Elbow Dislocation

First aid for a dislocated elbow

1. Do not try to push the joint back in. You can trap or tear the nerves and the brachial artery that run in front of the elbow.
2. Support the arm in the position you find it, using a sling, pillow or rolled jacket.
3. Remove rings and watches from that hand before it swells.
4. Apply an ice pack wrapped in a cloth.
5. Go to the ER or call 911 or your local emergency number, especially if the hand is cold, pale or numb.
6. Do not eat or drink in case sedation or surgery is needed.

What happens in an elbow dislocation

The elbow is one of the most stable joints in the body, held by the shape of the bones and by strong ligaments on the inner (medial collateral) and outer (lateral collateral) sides. When a large force goes up the forearm, usually with the arm straight and twisting, the ligaments tear and the ulna and radius slide out of place.

• Posterior dislocation: the forearm bones move behind the humerus. About 90% of cases.
• Anterior dislocation: rare, usually from a direct blow to a bent elbow.
• Simple dislocation: only ligaments and soft tissue are injured.
• Complex dislocation: there is also a fracture. The most serious pattern, the "terrible triad", combines dislocation with fractures of the radial head and the coronoid process of the ulna. It is unstable and almost always needs surgery.

Elbow dislocation is the second most common large-joint dislocation in adults after the shoulder. In young children, a much more common and milder injury is a pulled elbow (radial head subluxation), where the radius slips partly out of its ring ligament when a child is lifted or swung by the hand.

Symptoms

• Severe pain at the moment of injury, sometimes with a felt or heard pop
• An obvious deformity, with the point of the elbow prominent at the back
• Swelling and later bruising
• Inability to bend or straighten the arm
• Numbness or tingling in the hand if a nerve is stretched, most often the ulnar nerve (ring and little fingers) or the median nerve (thumb, index and middle fingers)

A partial dislocation (subluxation) may slip back into place on its own, leaving elbow pain, swelling and a feeling of instability. It still needs assessment.

Diagnosis

The ER doctor checks the pulse at the wrist, the color and warmth of the hand, and the feeling and movement of each finger, both before and after the joint is reduced. X-rays in two views confirm the direction of the dislocation and look for fractures. A CT scan is often done if a fracture is seen or suspected, to plan surgery. An MRI is sometimes used later if the elbow stays unstable.

Treatment

Reduction

Most dislocations are put back in place (reduced) in the ER under sedation or strong pain relief. The doctor applies steady traction and guides the bones back, usually with a satisfying clunk. Relief of pain is often immediate. After reduction, the nerves and blood supply are checked again, the elbow is gently moved to test stability, and repeat X-rays confirm alignment.

After reduction: simple dislocations

• A splint or sling, usually for no more than 1 to 2 weeks. Long immobilization causes lasting stiffness.
• Early, gentle range-of-motion exercises, often starting within a week
• Physical therapy to restore bending, straightening and forearm rotation, then strength
• Pain relief: acetaminophen (paracetamol) or an anti-inflammatory such as ibuprofen at the label dose, if safe for you, plus ice and elevation

Surgery

Surgery is needed when there is a significant fracture, when the joint will not stay in place, when it cannot be reduced, or with artery damage. Surgeons fix fractures, repair or reconstruct the torn ligaments, and occasionally replace the radial head or use a hinged external fixator.

Complications

• Stiffness: the most common problem. Losing the last 10 to 15 degrees of straightening is typical and usually does not affect daily life.
• Nerve injury: usually stretching, which often recovers over weeks to months.
• Artery injury: uncommon but limb-threatening, needing urgent repair.
• Compartment syndrome: rising pressure in the forearm muscles after injury. It needs emergency surgery.
• Recurrent instability: more likely with complex injuries.
• Heterotopic ossification: extra bone forming in the soft tissue, limiting movement.
• Post-traumatic arthritis: more likely after fractures.
• Complex regional pain syndrome: rare, ongoing burning pain and swelling out of proportion to the injury.

Dislocated elbow recovery time

Complex dislocations with fractures take longer, often several months. Doing your exercises consistently is the single biggest factor in getting a good range of movement back.

Frequently asked questions

How long does a dislocated elbow take to heal?

Most simple dislocations allow light use within 2 to 4 weeks and near-normal movement by 6 to 8 weeks. Full strength and return to sport usually take about 3 months. Elbows with fractures or surgery take longer, and range of motion can keep improving for up to a year.

Can you pop a dislocated elbow back in yourself?

No. Trying to force the elbow back can damage the nerves and the main artery that run across the front of the joint, and it can shift an unseen fracture. Support the arm as it is and get emergency care, where reduction is done with pain relief and X-rays.

Is a dislocated elbow worse than a broken arm?

It depends on the injury. A simple dislocation often recovers faster than many fractures, but stiffness is a common long-term problem. A dislocation combined with fractures is one of the more difficult elbow injuries to treat and usually needs surgery.

Will my elbow ever be the same after a dislocation?

Most people regain nearly full function. It is common to lose a small amount of straightening, often barely noticeable. Early movement and physical therapy give the best result. Ongoing instability, arthritis or significant stiffness are less common and more likely after complex injuries.

What is the difference between a dislocated elbow and a pulled elbow?

A pulled elbow (nursemaid's elbow) occurs in children under about 5, when lifting or swinging them by the hand makes a forearm bone slip partly out of its ligament ring. There is no deformity, the child simply will not use the arm, and a doctor can usually fix it in seconds. A true dislocation is a major injury from a fall.