Lesson

Elbow dislocation

Dislocation of the elbow joint is the second most common dislocation of the upper extremity (following the shoulder) and is typically seen in young adults doing sporting activities. Elbow dislocations are generally more common in women and in the non-dominant arm.1 Elbow instability is typically described as being either ‘perched’ or ‘complete’. With a ‘perched’ injury the elbow is subluxed, but the coronoid process is impinged on the trochlea. A complete dislocation generally occurs in a posterior and lateral direction.

 

History

This type of injury can occur in contact sports or when falling on an outstretched arm. Athletes can sustain this type of injury in a number of sports, including football. Presenting complaints are generally pain, a popping sensation and obvious deformity.

 

Examination

When the elbow is dislocated, the deformity is usually obvious. Once reduced, it is important to assess for associated injuries. A careful neurovascular examination is needed as there is the potential for injuries to the brachial artery as well as the ulnar and medial nerves.

 

Investigations

X-rays are needed in all cases of elbow dislocation. Posterior elbow dislocations comprise over 90% of elbow injuries and fractures occur in about 30% of all dislocations.1 When more than half the coronoid is involved the fracture is often surgically fixed to prevent recurrent elbow instability. Associated radial head fractures are generally managed conservatively.

Click on the following images to view an image of a dislocated elbow.

It is best to attempt reduction early – before the athlete experiences too much pain and muscle spasm.

Treatment

Early reduction is needed. It is important to obtain post-reduction x-rays to both confirm reduction and look for associated bone injuries. After reduction, it is also important to assess the stability of the collateral ligaments (the UCL is always ruptured or avulsed in the dislocated elbow).

A short period of immobilisation is suggested for pain relief (no more than three weeks). Avoid early passive movement due to the risk of heterotopic ossification. Perched dislocations recover faster than complete dislocations. Recurring instability and re-dislocation is uncommon. Athletes usually return to sport at around six weeks. Verrall describes return to sport at between seven and 21 days for stable dislocations with no fractures.2

There are several techniques which have been described to reduce a dislocated elbow. Parvin’s method involves the patient lying prone while the physician applies gentle traction to the wrist for a few minutes. As the olecranon begins to slip distally, the physician lifts up gently on the upper arm. No assistant is required and, if the manoeuvre is done gently, no anaesthesia is required either.3 A variation where only the forearm hangs from the side of the stretcher has also been described. As gentle downward traction is applied on the wrist, the physician guides the reduction of the olecranon with the opposite hand.4

André Pedrinelli

Orthopaedic – Prosthetics / Sports Medicine