Introduction
Dislocation of the elbow – where the bones in the elbow joint are moved out of alignment - is a relatively common dislocation, second only to shoulder dislocation. It can happen to anyone, although it primarily affects children and young people aged 10-20 who sustain injuries during playing and sport. Dislocation of the elbow are classified into three types:
- Simple – no bone fracture(s).
- Complex – bone fracture(s) accompanied by ligament rupture (generally affecting the forearm).
- Severe – as complex described above but incorporating damage to other tissue such as blood vessels and nerves around the elbow.
Causes
Elbow dislocations are generally the result of some form of trauma directly to the elbow. Common causes include:
- High energy trauma accidents, for example vehicle accidents, falls from a height.
- Falling on an outstretched hand ('FOOSH').
- Accidents during sport (or incorrect technique).
- Elbow ligament weakness (relatively common in children) - swinging a young child by the hands / wrists with extended arms can cause a dislocation known as 'nursemaid's elbow'.
- Congenital (inherited) conditions, for example malformation of the ulna bone in the forearm or hypermobility (where ligaments are looser than normal).
People with epilepsy are also prone to elbow dislocations, as are people who have a history of elbow instability or who have not followed rehabilitation guidelines after a previous dislocation.
[Developer Note: “elbow instability” links to “Elbow instability”]
Symptoms
The main symptom of elbow dislocation is sudden and severe pain as it occurs. The following symptoms may also be present;
- Swelling / bruising around the elbow.
- Tenderness.
- Obvious deformation of the elbow.
- Affected forearm longer than the other forearm (indicates a rarer form of dislocation known as 'anterior dislocation').
- Numbing / loss of feeling below the elbow or difficulty moving fingers and thumb of affected arm (caused by nerve damage).
Tests / Diagnosis
All elbow dislocations are regarded as serious injuries and need prompt medical attention. Applying an ice pack will ease some of the pain before getting to the doctor or emergency department. Someone with a suspected elbow dislocation will need to be physically examined and checked for potential artery or nerve damage. A dislocated elbow can sometimes be 'reduced', that is relocated. In most instances an X-ray will be required and where a complex dislocation is a possibility, a CT scan may also be required.
Treatment
Simple dislocations generally do not require surgery and can be treated with a splint and sling. Complex and severe dislocations generally require surgical treatment i.e.: an elbow stabilisation.