Elbow Dislocation

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The elbow is one of the largest joints in the body. In conjunction with the shoulder joint and wrist, the elbow gives the arm much of its versatility, as well as structure and durability. Usually, the elbow has the ability to swing 180 degrees in a single direction to extend the forearm, and it also helps turn the forearm at the point where the parallel bones in the forearm (the radius and ulna) meet.

An elbow dislocation occurs when any of the three bones in the elbow joint become separated or knocked out of their regular positions. Dislocation can be very painful, causing the elbow to become unstable and sometimes unable to move. Dislocation damages the ligaments of the elbow and can also damage the surrounding muscles, nerves, and tendons.

Typically, elbow dislocations happen if an individual falls onto an outstretched hand. The impact is then sent to the elbow when the hand hits the ground. There can be a turning motion from the force of the impact. This can rotate the elbow out of its socket. In addition, elbow dislocations are categorized into 5 types of severity, including the following below:

 

  • Simple dislocation – A simple elbow dislocation does not have any major bone injury, although it may require treatment for a full recovery.

 

  • Complex dislocation – Complex dislocations may have severe ligament and bone injuries.

 

  • Partial dislocation (subluxation) – This type of elbow dislocation involves a slight misalignment. Therefore, it is common if you accidentally hit your elbow up against something or something hits your elbow.

 

  • Complete dislocation – A complete dislocation is common after a traumatic fall or accident where you land on your elbow or reach forward to brace for impact. With a complete dislocation, the joint surfaces are separated entirely.

 

  • Severe dislocation – is when the blood vessels and nerves travel across the elbow and are injured. This is the most severe dislocation because there is a high risk of losing the arm.

Causes & Symptoms

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Elbow dislocations often occur after a trauma. This can result after a fall, car accident, or sports injury. The elbow is a very stable joint because of strong ligaments and the way the bones are shaped like a door hinge. Thus, it takes a large amount of force to cause the elbow to dislocate.

Having loose ligaments may also put you at risk for dislocation, even with minor injuries. If you experienced a previous fracture that did not heal properly and the shape of the bone was changed, you are at risk for recurrence of a dislocated elbow. The abnormal bone shape may change the stability of the joint, therefore, if you had a previous dislocation, you are at the highest risk.

Generally, there can be various causes of a dislocated elbow, such as the following below:

 

  • Overuse can be a cause of dislocation.

 

  • Most elbow dislocations occur when people try to stop a fall with their outstretched hands.

 

  • In most cases, a joint disorder such as Ehlers-Dahlos syndrome causes dislocations. This type of syndrome makes joints unusually loose and flexible.

 

As mentioned earlier, complete elbow dislocation is extremely painful. The arm will look deformed and may have an odd twist at the affected area where it has been impacted. A partial elbow dislocation or subluxation can be harder to detect. Typically, it mainly occurs after an accident such as a motor vehicle accident.

Because the elbow is only partially dislocated, the bones can spontaneously relocate and the joint may appear fairly normal. The elbow will usually move fairly well, however, there may be pain presented. There may also be bruising on the inside and outside of the elbow whereas the ligaments may have been stretched or torn. Partial dislocations can continue to recur over time if the ligaments never heal properly.

Who gets Elbow Dislocation?

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Overall, anyone can experience a dislocated elbow from young adults to elders. However, older adults ages 65 and older are more prone to dislocating their elbow due to degeneration of bone. As for younger adults, he or she is less likely to experience elbow dislocations because of having a much more flexible elbow.

Heredity is also a risk factor that takes place in dislocating an elbow. Some patients are born with elbow ligaments that are looser than those of other people. Lastly, many elbow dislocations can be caused due to sports-related events. Sports that require weight-bearing with the arms, such as gymnastics floor exercise, are at higher risk for elbow dislocations.

How Does it Affect You? How Serious is it?

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Certain complications of a dislocated elbow include fractures, pinched nerves, trapped arteries, avulsion fractures, and osteoarthritis, as described below:

 

Fractures

If a fracture occurs in any of these bones, it can cause extreme pain and greatly impair your ability to move your arm. Elbow fractures occur from a direct blow to the elbow from a fall, accident, or sports injury. There are also three types of elbow fractures, which are distal humerus fracture, olecranon fracture, and radial head fractures. The distal humerus is the bone that connects the elbow to the shoulder joint. The olecranon is the bony tip of the elbow and part of the ulna. Radial head fractures can easily occur with elbow dislocations.

 

Pinched nerves

A pinched nerve is a compressed nerve surrounding tissues that press on nerve roots that can cause pain, numbness, and tingling in different areas of your body. In rare cases, nerves that travel across the elbow can become pinched or trapped between the dislocated bones or within the joint when the bones are realigned. Pinched nerves can cause numbness in the arm and hand.

 

Avulsion fractures

An avulsion fracture occurs when a ligament or tendon pulls part of your bone off. This normally happens as the result of a traumatic injury. Avulsion fractures commonly occur in the hip, ankle, and elbow in young people who play sports. However, they can happen anywhere in your body that soft tissue attaches to the bone.

 

Trapped arteries

In some cases, blood vessels that supply the arm and hand can become pinched or trapped between the dislocated bones or within the realigned joint. Lack of blood supply can cause severe pain and permanent tissue damage in the arm and hand.

 

Osteoarthritis

Osteoarthritis is a very common condition that can affect any joint in the body. It’s most likely to affect the joints that bear most of our weight, such as the knees and feet. Joints that we use a lot in everyday life, such as the joints of the hand, are also commonly affected. Osteoarthritis of the elbow occurs when the cartilage surface of the elbow is worn out or is damaged. This can occur because of a previous injury such as a fracture or dislocation.

Recommended Treatment & Rehabilitation

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During a diagnosis for an elbow dislocation, in evaluating an elbow for a possible dislocation, a history of events leading up to the injury will be asked for by a healthcare provider. Then a physical examination of the injured elbow will take place afterward. If there is any further concern for a dislocation, X-rays will be taken.

X-rays are helpful because they will show in which direction the bones are dislocated; in addition, X-rays may also reveal a fracture. In some cases, a CT scan or MRI can assist in determining other important injuries associated with the elbow dislocation that are not easily seen on X-rays (ligaments, nerve, and cartilage).

These advanced tests often follow any initial treatment. Sometimes, a surgeon may examine the joint under a video X-ray machine, called fluoroscopy, to see if the proper position of the bones stays in place during motion or when gentle stresses are applied to the joint.

Starting physiotherapy in the first few weeks after an elbow dislocation is crucial to recovery and to not lose range of motion. After the elbow injury, the elbow can become stiff without proper exercise. Physiotherapy can help elbow dislocations by providing range of motion exercises.

The ultimate goal of physiotherapy is to fully return strength as well as improve the endurance of the elbow through muscle-strengthening activities. If the injury is sports-related, your physiotherapist will provide sports-specific training in order to prepare you for your full return.

Elbow stretching is also an important part of the healing process. Stretching the elbow is important in both healing and prevention, and these exercises may be repeated at home multiple times a day in order to ensure mobility of the elbow. The following below are some of these range of motion exercises:

 

Elbow flexion

First, stand with your arm at your side. Then, actively bend your elbow up as far as possible, then grasp your forearm or wrist with your other hand and gently add overpressure. Hold the bent position of your elbow for 5-10 seconds, and then release the stretch by straightening your elbow. Repeat this exercise 10 times a day.

 

Elbow extension

Sit in a chair with your elbow resting on a table. You may want to rest your upper arm on a pillow or folded towel for comfort. Next, straighten your elbow out all the way, and then apply pressure to your forearm or wrist to add more pressure to the stretch. Straighten your elbow out as far as you can with over pressuring and hold the stretch for 5-10 seconds. Release the stretch and allow your elbow to bend a bit. Repeat this exercise for 2 sets of 10 repetitions a day.

 

Forearm supination

Begin by standing or sitting with your arm at your side and your elbow bent about 90 degrees. Next, keep your elbow at your side and turn your wrist and hand over so your palm faces up. To add more pressure to the stretch, use your opposite hand and reach underneath the forearm of your supinated arm. Grab your wrist and gently add pressure by turning your hand further into supination. When a stretch is felt, hold the position for 5-10 seconds. Repeat this elbow supination exercise with 2 sets of 10 repetitions a day.

 

Elbow pronation

Stand or sit with your elbow bent at a 90-degree angle and tucked in at your side. Turn your hand and wrist over as far as possible, then reach your other hand over the top of your forearm. Then, grab your wrist, and turn your arm further into a pronated position. Finally, hold the position with pressure for 5-10 seconds, and then release the stretch. Repeat this stretch with 2 sets of 10 repetitions a day.

Along with exercises and stretches, your physiotherapist may use modalities to help ease your pain. Heat, ice, ultrasound, and electric stimulation, splints, and braces can be used to decrease pain and swelling. Hands-on massages may also be provided to help circulation and pain.

Alternative & Homeopathic Treatment

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The following homeopathic treatments are to help ease discomfort and encourage healing after being treated for a dislocated injury:

 

  • Rest – Rest your dislocated elbow. It is recommended to not repeat the action that caused your injury and rest your affected area before continuing with lighter activities.

 

  • Ice and heat application – Putting ice on your injured joint helps reduce inflammation and pain. Use a cold pack for 15-20 minutes at a time. For the first day or two, try to do this every couple of hours during the day. After 2 or 3 days, when the pain and inflammation have improved, hot packs or a heating pad may help relax tightened and sore muscles. Limit heat applications to 20 minutes at a time.

 

  • Non-steroidal anti-inflammatory drugs (NSAIDs) – Over-the-counter medications, such as ibuprofen, naproxen, or acetaminophen, can all help relieve pain due to the dislocation.

 

  • Balance your range of motion – Maintain the range of motion in your joint. After one or two days, perform some gentle exercises as directed by your doctor or physiotherapist to help maintain the range of motion in your injured joint.