Fractures And Dislocations Of The Elbow
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A fracture or dislocation of the elbow can be very painful and keep you from your favorite activities. At TriHealth Orthopedics& Sports Institute and Beacon Orthopaedics & Sports Medicine, our team offers treatment tailored to your injury. Whether you have a simple injury that calls for bracing or a more complex break or dislocation, were here for you. Our surgeons, hand therapists and physical therapists work closely together to help you return to the activities you enjoy.
What Are The Signs & Symptoms Of Nursemaid’s Elbow
The injury might not be obvious because nursemaid’s elbow doesn’t make the elbow look swollen or bruised. A child with nursemaid’s elbow will not want to use the injured arm because moving it is painful. They will hold the arm straight or with a slight bend in the elbow. Kids will say it hurts in the wrist, forearm, or elbow.
An arm or elbow injury that causes severe pain, bruising, or swelling might be a sign of an elbow fracture . It can be hard for a parent to tell whether an elbow injury is nursemaid’s elbow or a fracture, so it’s important to call the doctor if your child has an injured elbow.
What Causes A Dislocated Elbow
There can be various causes of a dislocated elbow.
- Most elbow dislocations occur when people try to stop a fall with their outstretched hand.
- Car accidents can cause dislocated elbows when people reach out to brace themselves against impact.
- Sports injuries can cause dislocations.
- Overuse can also be a cause.
- In some cases, a joint disorder such as Ehlers-Danlos syndrome causes dislocations. Ehlers-Danlos makes joints unusually loose and flexible.
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What Are The Causes And Risk Factors Of A Dislocated Elbow
Falling onto an outstretched hand or a traumatic event like a car accident commonly cause an elbow dislocation. Risk factors include contact sports, gymnastics, rollerblading, and similar activities. In children, radial head subluxations may occur when the child’s elbow is extended and then pulled or yanked .
Sometimes Its A Kid Thing
You may be more likely to take your kid in for this kind of injury than to get one yourself. Thereâs a type of partial dislocation called nursemaidâs elbow, or pulled elbow, and itâs common in tots 4 and younger.
It usually happens when you pull children by their hands. Their ligaments are loose because their bones arenât fully formed. Itâs easy for them to slip right over the radial head — the thing that helps them flex and bend their elbow and forearm — or get trapped in the elbow joint.
It happened to Bethany Afsharâs daughter Katie twice. The first time was when she was almost 2 and ran behind her big brother into the swimming pool. Her father quickly pulled her out of the pool by her left arm.
âLater, we noticed that she couldnât pick up a pacifier with that arm and took her to urgent care,â says Afshar, who lives in Georgia. âThey gave her a Popsicle, lifted her arm and twisted it real quickly back into place, just like that.â
Katie got the same treatment after it happened again in preschool a year or two later, âprobably on the jungle gym,â Afshar says. Katie is 9 now, and it hasnât happened since. The risk drops as kids get older — their ligaments tighten and their bones grow.
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Fighting Your Natural Instincts After An Elbow Dislocation
Elbow dislocations are less common than shoulder dislocations but they occur more frequently than you might think. There are some unique aspects to elbow dislocations, of which you may not be aware.
Before delving deeper, lets male sure we are on the same page by clarifying some definitions.
A joint is where 2 or more bones come together and form a moving surface. These surfaces are usually covered with cartilage and fit congruently. Dislocation is the word we use to describe an event when the joint surfaces disconnect from one another. This event is often forceful and involves failure of some soft tissues such as ligaments or tendons.
Dislocations around the elbow come in 2 varieties: simple and complex.
A simple dislocation is one that occurs without a fracture of the elbow. A complex dislocation involves a fracture around the elbow AND a dislocation. Obviously the latter problem is more involved.
Dislocations are unsettling. They usually dont go back into place unless you or a medical professional puts them back into place. This may require some medication for relaxation.
Elbow Dislocation And Fracture Prevention
Its impossible to completely prevent an elbow fracture or dislocation. You can, however, take a few steps to lower your risk:
- Wear protective gear during physical activities, like elbow pads when roller skating
- Try not to fall with your arm outstretched
- Dont try stunts beyond your skill level
- Always have someone helping spot you when climbing a ladder
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Elbow Dislocation Causes Symptoms And Treatment
An elbow dislocation occurs when the upper arm and forearm get separated from their normal position. The bone of the upper arm normally touches the bones of the forearm . When an elbow dislocation occurs, these bones are separated from their normal alignment. Elbow dislocations are the second most common joint dislocation, following shoulder dislocations.
There are two basic types of elbow dislocations.
- Simple elbow dislocation: A simple elbow dislocation means there is no fracture of the bones around the elbow joint. The prognosis of simple elbow dislocation is better, since surgery is often not required for treatment.
- Complex elbow dislocation: A complex elbow dislocation means that there is a fracture, usually of the forearm, that has occurred along with the elbow dislocation. In a complex elbow dislocation, surgery is often needed to fix the broken bone in order to maintain the elbow joint in a normal position.
How Do You Know If Your Elbow Is Dislocated
Elbow Dislocation Symptoms Severe pain in the elbow, swelling, and inability to bend your arm are all signs of an elbow dislocation. In some cases, you may lose feeling in your hand or no longer have a pulse .
Can you pop an elbow out of place?
A dislocated elbow occurs when any of the three bones in the elbow joint become separated or knocked out of their normal positions. Dislocation can be very painful, causing the elbow to become unstable and sometimes unable to move.
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What Are The Treatment Options For A Dislocated Elbow
The doctor will manipulate the elbow back in place by pulling down on your wrist and levering your elbow back into place. This is very painful, so powerful medications for pain are generally given before reduction. Many doctors who attempt this procedure will offer the patient “conscious sedation.” The patient is given an anesthetic dose that is strong enough to reduce or stop the pain sensation of the elbow reduction technique but the patient remains conscious enough to control their own breathing.
After the elbow is back in place, the doctor will get X-rays and then put the patient in a splint that will keep their elbow bent. The splint will make an “L” around the back of the elbow. It will be made of plaster or fiberglass. Its purpose is to prevent movement of the arm at the elbow. Usually, the arm will be placed in a sling to help the patient hold the splint in a level position and to prevent pressure on the elbow joint.
Nursemaid’s elbow, because the developing elbow joint does not have the resistance of the adult joint, can usually be reduced easily without anesthesia by a person trained in the simple technique. However, unless trained, this reduction technique should not be done.
While the patient is being discharged from the doctor’s office or emergency department, they will be instructed to follow up with a bone doctor , usually within 24-48 hours.
When Can I Go Back To My Regular Activities
Healing time for a dislocated elbow varies depending on the severity of the injury. Most people with a dislocated elbow can return to their usual activities once a doctor has returned the joint to its normal position.
A sling can help protect the elbow joint so you can return to your usual activities while the joint heals. Your doctor will let you know when you can resume more physical activities such as sports or lifting heavy objects.
Last reviewed by a Cleveland Clinic medical professional on 09/25/2018.
References
- American Academy of Orthopaedic Surgeons. Elbow Dislocation. Accessed 9/26/18.
- Merck Manual. Overview of Dislocations. Accessed 9/26/18.
- Robinson PM, Griffiths E, Watts AC. Simple elbow dislocation. Shoulder Elbow. 2017 9:195-204.
- Rempel DM, Amirtharajah M, Descatha A. Shoulder, Elbow, & Hand Injuries. In: LaDou J, Harrison RJ. eds. CURRENT Diagnosis & Treatment: Occupational & Environmental Medicine, 5e New York, NY: McGraw-Hill 2013.
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Can Pulled Elbow Correct Itself
Sometimes it gets unstuck by itself. In most cases, a health care professional gets the ligament back in place by doing a quick, gentle move of the arm. A child with nursemaids elbow has some arm pain when the injury happens, but it doesnt cause long-term damage.
Can a dislocated elbow heal itself?
Because the elbow is only partially dislocated, the bones can spontaneously relocate and the joint may appear fairly normal. The elbow will usually move fairly well, but there may be pain. There may be bruising on the inside and outside of the elbow where ligaments may have been stretched or torn.
What Is A Dislocated Elbow
A dislocated elbow occurs when any of the three bones in the elbow joint become separated or knocked out of their normal positions.
Dislocation can be very painful, causing the elbow to become unstable and sometimes unable to move. Dislocation damages the ligaments of the elbow and can also damage the surrounding muscles, nerves and tendons .
You should seek immediate medical treatment if you think you have an elbow dislocation. Treatment reduces the risk of irreversible damage.
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Can A Dislocated Elbow Be Realigned Without Surgery
Complications can occur if the dislocated elbow pinches or traps the blood vessels and the nerves that serve the lower arm and hand. A dislocated elbow can usually be realigned without surgery. However, if your elbow is also fractured, you might need surgery. Signs and symptoms of a dislocated elbow include:
How old do you have to be to get a dislocated elbow?
Its the most common joint dislocation in children under 10 years old and is more common in teens and adults people under 25. An elbow dislocation can be extremely painful. People sometimes feel or hear a pop when the elbow is injured. And sometimes you can break one of the arm bones at the same time.
Enhancing Healthcare Team Outcomes
Interprofessional care is fundamental to the treatment of patients with elbow dislocation. If an elbow dislocation occurs on the field of a sporting event, a member of the healthcare team may be able to reduce it immediately. Education of these healthcare providers, such as physical therapists or athletic trainers, may allow prompt treatment if a physician is not available.
Plain radiographs of the elbow are needed to understand the direction of the dislocation, including anteroposterior, lateral, and oblique views. Coordination with radiology technicians is needed to produce accurate and reproducible images of the elbows.
Closed reduction is often the initial management, and likely to occur in the emergency department . For adequate relaxation for reduction, the emergency department often sedates the patients. Length of stay in the ED can improve through interprofessional communication strategies and has been shown to improve patient satisfaction. Follow-up care should involve a nurse with orthopedic specialty training to ensure therapeutic progress, answer questions, and evaluate compliance. This care should be coordinated with the clinical team.
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How Is Elbow Dislocation Treated
- NSAIDs , such as ibuprofen, help decrease swelling, pain, and fever. This medicine is available with or without a doctor’s order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow directions.
- Acetaminophen decreases pain and fever. It is available without a doctor’s order. Ask how much to take and how often to take it. Follow directions. Read the labels of all other medicines you are using to see if they also contain acetaminophen, or ask your doctor or pharmacist. Acetaminophen can cause liver damage if not taken correctly.
- Reduction is a procedure to move your elbow bones back into place. You will be given medicine to help you relax before your healthcare provider moves your elbow.
- Surgery may be needed to put your bones back into place if it cannot be done with reduction. You may also need surgery if you have a broken bone.
Do I Have A Fractured Elbow Or A Torn Ligament
When a ligament is stretched or torn, its called a sprain. In most cases, people whove sprained their elbow can still move it, though it may cause discomfort. A sprain can exhibit similar symptoms as a fracture, so its important to see your healthcare provider for a proper diagnosis. They will perform a physical examination and take X-rays to determine if your elbow is fractured.
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What Is The Recovery Time For A Dislocated Elbow
For simple elbow dislocations, you may need to use a sling for up to 3 weeks. It can take up to 5 months to regain the ability to extend the elbow. PT is important to regain flexibility, strength, and function of the joint.
After surgery for complex dislocations, you may need a splint for up to 6 weeks. PT during this time can help with your recovery. Full recovery from surgery depends on the extent of the injury and surgical repair.
Stiffness is common even after recovery, and many people will not be able to fully straighten or bend their affected arm. Research also notes that, on average, the stiffness can decrease the range of motion by about 10 degrees. In some cases, surgery is necessary after recovery to reduce this stiffness. The surgery involves removing scar tissue and any excessive bone growth.
How Does A Pulled Elbow Happen
A pulled elbow is a common minor injury which usually affects children under the age of 6 years. It occurs when one of the forearm bones, called the radius, partially slips out of a ring shaped ligament at the elbow, which secures the radius to the bone next to it called the ulna.
How do you test for nursemaid elbow?
Usually, no special tests are needed to diagnose nursemaids elbow. X-rays are done only if a fracture is suspected. If theres no swelling or signs of another injury, the doctor will do a gentle maneuver called a reduction.
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Research On The Horizon
Treatment for simple dislocations is usually straightforward and the results are usually good. Some people with complex dislocations still have some type of permanent disability at the elbow. Treatment is evolving to improve results for these people.
One of the areas being researched is the best time to schedule surgery for the treatment of a complex dislocation. For some patients with complex dislocations, it seems that a slight delay for final surgery may improve results by allowing swelling to decrease. The dislocation still needs to be reduced right away, but then a brace, splint, or external fixation frame may rest the elbow for about a week before a specialist surgeon attempts major reconstructive surgery.
Moving the elbow early appears to be good for recovery for both kinds of dislocations. Early movement with complex dislocations can be difficult, however. Pain management techniques encourage early movement. Improved therapy and rehabilitation techniques, such as continuous motion machines, dynamic splinting , and progressive static splinting can improve results.
Deterrence And Patient Education
Certain activities are more prone to elbow dislocations due to the nature of the forces encountered. The most common sports being football, roller-blading or skateboarding, and wrestling. These patients should be counseled, wear protective equipment, and, if possible, try to avoid excessive stresses to these areas.
Patients quite commonly lose 10-15 degrees of terminal extension after elbow dislocations. Patients should be counseled about this early and should work towards increasing the range of motion as soon as allowed.
Lastly, elbow dislocations are the most common large joint dislocation in children. These patients tend to regain more range of motion and elbow function than adults. However, parents need to understand the possibility of growth disturbances.
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Elbow Fractures And Dislocations
Elbow fractures and dislocations are two different types of injuries to the elbow. A fracture to the elbow is when one of the bones at the elbow joints breaks. An elbow fracture needs to be diagnosed and treated quickly by a medical professional to ensure there isnt any damage to joint surface of the elbow and to realign the bones so that they can function normally.
An elbow dislocation happens when the bones that make up your elbow joint move out place when compared to the upper arm. This causes the elbow joint to move out of place. This injury requires immediate medical assistance.