Elbow Dislocation

The elbow, the structure that connects the arm (composed of the humerus) with the forearm (made of the radius and the ulna), is a complex articulation of our body, composed of three different joints; the ulnohumeral (ulna with humerus), radiohumeral (radius with humerus), and radioulnar (radius with ulna) joints. The elbow has the paramount function of allowing flexion-extension and rotation movements of the arm. The elbow’s stability is maintained by passive (e.g.: capsule, ligaments, etc.) and active (muscles) stabilisers. The elbow is one of the most commonly dislocated joints in both the athletic and general population. Depending on the degree of bone separation, dislocation (full separation of joint with the bones out of place) or subluxation (partial separation of the joint with the bones still in contact) are possible. The most common dislocation direction is posterior, however, anterior dislocations are also possible. Medial and lateral dislocation are often presented in combination with the main anterior and posterior directions. The direction of the dislocation and the consequent symptoms are typically dictated by the injury mechanism, which typically involves falling into an outstretched hand (posterior dislocation) or on a flexed elbow (anterior dislocation). Other injury patterns exist and typically involve high-force contact in sports, and motor vehicle accidents. Patients affected by this injury typically present pain localised around the elbow that can radiate to other structures, swelling, bruises, elbow deformity, and severely impacted arm-elbow functioning. Aside from collecting data from the injury mechanisms and performing a physical assessment of the patient, an imaging examination (e.g.: x-ray, computed tomography, MRI) is typically performed to optimally visualise the specifics of the injury.

Management

After elbow dislocation, a reduction technique must be implemented to relocate the joint back into its natural position. Following elbow reduction, the management of patients affected by this injury is influenced by several factors related to the traumatic event itself, such as the presence of associated injuries (e.g., fractures, ligament injuries, etc.), additional structures involvement (e.g.: damages reported to the neural, vascular system, etc.) and the characteristics of the affected patients (e.g.: age). Conservative treatment typically consists of immobilisation with a long arm splint that prevents the elbow’s movements. After re-evaluating the stability of the joint following a period of immobilisation, rehabilitation can commence, as prolonged immobilisation can be deleterious for the recovery. In case surgical treatment is deemed necessary (e.g.: severe joint laxity, associated injuries, fractures, etc.), many different procedures are available and always discussed between the patient and the medical-surgical staff. After surgery, a period of immobilisation/protection with the use of a sling is typically recommended and rehabilitation should start as soon as indicated by the medical team. In Isokinetic, after being thoughtfully visited by one of our specialised doctors, your recovery process will be structured in different stages and take place in four different environments, the pool, the gym, the movement analysis and retraining room and the pitch. In the early stages, the main goals are to restore homeostasis by reducing pain and swelling, recovering mobility, and gradually restoring elbow and upper limb functioning. In the mid-stage of rehabilitation, shoulder and elbow strength recovery becomes the priority, together with the optimisation of the general movement quality to learn how to integrate the elbow and upper limb back into activities of daily living and sports. Finally, to complete the recovery process, on-field rehabilitation plays a fundamental role in allowing our patients to safely and effectively return to participate in their favourite activities and sports that require the utilisation of the upper limb (e.g.: throwing-, rackets-, falling-, related sports, etc.), maximising the recovery outcomes and reducing the likelihood of complications.

Elbow Dislocation

Management

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