What is a dislocated elbow?
A dislocated elbow is the term to describe the displacement of the ulna and radius (forearm bones) from the humerus (the upper arm bone). In essence it is when your elbow has popped out of its socket. The Elbow joint itself is formed by the union of the far end of the humerus (the upper arm bone) and the radius and ulna (the forearm bones). The end of the ulna the olecranon process hooks into the back of the humerus creating what is known as a hinge joint named as such as it only moves in flexion and extension. It is the joints between the radius and ulna that allow you to pivot you hand and forearm from palm upwards to palm downwards actions known as supination and pronation. The elbow is encased in a strong connective tissue capsule that contains the entire elbow joint. The capsule and surrounding ligaments keeps the joint flexible yet incredibly strong and durable. In the case of a dislocated elbow the muscles, ligaments and joint capsule have been dramatically overstretched causing them to tear and loosen, creating an unstable environment for the elbow and allowing the olecranon process to move out and away from the elbow socket on the humerus.
Why and when does a dislocated elbow happen?
Elbow dislocations are normally the result of traumatic falls or impacts against the elbow. A dislocated elbow can occur to anyone at any point during a lifetime but are most common within the younger generations that participate in contact sports. An elbow dislocation is a common result from a rugby tackle or wrestling match when there is a direct impact to the elbow. A fall to the ground with your arm outstretched can create enough force to travel up the arm and cause a dislocation. A pulled elbow is quite common in young children under five as their ligament and joints are more mobile and weak. Children who are yanked suddenly by the hand say when their parent lifts them by the hand or pulls them out of the way of danger suffer from a mild dislocation. The severity of trauma to cause an elbow dislocation means that there is normally additional injuries wrist, forearm and upper arm including fractures and nerve or artery damage. Injuries like this need immediate medical attention to avoid further long term complications.
The Royal Children’s Hospital Melbourne
What does a dislocated elbow feel like?
A dislocated elbow will cause sudden and severe pain around the elbow joint and down into the forearm and hand. There will most likely have been a pop or tearing noise at the time of dislocation. The arm will feel limp and weak from the elbow down and any movement of the forearm and hand will aggravate the already intense pain levels. Most patients instinctively opt to cradle their arm taking any weight and pressure of the elbow. The elbow will also look a slightly different shape and will have a large level of swelling around the joint. Due to the proximity of the arm nerves and arteries to the shoulder joint it means that some patients may experience numbness and pins and needles in the effected arm and hand. In most cases of pulled elbow children will cry straightaway and not use the injured arm at all, or simply have it hanging by their side.
What to do if a dislocated elbow is suspected?
Your actions immediately after a dislocation can greatly improve your recovery and reduce your pain levels. As soon as the injury is sustained you should follow the P.R.I.C.E protocol this involve Protection for the elbow by resting it in a sling. Rest the arm, try not to use it too much and if you have to then ensure you are not lifting heavy weights. Ice by applying a covered ice pack to the area may also significantly hasten the healing process by reducing the pain and swelling. Please make sure the ice pack is covered to prevent any ice burn and for best results use the icepack use regularly for 10-15 minutes with intervals of 30 minutes. Compression, try and keep the elastic bandage on during the day to limit the swelling and make sure to take it off at night. Elevation, keep the arm raised on a pillow to help limit the swelling.
You should seek medical attention straight away in order to have the joint reset to its proper alignment; your doctor will most likely put your arm in a sling or cast in order to provide it with support whilst it heals. It is advisable to follow the H.A.R.M protocol over the first three days. Avoid any heat whether it is a hot bath or a heat pack for the first three days after this heat will be quite soothing for the stiffened joint. Avoid alcohol as it will increase any bleeding and swelling. Running or aggravating exercise movements should be avoided in case of further injury. Massage should be avoided over the first three days after injury as it will also increase any bleeding and swelling.
How is a dislocated elbow diagnosed?
Patients may be taken to A&E and a full examination including checking your pulse at the wrist will be done to rule out any additional injuries or complications like fractures and nerve or arterial damage. Your doctor will most likely order an x-ray of the elbow and forearm to confirm the diagnosis and identify the extent of the dislocation. Occasionally an MRI or a CT scan will be ordered as this will give a more detailed view and rule out any additional damage or injury.
What treatments are available for a dislocated elbow?
The treatment options and healing times for a dislocated elbow vary depending on the severity of the dislocation and also on complications like the additional presence of a fracture or nerve or arterial damage. If a fracture is present or muscles are badly torn then there is an increased likelihood of surgical intervention. If the x-ray is clear then the olecranon process will be safely manipulated back into the olecranon fossa on the humerus. This procedure is known as reduction and should be performed only by a trained medical professional. If the reduction of the joint isn’t performed properly it can cause long term damage to the surrounding nerves, ligaments and cartilage. Once the elbow joint is back into position the doctor will use the sling to immobilise the affected arm and instruct the patient to rest completely whilst recovering. The doctor will most likely prescribe anti-inflammatory medication and painkillers for pain relief and to reduce any swelling. The sling must be worn for 3-4 weeks and all aggravating or painful activities that may risk another dislocation must be avoided for 6-8 weeks. Patients will be referred through to a physiotherapist who will provide exercises to strengthen the arm to aid the healing process. Stretches may be prescribed as early as week one to prevent your shoulder muscles from wasting but the most important rehab is the follow up rehab after the shoulder has healed to prevent further dislocations. Occasionally patients suffer from mid back and neck stiffness and discomfort due to the period of immobility and wearing a sling. In these cases manipulative therapies such as Chiropractic or osteopathy can help. Many patient’s also find massage therapies and Bowen technique good for relaxing the upper back and neck muscles.