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VilleAlanen

Dislocation of the Elbow Joint

Essentials

  • The forearm is usually dislocated backwards.
  • The arm is deformed and there is pain and loss of movement.

Reduction

  • Reduction is usually successful conservatively without anaesthesia.
  • The forearm is pulled so that one person holds the upper arm with both hands and the other holds the forearm with both hands (near the antecubital area and on the wrist), see picture 1.
  • Pull first in the direction of the forearm and then by extending the elbow gently.
  • At the end of traction bend the elbow with the hand holding the wrist as the other hand pushes the forearm from the elbow towards the wrist. The assistant keeps the upper arm fixed during traction.
  • After the reposition, the stability is tested in the flexion-extension plane, i.e. in which angle of flexion the dislocation is felt to happen again.
    • Critical angle considering treatment options is 60° (picture 2).
  • Crepitation felt in the elbow joint is a sign of possible fracture and the attempt of reduction is discontinued.

Further treatment

  • Confirm by x-ray that there are no fractures and that the joint in is place.
  • If the joint after reposition is stable enough to tolerate the movement from full flexion to a flexion angle of 60° (picture 2), the treatment is conservative. If the joint is dislocated again already before this, i.e. at a greater flexion angle, surgical tendon reconstruction should be considered.
  • An angular splint (90°; see Humeral and Forearm Fractures) is set one week, after which the arm is mobilized in a controlled fashion within the stable range of motion, i.e. from full flexion to the flexion angle observed during repositioning where the elbow joint still remained non-dislocated.
    • Passive exercise therapy and particularly manipulation must be avoided.
  • A stable joint can be mobilized from the beginning Interventions for Treating Acute Elbow Dislocations in Adults; however, full extension should be avoided.
  • A protective splint is worn between mobilization exercises for 3 weeks.
  • X-ray control is recommended at 1 and 3 weeks and always when a redislocation is suspected.

    References

    • Taylor F, Sims M, Theis JC et al. Interventions for treating acute elbow dislocations in adults. Cochrane Database Syst Rev 2012;(4):CD007908. [PubMed]