ELBOW DISLOCATION

Question 1

Def/Causes

Answer 1

(1) Most common dislocation in children and third most common in adults
(2) Resulting from a fall on an outstretched hand (FOOSH)
(3) 80% of elbow dislocations are posterior
(4) Dislocations may be complete or perched
(5) Lateral collateral ligament is always disrupted

Question 2

Clinical symptoms

Answer 2

(1) Extreme pain
(2) Swelling
(3) Inability to bend elbow

Question 3

Physical Exam

(1) Visual
(2) Palpation
(3) ROM
(4) Muscle Test
(5) Neurovascular
(6) Diagnostic Tests

Answer 3

(1) Visual
(a) Obvious deformity
(2) Palpation
(a) Tenderness noted throughout joint
(3) ROM
(a) No elbow flexion and extension
(b) Supination and pronation severely limited
(4) Muscle Test
(a) All motions will be limited by pain and inability to move joint.
(5) Neurovascular
(a) Do not overlook this exam
1) Possible neuropathy
2) Check radial pulse and cap refill
(6) Diagnostic Tests
(a) AP and lateral Radiographs are adequate to make a diagnosis
(b) Also required to rule out fracture

Question 4

Treatment

Answer 4

(1) Ice
(2) Appropriate pain management
(3) Splint
(4) Consider emergency reduction if delayed MEDEVAC time or neurovascular
compromise.
(5) Repeat neurovascular check after reduction

Question 5

How to Reduce:

Answer 5

Reduction should be performed as follows:

(a) Elbow extended to 45 degrees.
(b) Slow, steady downward traction of forearm in line with long axis of humerus.
(c) Gentle pressure over olecranon tip.
(d) Repeat neurovascular examination after reduction.

Question 6

Referral Decisions/Red Flags

Answer 6

(1) Reduction should be performed as soon as possible by an orthopedic surgeon - refer for
treatment ASAP.
(2) Patients with neurovascular compromise or bony injury require immediate
referral/MEDEVAC.
(3) Flexion contracture that limits activities of daily living (ADLs) requires further
evaluation.