Elbow dislocation or elbow luxation is the complete dislocation of the elbow joint. It is usually caused by trauma and there are additional injuries to the collateral ligaments, nerves or fractures. In children, elbow dislocation is the most common dislocation, and in adults it is the second most common after dislocation of the shoulder joint.
What is an elbow dislocation?
Schematic diagram showing the anatomy and structure of the elbow. Click to enlarge. Colloquially, elbow dislocation is referred to as “dislocated” or “dislocated.” Medically, this means that the elbow joint is severely displaced and no longer in its original anatomical position. The joint head is no longer in the socket. In some cases, there are concomitant injuries to the collateral ligaments, bone fractures or, due to overstretching, injuries to the ulnar and median nerves of the forearm. Symptomatically, the elbow luxation is noticeable by a malposition of the elbow, severe pain and considerable movement restrictions of the elbow. If additional injuries occur, for example a stretching of the ulnar forearm nerve, sensory impairments in the hand may occur. If the condyle is still partially in the socket, the condition is referred to as subluxation of the elbow.
Causes
In rare cases, elbow dislocation is congenital and exists from birth. In this case, there is incomplete formation of the elbow or humerus bones, which unstabilizes the elbow joint. The individual bones now shift slightly against each other. More common is the habituelle, the habitual, dislocation. In this case, the elbow joint spontaneously dislocates repeatedly without any externally apparent reason. The most frequent cause, however, is a fall or the application of force to the elbow, which is hyperextended backwards. Due to the abrupt impact of force, the joint surfaces are separated from each other and displaced against each other. The joint surfaces retain this abnormal position even after the force has ceased. It is not uncommon for capsular tears in the joint and ligament tears to occur in addition.
Symptoms, complaints, and signs
In most cases, an elbow dislocation is also associated with other injuries or trauma and does not occur alone. However, it primarily causes very severe pain in the affected area of the body. The pain often spreads to the neighboring regions and causes discomfort there as well. Especially at night, the elbow dislocation can therefore cause pain and difficulty falling asleep. Many sufferers are therefore irritable or even slightly aggressive and suffer from various psychological upsets or even depression. There are also restrictions in movement and generally a misalignment of the elbow. If the elbow dislocation is not treated, numbness and disturbances in sensitivity occur, which can spread to the arms and hands. In some cases, this leaves patients dependent on other people to help them in their daily lives and unable to do many everyday things on their own. Swelling can also occur as a result of elbow dislocation. In children, the condition leads to delayed development. However, it does not negatively affect the patient’s life expectancy.
Diagnosis and course
Acute elbow dislocation requires prompt treatment by a competent expert to minimize the risk of vascular and nerve damage. The physician can palpate the joints that are displaced against each other. Blood flow and function of forearm muscles and skin sensation on the forearm must also be examined to rule out associated diseases. X-ray examination is important to clearly differentiate between fractures and elbow dislocation. Only after fractures have been ruled out can therapy be initiated. A control x-ray after a few weeks serves to evaluate the success of treatment. Since elbow dislocation can be easily diagnosed by history and examination, further diagnostic procedures such as magnetic resonance imaging and computer tomography are only used to better assess the consequences of injury, for example nerve damage. In the case of a simple elbow dislocation without concomitant injuries, a very good prognosis can be assumed.After three to four months, the elbow joint can be fully loaded again.
Complications
Among the side effects in the absence of bony stabilization and especially in the presence of a concomitant radial head fracture and a fracture of the proc. coronoid, there may be a tendency toward reluxation. Because capsular ligamentous components are almost always injured in an elbow dislocation, lateral instability with permanent status may occur regardless of surgical or conservative treatment. The more severe the dislocation presents, the higher the risk of a circularly increasing tear related to the ligamentous complex. This would present from lateral to medial. In addition, osteochondral flakes (cartilage bone flaking) may occur. Osteochondrosis dissecans may also develop. Free osteochondral fragments also cannot be ruled out. Long-term complications include elbow osteoarthritis. If vascular nerve lesions are added to the elbow dislocation, there is a risk of gangrene of the hand or forearm. A forearm compartment syndrome can also not be ruled out. Possible complications also include joint stiffness in the narrow range of motion. Functional limitation may also occur. Very often, periarticular ossification occurs, resulting in significant movement restrictions. In simple dislocation without concomitant injuries, instability problems are known but rare. More commonly, however, there is permanent pain and stiffness.
When should you see a doctor?
If the affected person notices that his or her elbow joint can no longer be bent and extended as usual, there is cause for concern. A doctor should be consulted as soon as there is pain or impaired range of motion. If cracking noises can be perceived during common movements, a visit to the doctor is advisable. As soon as everyday tasks can no longer be performed as usual or professional obligations can no longer be fulfilled, a doctor is needed. If swelling occurs in the region of the joint, skin changes are noticeable or bruising forms, a doctor must be consulted. Consultation with a doctor is also recommended for emotional and psychological problems. Mood swings, depressive phases or conspicuous changes in behavior should be clarified by a doctor. If sleep disturbances occur, there is fatigue or a general feeling of malaise, a doctor should be consulted. Before taking any medication, a doctor should always be consulted to discuss possible side effects or risks. If the usual level of performance drops or if the symptoms lead to one-sided physical strain, a doctor should be consulted. In case of muscle pain, tension in the arms, shoulders or back, it is advisable to seek medical attention. A sleeping posture of the upper body should also be investigated.
Treatment and therapy
In any case, rapid treatment is important. Experts recommend it within six hours to minimize the risk of nerve and vascular damage. As initial measures until a doctor can be reached, rest and cooling of the joint are recommended, because the less swelling there is, the easier it is to set. After a thorough history, diagnosis and complexity assessment, the individual treatment of elbow dislocation is determined. Since conservative treatment with re-dislocation of the joint is very painful, it is usually performed under anesthesia. Even if soft tissues are involved, surgery is not always necessary. However, surgical therapy is indispensable in cases of open dislocation, vascular and nerve injuries, re-dislocation after dislocation and bone fracture. During this operation, the attending physician sutures injured soft tissue structures and stabilizes bone injuries with wires or screws. Complete immobilization of the joint with metal wires is performed in case of severe ligament rupture. Depending on the therapy performed, physiotherapy exercises are performed shortly after re-dislocation and splinting or only after the surgical wound has healed. The goal of physiotherapy is to strengthen the muscles and restore full joint mobility. A motion orthosis can have a supportive effect.
Outlook and prognosis
If there are no other injuries to the bones or surrounding vessels, the prognosis for elbow dislocation is favorable. Within a few months, elbow dislocation can heal completely with adequate rest and sparing. In a medical treatment, the joint is put back in place with a few simple steps. After about 3-4 months, the arm and the elbow can normally be fully loaded again as usual. However, some patients report that they are still able to bear weight, depending on their condition on the day. Overexertion should therefore be permanently avoided for a good prognosis. Spontaneous healing is not to be expected with a dislocation. Medical care is necessary to achieve relief from the symptoms. If bone splintering has occurred due to the cause of the elbow dislocation, surgical intervention is often necessary. In this, necessary corrections are made. A cure is also possible in most cases, but must be assessed according to the individual injuries. If the symptoms lead to a chronic disease of the bones, the prognosis worsens. The symptoms increase in intensity as the disease progresses. The last option is to replace the joint. This allows the patient to use his arm and achieve good functional activity in everyday life.
Prevention
It is difficult to prevent elbow dislocation because falls cannot always be avoided. However, those who suffer from congenital weakness of the elbow joint or habitual dislocation should take extra care of the joint and avoid risk factors.
Aftercare
Elbow dislocation does not usually adversely affect the life expectancy of the affected individual. In most cases, however, no special measures or options for aftercare are available to the patient, so the patient must first rely on complete healing of the symptoms. Since self-healing cannot occur in this process, early diagnosis with early treatment should always be carried out. Only in this way can further complications be avoided or limited as far as possible. The treatment itself is carried out either by setting the joint or by surgical intervention. After the operation, the patient should not put any strain on his or her body and should in any case take it easy. Bed rest should also be observed, and strenuous or stressful activities should be avoided. In many cases, the affected joint should be spared and not loaded in the case of an elbow dislocation. Through measures of physiotherapy or physiotherapy, the movement of the joint can usually be restored relatively well. Many exercises can also be done on the patient’s own, which may promote the healing of the elbow dislocation. Support and care from friends and through family also promote healing of this complaint.
This is what you can do yourself
Elbow dislocation, also called elbow luxation, is often the result of force or falls on the elbow. This injury requires accurate diagnosis and proper treatment by an expert. As a first aid measure until the doctor arrives, cooling of the affected elbow joint is recommended. It must be put back into place as soon as possible, which is often done under anesthesia, otherwise it would be too painful. Usually, the patient must wear an upper arm cast for seven to ten days after the dislocation. The arm requires absolute rest and must be kept in a right-angled crossed position. When the cast is removed, a motion orthosis can be applied. It stabilizes the joint and at the same time allows a slow approach to normal movements. During this time, it is very important to attend and actively support the prescribed physiotherapy treatments. How this is best done is communicated to the patient by the attending physicians and physiotherapists. It takes some time before the arm and elbow joint can be fully loaded again. Until then, it is important to activate the joint without overstraining it. There are no preventive measures that can prevent an elbow dislocation or elbow luxation from occurring in the first place. However, attempts should be made to avoid high-risk situations that can lead to falls with corresponding consequences.
