Elbow Dislocation
A serious injury involving displacement of the bones that form the elbow joint
Quick Facts
- Type: Joint Injury
- ICD-10: S53.1
- Urgency: Medical emergency
- Recovery: 6-12 weeks typically
Overview
Elbow dislocation is a serious injury that occurs when the bones forming the elbow joint are forced out of their normal position. The elbow is a complex hinge joint formed by three bones: the humerus (upper arm bone), the radius, and the ulna (both forearm bones). This joint allows for both bending and rotation of the arm.
Elbow dislocations are the second most common type of dislocation in adults after shoulder dislocations, and the most common dislocation in children. They account for approximately 10-25% of all elbow injuries and can be classified as simple (no associated fractures) or complex (with associated fractures of the surrounding bones).
The mechanism typically involves a fall on an outstretched hand with the elbow extended, causing the joint to hyperextend and the bones to dislocate. Most elbow dislocations are posterior or posterolateral, meaning the forearm bones are displaced backward relative to the humerus. This injury often damages surrounding ligaments, muscles, and sometimes nerves or blood vessels.
Prompt medical treatment is crucial for elbow dislocations to prevent complications such as nerve damage, blood vessel injury, chronic instability, or arthritis. With appropriate treatment, most patients can expect to regain good function, though some may experience ongoing stiffness or instability. Early recognition and proper management are essential for optimal outcomes and prevention of long-term complications.
Symptoms
Elbow dislocation symptoms are typically obvious and severe, developing immediately after the injury. The symptoms result from the displacement of bones and damage to surrounding soft tissues.
Primary Symptoms
Visual and Physical Signs
- Visible deformity: Obvious change in elbow shape and appearance
- Abnormal arm position: Arm may be held in an unusual position
- Complete loss of function: Inability to bend or straighten the elbow
- Bruising: Discoloration around the elbow and arm
- Muscle spasm: Involuntary muscle contractions around the injury
Associated Symptoms
- Wrist pain that may extend from the elbow
- Tenderness to touch around the elbow
- Feeling of instability in the joint
- Popping or snapping sensation at the time of injury
- Emotional distress or anxiety about the injury
- Irritability (particularly in children)
Neurological Symptoms
These may indicate nerve involvement and require immediate attention:
- Numbness or tingling in the forearm, hand, or fingers
- Weakness in grip strength
- Loss of sensation in specific areas of the hand
- Inability to make a fist or extend fingers normally
- Weakness in wrist or finger movements
Vascular Symptoms
These may indicate blood vessel damage and require emergency treatment:
- Pale or blue discoloration of the hand or fingers
- Cold hand or fingers compared to the other side
- Weak or absent pulse at the wrist
- Slow capillary refill in fingernails
- Severe swelling that doesn't improve
Signs of Complications
- Open wound or bone protruding through skin
- Signs of infection (fever, increased pain, redness)
- Persistent numbness after reduction
- Inability to move fingers or wrist normally
- Increasing pain despite treatment
Causes
Elbow dislocations typically result from high-energy trauma or specific mechanisms that force the elbow joint beyond its normal range of motion. Understanding the causes helps in both prevention and treatment planning.
Common Mechanisms of Injury
- Fall on outstretched hand (FOOSH): Most common mechanism, accounts for 90% of cases
- Hyperextension injury: Elbow forced backward beyond normal range
- Axial loading: Direct force transmitted through the forearm to the elbow
- Combined hyperextension and rotation: Twisting motion with hyperextension
- Direct blow: Impact directly to the elbow joint
Sports-Related Causes
- Gymnastics: Falls during routines or dismounts
- Wrestling: Awkward falls or grappling injuries
- Football: Tackles or falls with arm extended
- Basketball: Falls while attempting to break a fall
- Rock climbing: Falls with extended arms
- Skateboarding/rollerblading: Falls at high speed
- Martial arts: Impact or falling injuries
Age-Specific Causes
Children and Adolescents
- Playground injuries (monkey bars, slides)
- Trampolines and bouncing activities
- Sports participation
- Falls from height (trees, furniture)
- Bicycle accidents
Adults
- Motor vehicle accidents
- Work-related injuries
- Sports injuries
- Falls from ladders or stairs
- Home accidents
Elderly
- Simple falls due to balance issues
- Trips and falls at home
- Lower energy trauma (due to bone weakening)
Types of Elbow Dislocation
- Posterior dislocation: Most common (90%), forearm displaced backward
- Posterolateral dislocation: Forearm displaced backward and outward
- Lateral dislocation: Forearm displaced to the side
- Medial dislocation: Forearm displaced inward (rare)
- Anterior dislocation: Very rare, forearm displaced forward
Associated Injuries
Elbow dislocations often occur with:
- Fractures of the radial head
- Coronoid process fractures
- Olecranon fractures
- Medial or lateral epicondyle fractures
- Ligament tears (MCL, LCL, LUCL)
- Nerve injuries (ulnar, median, radial)
- Vascular injuries (brachial artery)
Risk Factors
Several factors can increase the likelihood of sustaining an elbow dislocation:
Age-Related Risk Factors
- Children (5-8 years): Peak incidence due to activity level and bone development
- Adolescents: Sports participation and risk-taking behavior
- Young adults: High-energy activities and sports
- Elderly: Increased fall risk due to balance issues and bone fragility
Activity-Related Risk Factors
- Contact sports: Football, wrestling, hockey
- High-risk sports: Gymnastics, skateboarding, skiing
- Overhead activities: Rock climbing, gymnastics
- High-speed activities: Cycling, motorcycling
- Occupational hazards: Construction, manual labor
Anatomical Risk Factors
- Joint hypermobility: Naturally loose ligaments
- Previous elbow injury: History of fractures or dislocations
- Muscle weakness: Poor conditioning around the elbow
- Poor proprioception: Decreased joint position sense
- Bone abnormalities: Congenital or developmental issues
Medical Risk Factors
- Osteoporosis: Weakened bones more prone to injury
- Connective tissue disorders: Ehlers-Danlos syndrome, Marfan syndrome
- Neurological conditions: Conditions affecting balance or coordination
- Medications: Drugs that affect balance or bone density
- Vision problems: Increased fall risk
Environmental Risk Factors
- Wet or slippery surfaces: Increased fall risk
- Poor lighting: Difficulty seeing hazards
- Cluttered areas: Trip and fall hazards
- Inadequate safety equipment: Lack of protective gear
- Unsafe play areas: Poorly maintained playgrounds or sports facilities
Behavioral Risk Factors
- Risk-taking behavior: Participation in dangerous activities
- Inadequate warm-up: Poor preparation for physical activity
- Fatigue: Tired muscles and decreased coordination
- Alcohol or drug use: Impaired judgment and coordination
- Ignoring safety guidelines: Not following proper techniques or using equipment
Diagnosis
Diagnosing an elbow dislocation typically involves a combination of clinical examination, patient history, and imaging studies. The diagnosis is often apparent from the clinical presentation.
Medical History
- Mechanism of injury: How the injury occurred
- Time of injury: When the dislocation happened
- Previous elbow problems: History of injuries or surgeries
- Immediate symptoms: Pain, deformity, loss of function
- Associated injuries: Other areas of pain or injury
- Medical conditions: Conditions that might affect healing
Physical Examination
- Visual inspection: Obvious deformity, swelling, bruising
- Palpation: Tenderness, bone alignment, muscle spasm
- Range of motion: Usually severely limited or impossible
- Stability testing: Performed after reduction
- Neurovascular assessment: Critical for detecting complications
Neurovascular Examination
Essential to rule out nerve and blood vessel damage:
- Pulse check: Radial and ulnar pulses at the wrist
- Capillary refill: Blood flow to fingertips
- Sensation testing: Light touch and pinprick sensation
- Motor function: Finger and wrist movement
- Nerve-specific tests: Testing individual nerve functions
Imaging Studies
X-rays
- Pre-reduction X-rays: Confirm dislocation and identify fractures
- AP and lateral views: Standard elbow X-ray views
- Post-reduction X-rays: Confirm proper joint alignment
- Stress views: May be used to assess stability
Advanced Imaging
- CT scan: For complex injuries or suspected fractures
- MRI: Evaluate soft tissue injuries, ligaments
- Arteriogram: If vascular injury suspected
- Ultrasound: May assess blood flow
Classification Systems
- Direction: Posterior, lateral, medial, anterior
- Complexity: Simple (no fractures) vs. complex (with fractures)
- Stability: Stable vs. unstable after reduction
- Associated injuries: Terrible triad, coronoid fractures
Differential Diagnosis
Other conditions to consider:
- Elbow fractures without dislocation
- Supracondylar humerus fractures
- Radial head fractures
- Olecranon fractures
- Monteggia fracture-dislocations
- Nursemaid's elbow (radial head subluxation)
Emergency Assessment
Key priorities in emergency evaluation:
- Confirm dislocation with X-rays
- Assess neurovascular status
- Identify associated fractures
- Plan for immediate reduction
- Prepare for potential complications
Treatment Options
Treatment of elbow dislocation focuses on prompt reduction of the joint, restoration of stability, and rehabilitation to restore function. The approach varies based on the type and complexity of the dislocation.
Emergency Treatment
Immediate Management
- Pain control: IV pain medication and sedation
- Neurovascular assessment: Document function before treatment
- Splinting: Temporary immobilization for transport
- Ice application: Reduce swelling and pain
- Patient preparation: Education and consent for reduction
Reduction Procedure
- Sedation: Conscious sedation or general anesthesia
- Reduction technique: Gentle traction and manipulation
- Confirmation: Clinical examination and X-rays
- Stability testing: Range of motion assessment
- Re-assessment: Neurovascular function post-reduction
Conservative Treatment
Simple Dislocations
- Early mobilization: Begin gentle motion within 1-2 weeks
- Progressive splinting: Gradually increase range of motion
- Physical therapy: Structured rehabilitation program
- Activity modification: Gradual return to normal activities
Immobilization Protocol
- Initial splinting: 7-10 days at 90 degrees flexion
- Range of motion brace: Allow controlled movement
- Progressive extension: Gradually increase extension
- Full motion: Usually achieved by 6-8 weeks
Surgical Treatment
Indications for Surgery
- Irreducible dislocations
- Unstable dislocations after reduction
- Associated fractures requiring fixation
- Neurovascular injuries
- Open dislocations
- Chronic instability
Surgical Procedures
- Ligament repair: MCL and LCL reconstruction
- Fracture fixation: ORIF of associated fractures
- Capsular repair: Joint capsule reconstruction
- External fixation: For unstable complex injuries
- Arthroscopy: Minimally invasive evaluation and treatment
Rehabilitation
Phase 1 (0-2 weeks): Protection
- Pain and swelling control
- Gentle passive range of motion
- Grip strengthening exercises
- Shoulder and wrist mobility
Phase 2 (2-6 weeks): Mobilization
- Progressive active range of motion
- Gentle strengthening exercises
- Joint mobilization techniques
- Functional activities
Phase 3 (6-12 weeks): Strengthening
- Progressive resistance training
- Sport-specific exercises
- Proprioception training
- Return to activity preparation
Phase 4 (3-6 months): Return to Sport
- Advanced strengthening
- Sport-specific drills
- Protective bracing if needed
- Gradual activity progression
Complications and Management
- Stiffness: Aggressive physical therapy, possible manipulation
- Instability: Bracing, strengthening, possible surgery
- Nerve injury: Monitoring, neurology consultation
- Arthritis: Activity modification, pain management
- Heterotopic ossification: NSAIDs, radiation therapy
Prevention
While elbow dislocations cannot always be prevented, especially those resulting from accidents, several strategies can reduce the risk:
Sports Injury Prevention
- Proper technique: Learn correct falling and landing techniques
- Adequate training: Progressive conditioning and skill development
- Protective equipment: Use appropriate padding and braces when indicated
- Safe playing environments: Well-maintained facilities and equipment
- Rule enforcement: Follow safety rules and regulations
- Proper supervision: Qualified coaching and spotting
Strength and Conditioning
- Elbow strengthening: Exercises for flexors, extensors, and rotators
- Shoulder stability: Strong shoulders protect the entire arm
- Core strength: Improves overall body control
- Proprioception training: Balance and coordination exercises
- Flexibility: Maintain good range of motion
Activity Modification
- Warm-up properly: Prepare muscles and joints for activity
- Cool-down: Gradual transition from activity to rest
- Progressive training: Gradually increase intensity and duration
- Rest periods: Allow adequate recovery between sessions
- Listen to your body: Don't ignore pain or fatigue
Home and Environmental Safety
- Fall prevention: Remove trip hazards, improve lighting
- Stair safety: Use handrails, maintain good lighting
- Ladder safety: Proper setup and use techniques
- Home maintenance: Keep walkways clear and well-maintained
- Appropriate footwear: Shoes with good traction and support
Age-Specific Prevention
Children and Adolescents
- Proper playground equipment and surfaces
- Age-appropriate activities and equipment
- Qualified supervision during sports
- Education about safe play practices
- Proper protective equipment use
Adults
- Workplace safety training
- Regular fitness and conditioning
- Proper lifting and movement techniques
- Vehicle safety and defensive driving
- Home safety modifications
Elderly
- Balance training programs
- Vision and hearing checks
- Medication review for fall risk
- Home safety assessments
- Assistive device use when appropriate
Equipment and Environmental Modifications
- Protective gear: Elbow pads for high-risk activities
- Proper equipment: Well-maintained, appropriate-sized gear
- Safe surfaces: Appropriate padding and cushioning
- Environmental controls: Good lighting, clear pathways
- Emergency preparedness: First aid knowledge and supplies
When to See a Doctor
Elbow dislocation is a medical emergency requiring immediate professional care. Never attempt to treat this injury yourself.
Seek Emergency Care Immediately
- Obvious elbow deformity or abnormal appearance
- Severe elbow pain following trauma
- Complete inability to move the elbow
- Arm held in an unusual position
- Numbness or tingling in the hand or fingers
- Pale, blue, or cold hand or fingers
- Weak or absent pulse at the wrist
- Open wound near the elbow
Critical Warning Signs
- Neurovascular compromise: Signs of nerve or blood vessel damage
- Open injury: Bone protruding through skin or deep wounds
- Multiple injuries: Suspected additional fractures or injuries
- Loss of consciousness: Head injury concerns
- Severe mechanism: High-energy trauma (motor vehicle accident)
During Recovery - Seek Medical Attention If:
- Increasing pain despite medication
- New onset numbness or tingling
- Loss of finger or wrist movement
- Signs of infection (fever, redness, swelling, discharge)
- Concerns about healing progress
- Persistent stiffness or loss of motion
- Instability or feeling of the elbow "giving way"
Follow-up Care
Regular follow-up appointments are essential for:
- Monitoring healing progress
- Adjusting treatment plans
- Addressing complications
- Progressing rehabilitation
- Determining return to activity
- Long-term outcome assessment
Emergency Department vs. Urgent Care
Emergency Department for:
- All suspected elbow dislocations
- Neurovascular compromise
- Open injuries
- Multiple trauma
Urgent Care may be appropriate for:
- Minor elbow injuries without deformity
- Follow-up concerns during business hours
- Questions about rehabilitation
What NOT to Do
- Never attempt to relocate the elbow yourself
- Don't give food or water (in case surgery is needed)
- Don't apply heat to the injury
- Don't massage or manipulate the elbow
- Don't delay seeking medical care
Medical Disclaimer: This information is for educational purposes only and should not replace professional medical advice. Elbow dislocation is a medical emergency requiring immediate professional treatment. Never attempt to relocate a dislocated elbow yourself. Always seek emergency medical care immediately if you suspect an elbow dislocation. Delayed treatment can result in permanent damage to nerves, blood vessels, and joint function.
References
- Josefsson PO, Nilsson BE. Incidence of elbow dislocation. Acta Orthop Scand. 1986;57(6):537-8.
- Stoneback JW, Owens BD, Sykes J, Athwal GS, Pointer L, Wolf JM. Incidence of elbow dislocations in the United States population. J Bone Joint Surg Am. 2012;94(3):240-5.
- Hobgood ER, Khan SO, Field LD. Acute dislocations of the adult elbow. Hand Clin. 2008;24(1):1-7.
- O'Driscoll SW, Jupiter JB, King GJ, Hotchkiss RN, Morrey BF. The unstable elbow. Instr Course Lect. 2001;50:89-102.
- Reichel LM, Milam GS, Reitman CA. Anterior dislocation of the elbow with brachial-artery disruption in a young athlete. J Bone Joint Surg Am. 2009;91(6):1519-22.