An Unusually Dislocated Elbow and its Treatment

Elbow dislocations are a common arm injury and although shoulder dislocations are more common in adults, dislocated elbows come a close second. They occur in about six to eight people out of 100,000. The most frequent cause is a fall onto an outstretched hand, although the elbow can be dislocated in other ways as well.

The injury is classified in one of four ways, depending on the direction of the dislocation: anterior, which means to the front, posterior, which means to the back, lateral, which means to the side, or divergent, which means that the bones moved apart from one another. The most common one, however, is the posterior one, with both the radius and the ulna (both bones in the forearm) becoming dislocated from the humerus, the upper arm bone. In 10 percent to 15 percent of cases, there can be other injuries, such as injury to the shoulder, to the arm bones themselves, and to the wrist bones.

The elbow is supported by "pulley" type system, called a trochia and this stabilizes the joint. The ligaments, tough tissue that hold bone together also help stabilize the elbow.

When an elbow is dislocated, usually it's treated by manipulating it back into place. The patient would normally receive only a local anesthetic, unless the reduction is complicated. After the elbow is put back into place, treatment can vary from the patient being encouraged to use the arm and elbow right away, to casting or bracing. The elbow is well protected, so repeat dislocations aren't usually a worry and that is also why surgery is usually not needed.

The authors of this article wrote about a 56-year-old woman who complained of a swollen and painful right elbow, with her forearm turning inwards toward her body. This happened after she fell and broke her fall by holding out her arm and landing on it as it was stretched out. When the doctor examined the patient, they saw on the x-ray that there was an unusual form of twisting at the elbow - the radius was twisted at a right angle (90 degrees) and the ulna at 180 degrees.

Treatment was to set it so the patient received a local anesthetic to the elbow and the doctor, along with an assistant, moved her arm back into place. Her arm was then casted in to place with the elbow bent at 90 degrees for three days. After that, the cast was replaced with a brace to remain on for three more weeks.

When the patient returned for follow up after three weeks, the doctors found that the patient was able to bend her arm quite a bit but had difficulty turning her wrist in towards her body and away from it. The doctors recommended exercises to regain that ability and the patient returned again two weeks later. at that point, there was no more pain in the elbow and she was able to move it completely in any direction.

References: Nikolaos Lasanianos, MD, and Christos Gamavos, MD. An Unusual Case of Elbow Dislocation. In Orthopedics. August 2008. Vol. 31:208.