Elbow Dislocation

An elbow dislocation happens when the bones of the elbow joint lose their normal contact. This injury usually involves tearing of the ligaments and joint capsule, and it should be evaluated promptly.

What Is an Elbow Dislocation?

A dislocation is an injury to a joint. A joint is where two bones connect through their shape and soft tissues such as ligaments and capsule. A dislocation occurs when there is complete lack of contact between the two bones. For this amount of change in bone position to occur, there is tearing of ligaments and capsule.

A partial dislocation occurs when the bones have lost some, but not all, contact with one another. This may completely or partially tear the soft tissue.

Elbow dislocations can be separated into simple and complex. Simple dislocations occur when there is no fracture. They are considered simple because there is only ligament injury, and they are more likely to be treated successfully without surgery. Complex dislocations have one or more fractures in addition to the soft tissue injury. These injuries are more complicated and more likely to need surgery. They can place the joint at risk for stiffness, recurrent instability, or pain.

Causes

Dislocations often happen after trauma, such as a fall, car accident, or sports injury. The elbow is usually a very stable joint because of strong ligaments and the way the bones are shaped like a door hinge, so it takes a lot of force to cause the elbow to dislocate.

Loose ligaments, sometimes described as being very flexible or “double jointed,” may increase the risk of dislocation, even with smaller injuries. A previous fracture that did not heal properly can also change the bone shape and stability of the joint. A prior dislocation creates the greatest risk for another dislocation.

Signs and Symptoms

The signs and symptoms of an elbow dislocation may include:

  • Severe pain in the elbow
  • Noticeable deformity or irregular appearance of the elbow joint
  • Inability to move the joint
  • Bruising and swelling of the elbow within the first few minutes to hours from internal bleeding
  • Tearing of the skin in severe dislocations, which can cause visible external bleeding
  • Numbness, tingling, or weakness in the arm and hand from stretching of the nerves that pass over the elbow to the hand

Diagnosis

Your health care provider will ask about the events leading up to the injury and examine the elbow. If there is concern for a dislocation, x-rays are usually taken.

X-rays help show the direction of the dislocation and may reveal a fracture. In some cases, a CT scan or MRI may help identify other injuries involving ligaments, nerves, or cartilage that are not seen on x-rays. A surgeon may also examine the joint with fluoroscopy, a video x-ray machine, to see whether the bones stay in place during motion or when gentle stress is applied to the joint.

X-Ray Examples

X-ray showing a normal elbow joint from the side
Figure 1: An x-ray showing a normal elbow joint from the side. The “spool” or trochlea of the humerus is sitting in the normal groove of the olecranon cup of the ulna, resembling a door hinge.
X-ray of the elbow from the side showing a dislocation
Figure 2: An x-ray of the elbow taken from the side showing a dislocation. The olecranon cup is empty.

Treatment

Elbow dislocations are unlikely to pop back into place on their own. The joint should be put back into place as quickly as possible by an experienced health care provider. Prompt care can help realign the bones before swelling and nerve stretch increase.

It is often helpful to obtain x-rays before and after treatment. X-rays help the care team understand how to maneuver the bones back into place and identify any fractures. Immediate treatment involves setting, or reducing, the bones. Reduction can decrease the risk of long-term nerve problems, decrease pain, and improve swelling.

Your health care team may use numbing medicine, intravenous medicine, sedation, or muscle relaxers to help correct the dislocation. Some dislocations may not go back into place with manipulation and may require surgery to open the joint, remove tissue or bone blocking the realignment, and repair torn or broken structures to regain stability.

Most elbow dislocations do not require surgery. After reduction, early motion is critical because elbows tend to stiffen quickly. Between exercise sessions, the joint may still need support with a brace, splint, or sling to avoid repeat dislocation or minor ligament strains.

Surgery may be indicated if the joint is not stable after reduction or if there are associated displaced or unstable fractures of the bones or cartilage of the elbow. Your surgeon will discuss this with you soon after reduction.

Recovery

Therapy to regain motion and strength will help maximize recovery, but the elbow may never be equal to the other side. Some stiffness often occurs after this injury, even with a smooth recovery.

Late nerve problems can sometimes develop from the nerve injury and scarring. The ulnar nerve, also known as the “funny bone” nerve, is closest to the elbow joint and is most likely to develop a problem after an elbow dislocation. Ulnar nerve symptoms include elbow pain and numbness or tingling in the ring and small fingers. These symptoms may increase with elbow flexion and improve when the elbow straightens.

The best treatment results occur when the injury is diagnosed and treated early. It is important to find a health care provider experienced in treating elbow dislocations.