Elbow dislocation is the second most common large joint dislocation after the shoulder. Most elbow dislocations occur during a fall on an outstretched arm and produce posterior or posterolateral displacement of the ulna and radius from the humerus. Treatment depends on the stability of the elbow after reduction, the presence of associated fractures, and any chronic instability that develops after the acute injury.
What Is an Elbow Dislocation?
Elbow dislocation is the complete loss of contact between the distal humerus and the proximal radius and ulna. The elbow is stabilized by:
- Bony congruence between the humeral trochlea and ulnar trochlear notch
- The radial head against the capitellum
- The medial collateral ligament (MCL) and lateral collateral ligament complex (LCL)
- The anterior capsule
Most elbow dislocations are posterior or posterolateral, with the ulna and radius displaced behind and lateral to the humerus. The injury tears multiple ligaments and may include fractures of the radial head, coronoid, or olecranon (collectively called the “terrible triad” pattern when all three are involved).
Simple dislocations involve only ligamentous injury. Complex dislocations include associated fractures and have higher rates of chronic instability.
Causes and Risk Factors
- Fall on an outstretched arm with the elbow in extension and rotation
- Contact sports collisions
- Falls from height
- Motor vehicle collisions
- Wrestling, gymnastics, and overhead sports
Symptoms
- Severe elbow pain at the time of injury
- Visible deformity of the elbow
- Inability to flex or extend the elbow
- Swelling and bruising
- Possible neurovascular symptoms (numbness, tingling, decreased pulse) requiring urgent evaluation
After reduction:
- Persistent pain and swelling
- Limited range of motion
- Possible instability with specific positions (lateral pivot shift apprehension)
- Recurrent dislocation in some cases (chronic instability)
Diagnosis
Dr. Chudik’s evaluation prioritizes neurovascular assessment and reduction of the dislocation. X-rays before and after reduction confirm joint alignment and identify associated fractures. CT is added for fracture characterization. MRI evaluates ligament status, particularly when chronic instability is suspected. The Westmont office has on-site high-field MRI and X-ray.
Treatment
Acute simple dislocations:
- Closed reduction under sedation
- Brief immobilization in a sling or hinged elbow brace for one to two weeks
- Early protected motion to prevent stiffness
- Progressive range of motion and strengthening
Complex dislocations with associated fractures (terrible triad and similar patterns):
- Open reduction and internal fixation of the radial head, coronoid, or olecranon as needed
- Repair or reconstruction of the lateral collateral ligament complex
- MCL repair or reconstruction in cases with persistent valgus instability
Chronic elbow instability after dislocation:
- Reconstruction of the lateral or medial ligament complex with tendon graft
- Coronoid reconstruction in cases with deficient anterior bony stability
Recovery and Outcomes
Recovery from simple dislocations typically allows return to most activity at 8 to 12 weeks. Stiffness is the most common complication and is mitigated by early motion.
Recovery from complex dislocations is longer, typically three to six months before return to sport. Outcomes depend on the quality of fracture reduction, ligament repair, and rehabilitation adherence. Post-traumatic arthritis is more common in complex patterns.
When to See Dr. Chudik
Schedule urgent evaluation after any elbow injury with severe pain, visible deformity, or inability to move the elbow. Call 630-324-0402 or request an appointment online.