Background & Etiology
The elbow joint is a connection point between the humerus (arm bone) and the radius and ulna (forearm bones) that is held together by ligaments in the joint. The elbow joint complex is responsible for the bending (flexion) and straightening (extension) motions of the arm and it also allows the arm to rotate the hand palm up (pronation) or palm down (supination).
Dislocations can impact the elbow’s ability to perform any of the motions of the elbow (flexion, extensions, pronation, or supination.) Elbow dislocation is when the radius or ulna bones (forearm) move out of place in relation to the humerus (upper arm)
Dislocation
An elbow dislocation occurs when the bones in the joint are separated, either partially (called a subluxation) or completely. Dislocations are most common in the younger population. When the elbow dislocates it stretches the ligaments that stabilize and support the joint.
- Sudden trauma or accident like a fall on outstretched or straight arm can cause an elbow dislocation
- Motor vehicle accident or sudden trauma.
- Significant pain in the elbow
- Individuals will prefer to keep the arm held at the side, and may feel and inability or unwillingness to move the arm.
- Swelling, weakness, numbness and occasional bruising of the elbow area
- Decreased circulation or loss of a pulse as nerves and arteries may be involved
- Related fracture
If you suspect an elbow dislocation you need to see your physician immediately. Any delay may affect the nerves and/or blood supply to the arm. Physicians reduce acute dislocations by pulling down and levering the arm. This is painful and will require strong medication. The patient will than be put in an L splint to allow for proper healing.
- If there is no fracture the patient will be placed in a splint and sling
- After 5-7 days the physician may allow gentle motion progressing to range of motion and stretching exercises.
- Ice may be applied to reduce swelling and pain.
- Physical Therapy may be recommended.
Physical Therapists are professionals, educated and trained to administer interventions. As stated in The Guide to Physical Therapist Practice interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis, and the goals of the patient or client. Common interventions in the treatment of Elbow Dislocation include:
- Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, and joint mobilization by a physical therapist to modulate pain and reduce any soft tissue or tendon irritation while helping to restore motion following a period of immobilization. Movements should avoid positions that place the elbow in the position that produced the dislocation (Apprehension Sign).
- Therapeutic Exercises (TE) including exercises to strengthen the muscles in the arm, including the biceps, and increase joint stability.
- Neuromuscular Reeducation (NMR) to restore stability, begin retraining the upper extremity, improve proximal joint stability and improve movement technique and mechanics (for example, throwing) in daily use of the involved upper extremity.
- Modalities including the use of ultrasound, electrical stimulation, ice, cold laser and others to decrease pain and inflammation at the elbow and tendons.
- Home program that includes strengthening, stretching and stabilization exercises as well as instructions to help the person perform daily tasks and advance to the next functional level.
Procedures that your physician may recommend and perform in addition to physical therapy.
- Relocation and initial immobilization of the dislocated elbow
- REST and ICE
- The use of NSAIDS (Non Steroidal Anti-Inflammatory Drugs)
- Pain medication to reduce the discomfort and allow the patient to perform the recommended exercises
Prognosis
Most people recover full function following a course of conservative care of physical therapy to strengthen and stabilize the elbow.
