injury, often resulting from a fall onto an outstretched arm (FOOSH injury) or direct trauma, forcing the elbow beyond its normal range of motion. While the most common type is posterior dislocation, where the forearm bones move backward relative to the humerus, other directions can occur. This injury typically damages the joint capsule and surrounding ligaments, particularly the ulnar collateral ligament (UCL) and radial collateral ligament (RCL), which are crucial for elbow stability.

Immediate Medical Attention: The Critical First Steps

It is paramount to seek immediate medical attention for an elbow dislocation. Attempting to reduce the dislocation yourself can cause further damage to nerves, blood vessels, or the joint surfaces.

• Emergency Assessment: Upon arrival at an emergency department, medical professionals will assess the injury. This includes a thorough physical examination to check for any signs of nerve or blood vessel compromise (e.g., numbness, tingling, pallor, weak pulse), which are critical complications requiring urgent attention.
• Diagnostic Imaging: X-rays are essential to confirm the diagnosis of dislocation, determine its direction, and rule out associated fractures of the humerus, radius, or ulna, which occur in a significant percentage of elbow dislocations.
• Reduction: The primary goal is to "reduce" the dislocation, meaning to put the bones back into their proper alignment.
  • Closed Reduction: This is the most common method. After administering pain medication and often sedation, a physician will manually manipulate the arm to guide the bones back into place without surgery.
  • Open Reduction: If closed reduction is unsuccessful, or if there are associated complex fractures, significant soft tissue damage, or nerve/vascular compromise, surgical intervention (open reduction) may be necessary.

Post-Reduction Management

Once the elbow is successfully reduced, the focus shifts to protecting the joint while initiating the healing process.

• Immobilization: The elbow is typically immobilized in a splint or sling for a short period, usually 1-3 weeks. The duration depends on the severity of the dislocation, the presence of associated injuries (like fractures or significant ligamentous tears), and the physician's judgment. Prolonged immobilization is generally avoided to prevent excessive stiffness.
• Pain and Swelling Management: Over-the-counter or prescription pain relievers may be used. Applying ice packs to the elbow for 15-20 minutes several times a day can help reduce swelling and discomfort.
• Follow-up Imaging: Post-reduction X-rays are taken to confirm proper alignment and ensure no new fractures occurred during the reduction process.
• Early Controlled Motion: In many cases, especially for simple dislocations, early initiation of gentle, controlled range of motion exercises is encouraged once the initial pain and swelling subside. This helps prevent joint stiffness, a common complication, and promotes healing of the joint capsule and ligaments.

Rehabilitation: Restoring Function and Strength

Rehabilitation is a critical phase of treatment, essential for regaining full elbow function and preventing chronic instability or stiffness. It is typically guided by a physical or occupational therapist.

• Phase 1: Early Motion and Pain Control (Weeks 1-3/4)
  • Goal: Reduce pain and swelling, protect the healing tissues, and gently restore basic range of motion.
  • Exercises: Passive and active-assisted range of motion exercises (e.g., gentle flexion and extension, pronation and supination of the forearm) within pain-free limits. Avoidance of sudden movements or stressing the healing ligaments.
  • Modalities: Ice, compression, and possibly electrical stimulation for pain and swelling.
• Phase 2: Gradual Strengthening (Weeks 4-8)
  • Goal: Increase strength, endurance, and full range of motion.
  • Exercises: Progress from isometric exercises (muscle contractions without joint movement) to light isotonic exercises (e.g., bicep curls, triceps extensions with very light weights or resistance bands). Focus on restoring strength in the muscles surrounding the elbow and shoulder.
  • Proprioception: Exercises to improve joint awareness and stability (e.g., gentle weight-bearing activities).
• Phase 3: Functional and Sport-Specific Training (Weeks 8+ to Return to Activity)
  • Goal: Prepare the elbow for the demands of daily activities, work, or sport.
  • Exercises: Progress to more challenging resistance exercises, plyometrics (if appropriate for sport), and activities that mimic specific movements required for the individual's sport or occupation. Emphasis on dynamic stability and power.
  • Gradual Return to Activity: A carefully planned, progressive return to sports or physically demanding activities is crucial to prevent re-injury. This phase may take several months, depending on the individual and the demands of their activities.

Potential Complications and What to Watch For

While most elbow dislocations heal well with proper treatment, certain complications can arise:

• Stiffness (Contracture): The most common complication, often due to prolonged immobilization or inadequate rehabilitation. Early, controlled motion helps mitigate this.
• Recurrence: Re-dislocation can occur, especially if ligaments remain unstable or if the return to activity is too rapid.
• Nerve or Vascular Injury: Though rare, damage to the ulnar, median, or radial nerves, or to the brachial artery, can occur during the initial injury or reduction. Symptoms include numbness, tingling, weakness, or coolness/pallor of the hand.
• Heterotopic Ossification: The abnormal formation of bone in soft tissues around the joint, leading to pain and stiffness.
• Chronic Pain or Instability: Persistent discomfort or a feeling of the elbow "giving way" can occur, often requiring further investigation or intervention.
• Post-Traumatic Arthritis: Long-term wear and tear on the joint surfaces can lead to arthritis, especially if there were associated cartilage injuries.

Prevention and Long-Term Outlook

While not all dislocations are preventable, minimizing risks involves:

• Falls Prevention: Especially for older adults or those with balance issues.
• Proper Technique in Sports: Learning and practicing correct falling techniques in sports where falls are common.
• Strengthening and Flexibility: Maintaining good overall arm strength and flexibility can contribute to joint stability.

The long-term outlook for a simple elbow dislocation treated promptly and followed by comprehensive rehabilitation is generally good, with most individuals regaining excellent function. However, adherence to the prescribed rehabilitation program is crucial for optimal recovery and minimizing the risk of complications.

When to Seek Further Medical Advice

Contact your physician or physical therapist if you experience any of the following during your recovery:

• Increased pain, swelling, or redness around the elbow.
• Signs of nerve damage (new or worsening numbness, tingling, or weakness in the hand or fingers).
• Signs of vascular compromise (coolness, pallor, or bluish discoloration of the hand).
• Significant loss of range of motion or increased stiffness.
• A feeling of instability or the elbow "giving way."
• Fever or other signs of infection.
• Failure to progress in rehabilitation as expected.