Elbow Dislocation

Ovid: 5-Minute Sports Medicine Consult, The

Elbow Dislocation
John Munyak
Robert Bramante
  • Separation/disruption of the articulations between distal humerus, proximal radius, and proximal ulna. Typically resulting from trauma and injury to the supporting soft tissue structures.
  • Subtypes: Anterior (rare) vs posterior (common) and simple (soft tissue injury) vs complex (fracture-dislocation)
  • Complete (dislocation) or partial (subluxation)
  • System(s) affected: Musculoskeletal
  • The elbow is the second most frequently dislocated major joint after the shoulder.
  • Comprises 10–25% of all elbow injuries
  • More frequently seen in wrestling, gymnastics, football, falls, and motor vehicle accidents
  • Adults: 6–8/100,000
  • 10–50% sports-related
  • Usually on the nondominant side
  • Predominate age:
    • Mean 30 yrs old
    • 2nd most common dislocation in adults
  • Predominate sex: Males > Females
Risk Factors
  • Anatomical risk factors include a shallow olecranon fossa and a prominent olecranon tip.
  • Age and sports activity
  • Fall on an outstretched hand
General Prevention
  • Sport protective padding may provide a benefit.
  • Avoidance of falls
  • Progression of injury from lateral collateral ligament to capsule to medial collateral ligament in posterior dislocation
  • Anterior dislocation from trauma to the posterior portion of a flexed elbow
  • Fall on outstretched hand
  • Axial loading and rotation upon impact
Commonly Associated Conditions
  • Common: Radial head/neck fracture, epicondyle avulsion fracture, soft tissue edema, coronoid process fracture
  • Rare: Neurovascular injury (brachial artery and median nerve), compartment syndrome
  • Mechanism of fall
  • Type of activity leading to injury (sports, fall, work, accident)
  • Time since injury
  • Reduction attempts
Physical Exam
  • An obvious visual deformity usually is present.
  • Note the condition of the skin: Look for wounds indicating an open dislocation.
  • Palpation of deformity and effusion:
    • Prominent olecranon: Posterior
    • Long extended forearm: Anterior
  • Neurovascular evaluation, especially brachial artery and ulnar, interosseous and median nerve function
  • Consult orthopedics/vascular surgery urgently for any signs of neurovascular injury.
  • Rule out additional injuries, especially in contiguous musculoskeletal structures.
  • In reduced elbows: Lateral pivot-shift apprehension test is highly sensitive (1)[C]
    • Sensation of dislocation is a positive test.
Diagnostic Tests & Interpretation
  • Initial anteroposterior and lateral radiographs: Evaluate relationship between distal humerus and radio-ulnar complex. Identify associated fracture (2)[C].
  • Maintain a high index of suspicion for additional injuries and obtain radiographs of the humerus, forearm, or wrist as indicated.
  • Exception: On-field reduction by a medical professional can precede initial films (3)[C].
  • Postreduction radiographs: All dislocations (3)[C]
  • CT: Reserved for complex fracture dislocations or reconstruction planning
Diagnostic Procedures/Surgery
Angiography for suspected arterial injury
Differential Diagnosis
  • Elbow subluxation
  • Spontaneous elbow dislocation and reduction
  • Be especially cautious in the pediatric age group, as supracondylar humerus fractures are common in 5–10-yr-olds.
  • Nursemaid's elbow (pediatrics)
  • Other elbow joint/forearm fracture
Ongoing Care
Follow-Up Recommendations
Consultation with an orthopedic surgeon should be obtained in most cases.
Patient Education
Avoid activities that specifically stress the elbow joint (eg, throwing) until ready upon re-evaluation.
  • Generally full recovery
  • Poor outcome related to stiffness/decreased ROM:
    • Early physical therapy/ROM exercises decrease stiffness.
  • 832.00 Closed dislocation of elbow, unspecified site
  • 832.01 Closed anterior dislocation of elbow
  • 832.10 Open dislocation of elbow, unspecified site

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