Radial Dislocation: Types, Treatment, Recovery, and Prevention

How to fix radial dislocation?

Fixing a radial dislocation, particularly a traumatic one, is a complex medical procedure that must be performed by a qualified healthcare professional. Attempting to self-reduce a dislocated joint can lead to severe complications, including nerve damage, blood vessel injury, fracture, or permanent instability.

Understanding Radial Dislocation

The radial head, the top part of the radius bone in the forearm, forms a joint with the capitellum of the humerus (upper arm bone) at the elbow. It is stabilized by the annular ligament, which encircles the radial head, holding it in place against the ulna. A radial dislocation occurs when the radial head slips out of this ligamentous ring or its articulation with the capitellum.

Types of Radial Dislocation:

• Nursemaid's Elbow (Pulled Elbow): This is the most common type, almost exclusively seen in young children (typically under 5 years old). It occurs when a sudden pull on the arm (e.g., lifting a child by one hand, swinging a child by the arms) causes the radial head to sublux (partially dislocate) from under the annular ligament.
• Traumatic Radial Head Dislocation: Less common, this type occurs in older children and adults due to significant trauma, such as a fall onto an outstretched arm, a direct blow to the elbow, or as part of a more complex elbow dislocation (e.g., Monteggia fracture-dislocation, where a ulnar fracture accompanies a radial head dislocation).
• Congenital Radial Head Dislocation: A rare condition present from birth, often associated with other developmental anomalies.

Anatomy and Biomechanics: The elbow joint is a hinge joint primarily, but the radial head's articulation allows for pronation and supination (rotating the forearm). When the radial head dislocates, this rotational movement is severely impaired and painful. In Nursemaid's elbow, the annular ligament becomes entrapped between the radial head and the capitellum.

Why Self-Treatment is Dangerous

Attempting to "fix" a radial dislocation without medical expertise is highly ill-advised for several critical reasons:

• Risk of Misdiagnosis: Without X-rays or a thorough medical examination, it's impossible to differentiate a simple dislocation from a fracture (e.g., radial head fracture, epicondyle fracture) or other soft tissue injuries. Performing a reduction maneuver on a fractured bone can cause significant, irreversible damage.
• Nerve and Vascular Injury: The elbow region is rich in vital nerves (radial, ulnar, median) and blood vessels. Improper manipulation can directly injure these structures, leading to permanent numbness, weakness, or circulatory problems.
• Incomplete Reduction: If the joint is not fully and correctly reduced, it can lead to chronic pain, instability, reduced range of motion, and increased risk of re-dislocation.
• Growth Plate Damage (in Children): In children, the bones are still developing with open growth plates (epiphyseal plates). Incorrect reduction techniques can damage these plates, potentially leading to growth disturbances or deformities.
• Increased Pain and Trauma: Unskilled attempts at reduction are incredibly painful and can cause further soft tissue damage.

Immediate Steps After a Suspected Dislocation

If you suspect a radial dislocation, or any joint dislocation, follow these immediate first aid principles while awaiting professional medical help:

• Do Not Attempt to Reduce It: Reiterate this critical point. Your primary goal is to prevent further injury.
• Immobilize the Arm: Gently support the affected arm in the most comfortable position possible. A sling or simply holding the arm against the body can help. Avoid any movement of the elbow.
• Apply Ice: Apply a cold pack (wrapped in a cloth to protect the skin) to the elbow area for 15-20 minutes at a time to help reduce swelling and pain.
• Seek Immediate Medical Attention: Transport the individual to an emergency room or urgent care clinic as quickly as possible. Inform medical staff about the mechanism of injury.

Medical Management of Radial Dislocation

Upon arrival at a medical facility, the healthcare team will follow a structured approach to diagnose and treat the dislocation.

1. Diagnosis:

• History and Physical Examination: The doctor will ask about the injury, assess pain levels, observe the arm's position, and check for signs of nerve or blood vessel compromise (e.g., sensation, pulse).
• Imaging: X-rays are crucial to confirm the dislocation and, more importantly, to rule out any associated fractures. In some complex cases, a CT scan or MRI may be necessary.

2. Reduction Techniques (Performed by Professionals): The specific technique used depends on the type and complexity of the dislocation, and often requires pain medication or sedation.

• For Nursemaid's Elbow:
  • Supination-Flexion Method: The most common technique. The physician holds the child's elbow, applies pressure to the radial head, then supinates (turns the palm up) the forearm while simultaneously flexing the elbow. A subtle "click" or "pop" may be felt, indicating successful reduction.
  • Hyperpronation Method: An alternative technique where the physician hyperpronates (turns the palm down excessively) the forearm while applying pressure to the radial head. This is often successful if supination-flexion fails.
• For Traumatic Radial Head Dislocation (Adults/Older Children):
  • These are often more challenging and may require stronger pain relief or general anesthesia.
  • The physician will apply specific traction and manipulation techniques to guide the radial head back into its correct anatomical position.
  • If the dislocation is irreducible (cannot be put back in place manually) or associated with significant fractures, open reduction surgery may be necessary. This involves a surgical incision to directly visualize and realign the joint.

3. Post-Reduction Care:

• Confirmation of Reduction: Post-reduction X-rays are typically taken to confirm the radial head is correctly aligned.
• Immobilization: The elbow may be immobilized in a sling, splint, or cast for a period (ranging from a few days for Nursemaid's elbow to several weeks for traumatic dislocations) to allow soft tissues to heal and prevent re-dislocation.
• Pain Management: Pain medication will be prescribed as needed.
• Follow-up: Regular follow-up appointments with the physician are essential to monitor healing and guide rehabilitation.

Rehabilitation and Recovery

Rehabilitation is crucial for restoring full function to the elbow after a dislocation. The process is guided by a physical therapist and tailored to the individual's injury severity and type.

Goals of Rehabilitation:

• Restore full, pain-free range of motion.
• Regain strength in the surrounding musculature (biceps, triceps, forearm muscles).
• Improve joint stability and proprioception (the body's awareness of joint position).
• Return to daily activities, work, and sport.

Phases of Rehabilitation:

• Phase 1: Acute/Protection Phase (Initial 1-2 weeks post-reduction):
  • Focus: Pain and swelling control, gentle protected range of motion (ROM) exercises as advised by the therapist.
  • Exercises: Passive or active-assisted ROM within comfortable limits.
• Phase 2: Intermediate/Mobility & Early Strengthening Phase (Weeks 2-6):
  • Focus: Increasing ROM, initiating gentle strengthening.
  • Exercises: Active ROM exercises, isometric exercises, light resistance band exercises for elbow flexors, extensors, pronators, and supinators.
• Phase 3: Advanced/Strengthening & Functional Phase (Weeks 6+):
  • Focus: Progressive strengthening, endurance, balance, and sport-specific training.
  • Exercises: Progressive resistance training with weights, functional movements, plyometrics (if appropriate for sport).
• Phase 4: Return to Activity Phase:
  • Gradual return to full activities, work, and sport, guided by the physical therapist and physician. This phase emphasizes sport-specific drills and ensuring the elbow can withstand the demands of the activity.

Prevention Strategies

While not all dislocations are preventable, certain measures can reduce the risk:

• For Children (Preventing Nursemaid's Elbow):
  • Avoid Lifting by Arms: Do not lift or swing young children by their hands or wrists. Always lift them by the armpits or torso.
  • Proper Handling: Be mindful when dressing or pulling a child's arm through a sleeve.
• For Adults (Preventing Traumatic Dislocation):
  • Fall Prevention: Maintain good balance, use handrails on stairs, clear tripping hazards, and ensure adequate lighting.
  • Sports Safety: Use proper technique in sports, wear appropriate protective gear (e.g., elbow pads in contact sports), and engage in strength and conditioning to improve joint stability.
  • Workplace Safety: Adhere to safety protocols, especially in occupations involving heavy lifting or repetitive arm movements.

When to Seek Emergency Care

Seek immediate emergency medical attention if you or someone you know experiences any of the following after an elbow injury:

• Severe pain and inability to move the arm.
• Obvious deformity around the elbow.
• Numbness, tingling, or weakness in the hand or fingers.
• Coolness or paleness of the hand, indicating potential blood flow compromise.
• Open wound over the joint, suggesting an open dislocation.

Disclaimer: This article provides general information and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.