Return to Play
A follow-up examination before the patient's return to play is necessary to reassess motion of the formerly dislocated elbow following the immobilization and early ROM period. Most individuals can return to play 3-6 weeks following an elbow dislocation.
In sports in which an elbow dislocation occurs in a player's nondominant arm, return to play may occur at the earlier end of the rehabilitation spectrum — as long as motion is back to a level that is suitable to the physician and athlete. For elbow dislocations that occur in a player's dominant arm, return to play may take a longer time period. Throwing sports, such as baseball, may require the patient to undergo periods of rest up to 3 months following a dislocation, followed by a strengthening rehabilitative program once full motion is achieved.
Complications
Complications of elbow dislocation primarily include neurovascular compromise, compartment syndrome, and loss of ROM. Chronic regional pain syndrome may occur. Close attention to the neurologic examination pre- and postreduction as well as at the follow-up visit may alert the physician to potential neurologic problems.
Prevention
Elbow dislocations in children due to radial head subluxation (nursemaid's elbow) are often preventable. A child should not be forcibly pulled, lifted, or swung in the air by the hand or wrist. Always lift a small child from under the arms, rather than by the hand or wrist. Athletes who participate in high-risk sports, where falling on an outstretched arm is common, may be advised to wear protective gear to prevent elbow injuries.
Prognosis
Approximately 50% of patients with dislocated elbows achieve a full recovery, including full ROM. One third of patients experience some limitation of motion at the elbow, usually less than 10° of compromised motion. The remaining 10-15% of patients have more significant losses in function, primarily related to limited ROM. Some correlation exists between the severity of the initial injury and the likelihood of having significant motion limitations further in time from the injury occurrence. [23, 24]
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Posterior and lateral dislocation of the left elbow in a soccer goalie. A small avulsion fracture of the olecranon is present.
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The preferred method for posterior elbow dislocation reduction is to lay the patient prone with the humerus supported by the exam table. Place one hand around the wrist of the affected arm and apply downward traction, while the other hand stabilizes the humerus and the thumb is placed over the olecranon, with gentle pressure applied to facilitate reduction.
