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ELBOW DISLOCATION
ELBOW DISLOCATION
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GENERAL INFORMATION
DEFINITION--An injury to the elbow joint so that adjoining bones are displaced from their normal position and no longer touch each other. An elbow dislocation is usually a surgical emergency because damage to nerves and blood vessels is common and severe.
BODY PARTS INVOLVED--------------------
Elbow joint.
Adjoining arm bones (ulna, radius and humerus).
Collateral ligament of the elbow.
Soft tissue surrounding the dislocation, including nerves, tendons, muscles and blood vessels.
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SIGNS & SYMPTOMS--------------------
Excruciating pain at the time of injury.
Loss of elbow function.
Severe pain when attempting to move the elbow.
Visible deformity if the dislocated bones have locked in the dislocated position. Bones may spontaneously reposition themselves and leave no deformity, but damage is the same.
Tenderness over the dislocation.
Swelling and bruising around the elbow.
Numbness or paralysis in the arm below the dislocation caused by pressure on blood vessels or nerves.
Decreased or absent pulse at the wrist because of blood-vessel damage.
CAUSES--------------------
Direct blow to the elbow.
Fall onto an outstretched hand.
End result of a severe elbow sprain.
Congenital elbow abnormality, such as shallow or malformed joint surfaces.
Powerful muscle contractions.
RISK INCREASES WITH--------------------
Contact sports such as football, soccer or basketball.
Field or track events that involve jumping, such as the high jump or pole vault.
Previous elbow dislocations or sprains.
Repeated elbow injury of any kind.
Arthritis of any type (rheumatoid, gout).
Poor muscle conditioning.
HOW TO PREVENT--------------------
Build your overall strength and muscle tone with a long-term conditioning program appropriate for your sport.
Wear elbow pads for contact sports.
WHAT TO EXPECT========================================
APPROPRIATE HEALTH CARE
Doctor's treatment to aspirate blood from the dislocated elbow and to reposition the bones with manipulation under general anesthesia.
Surgery (sometimes) to restore the elbow to its normal position and repair tendons and collateral ligament. Acute or recurring dislocations may require surgical reconstruction or replacement of the elbow.
Application of splints or cast and a sling.
DIAGNOSTIC MEASURES--------------------
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the elbow and adjacent bones.
POSSIBLE COMPLICATIONS--------------------
Damage to nearby nerves or major blood vessels.
Excessive internal bleeding.
Shock or loss of consciousness.
Recurrent dislocations, particularly if a previous dislocation has not healed completely.
Proneness to repeated injury.
Unstable or arthritic elbow following repeated injury.
PROBABLE OUTCOMEAfter the dislocation has been corrected, the elbow will require immobilization with anterior and posterior splints and a sling for 3 to 5 weeks. There will be marked stiffness after all elbow dislocations, but with competent medical care, motion should be unrestricted after 2 to 6 months. Injured liga-
ments require a minimum of 6 weeks to heal.
HOW TO TREAT========================================
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AID--------------------
Keep the person warm with blankets to decrease the possibility of shock.
Cut away clothing if possible, but don't move the injured area to do so.
Immobilize the elbow, shoulder and wrist with padded splints in the position they are in. Don't try to manipulate the elbow.
Follow instructions for R.I.C.E., the first letters of REST,
ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
The doctor will manipulate and realign the dislocated bones. Surgery may be required to do this. Manipulation should occur within 6 hours of injury or shock may occur. Also, many tissues lose their elasticity and may become difficult to return to a normal functional position.
CONTINUING CARE--------------------
Splints will be necessary to immobilize the elbow, and a sling will be necessary to immobilize the entire arm. The posterior (hind) splint is usually removed 2 weeks after injury, and the anterior (front) splint is removed 1 week later. A sling is used for another week.
Use ice soaks 3 or 4 times a day. Fill a bucket with ice water, and soak the injured area for 20 minutes at a time.
Use heat applications if heat feels better. Use heat lamps, hot showers or heating pads.
Take whirlpool treatments, if available.
MEDICATIONYour doctor may prescribe:
General anesthesia or muscle relaxants to make joint manipulation possible.
Acetaminophen to relieve moderate pain.
Narcotic pain relievers for severe pain.
Antibiotics to fight infection if surgery is necessary.
ACTIVITY--------------------
Actively exercise all muscle groups not immobilized. The muscle contractions promote proper bone alignment and hasten healing.
Resume your normal activities gradually.
Don't drive until all symptoms disappear.
DIET--------------------
Drink only water before manipulation or surgery to correct the dislocation. Solid food in your stomach makes vomiting under general anesthesia more hazardous.
Eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation due to decreased activity.
REHABILITATION--------------------
Begin daily rehabilitation exercises when supportive wrapping is no longer needed.
Use ice massage for 10 minutes before and after workouts. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly in a circle over the injured area.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF========================================
Any of the following occur after injury:
Numbness, paleness or coldness in the elbow. This is an emergency!
Elbow deformity.
Difficulty moving the elbow joint.
Nausea or vomiting.
Numbness or complete loss of feeling below the elbow.
Any of the following occur after treatment:
Swelling above or below the splints.
Blue or gray skin color under the fingernails.
Constipation.
Any of the following occur after surgery:
Increased pain, swelling or drainage in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
New, unexplained symptoms develop. Drugs used in treatment may cause side effects.
Elbow dislocations that you can "pop" back into normal position occur repeatedly.
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From Complete Guide to Sports Injuries by H. Winter Griffith, M.D. Copyright by Putnam Publishing
Group. Electronic rights by Medical Data Exchange.
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