When your elbow dislocates, your elbow’s joint surfaces separate. It is considered an emergency injury due to the urgency of returning the elbow to its normal alignment. Elbow dislocation usually occurs after a trauma and can partially or completely dislocate. Partial elbow dislocations (subluxation) result in joint surfaces only partly separated. In a complete dislocation, the joint surfaces are completely separated. Injuries and dislocations of the elbow can affect either of its two basic movements: bending (flexion) and straightening (extension) and forearm rotation (pronation – palm down; supination – palm up).
Elbow dislocations are uncommon. They typically occur when a person falls onto an outstretched arm. When the hand hits the ground, the impact is sent to the elbow. This force is usually accompanied by a turning motion, which then drives the elbow out of socket. There are two types of dislocations:
- Simple dislocation – major bones are not injured
- Complex dislocation – bones and ligaments are severely injured
In complex dislocations, blood vessels and nerves around the elbow may also be injured. In severe dislocations, there is risk of losing the arm.
Some people are born with greater flexibility or looseness in their ligaments. These people are at greater risk of elbow dislocation. Some people are born with a shallow groove in their ulna bone for the elbow hinge joint. These people are also at a higher risk for elbow dislocation as well.
Bones of the Elbow
Three bones come together to make up the elbow joint. The humerus is the bone in the upper arm. Two bones from the forearm (the radius and the ulna) form the lower part of the elbow. Each of these bones has a very distinct shape.
Symptoms of Elbow Dislocation:
- Complete dislocations have very obvious deformity such as an odd twist at the elbow
- Complete dislocations are extremely painful
- Partial subluxations can be harder to detect visually; the joint may appear fairly normal
- Partial subluxations are painful, but the elbow will usually move fairly well still
- Bruising on the outside and inside of the elbow where injury is located
Dr. Stowell will perform a physical examination, checking for tenderness, swelling, and deformity. He will evaluate your skin and arm circulation. He will check the pulse on your wrist. If an artery was injured with your dislocation, the hand will be cool to touch and may have a purple or white hue. Dr. Stowell may also check the nerve supply to your hand. If your nerves were injured during your dislocation, some or all of your hand may feel numb or unable to move.
Dr. Stowell will order imaging. An Xray will be used to determine if there is bone injury and will help show the direction of the dislocation. If an Xray does not suffice, Dr. Stowell may order a CT scan to examine further bone detail. An MRI may be needed if Dr. Stowell needs further evaluation of your ligaments. Before any CT or MRI scan, Dr. Stowell will set your elbow to put your dislocated elbow back in place. The long-term goal is to restore function to your arm.
Before your elbow is realigned, Dr. Stowell may administer sedatives and pain medications. This act of restoring alignment is called a reduction maneuver. Dr. Stowell will perform a reduction maneuver gently and slowly.
Simple elbow dislocations have fairly simple and straightforward treatments with usually good results. It can be treated by keeping the elbow immobile in a sling or splint for about 1 to 3 weeks. Early motion exercises and physical therapy may be implemented to maintain mobility and flexibility. Even after some rehabilitation, some people will never be able to fully extend their arm; however, the elbow can still function very well without full range of motion. Once there is visible improvement with your elbow’s range of motion, Dr. Stowell may add a strengthening program to ensure the bones of the elbow joint remain well aligned.
In more complex elbow dislocations, surgery may be necessary to repair ligaments and restore bone alignment. After surgery, Dr. Stowell may protect your elbow with an external hinge, protecting it from dislocating again. Additional surgery may ne needed if blood vessel or nerve damage exists with the elbow dislocation. Some people with complex elbow dislocations still have some type of permanent disability at the elbow, although treatment continues to evolve.
Stiff elbows can be treated with late reconstructive surgery to successfully restore motion. In this surgery, Dr. Stowell will remove scar tissue and extra bone growth that inhibits movement. Over time, if the elbow joint is not aligned well, there is repeated dislocations, or the elbow does not rotate and move normally, there is an increased risk of arthritis.
Research to improve the treatment of complex elbow dislocations continues and Dr. Stowell remains at the forefront of this knowledge.