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]}

O'Driscoll SW. Elbow dislocations. Morrey BF, ed. The Elbow and Its Disorders. 3rd ed. Philadelphia, Pa: WB Saunders; 2000. 409-17.
Rockwood CA Jr, Green DP, Bucholz RW, eds. Rockwood and Green's Fractures in Adults. 4th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1996. 971-85.
Kuhn MA, Ross G. Acute elbow dislocations. Orthop Clin North Am. 2008 Apr. 39(2):155-61, v. [QxMD MEDLINE Link].
Ross G. Acute elbow dislocation: on-site treatment. Phys Sportsmed. Feb 1999. 27(2):121-2. [QxMD MEDLINE Link]. [Full Text].
Parsons BO, Ramsey ML. Acute elbow dislocations in athletes. Clin Sports Med. 2010 Oct. 29(4):599-609. [QxMD MEDLINE Link].
Sheps DM, Hildebrand KA, Boorman RS. Simple dislocations of the elbow: evaluation and treatment. Hand Clin. 2004 Nov. 20(4):389-404. [QxMD MEDLINE Link].
Carter SJ, Germann CA, Dacus AA, Sweeney TW, Perron AD. Orthopedic pitfalls in the ED: neurovascular injury associated with posterior elbow dislocations. Am J Emerg Med. 2010 Oct. 28(8):960-5. [QxMD MEDLINE Link].
Dizdarevic I, Low S, Currie DW, Comstock RD, Hammoud S, Atanda A Jr. Epidemiology of Elbow Dislocations in High School Athletes. Am J Sports Med. 2016 Jan. 44 (1):202-8. [QxMD MEDLINE Link].
Nelson AJ, Izzi JA, Green A, Weiss AP, Akelman E. Traumatic nerve injuries about the elbow. Orthop Clin North Am. 1999 Jan. 30(1):91-4. [QxMD MEDLINE Link].
Lee KS, Rosas HG, Craig JG. Musculoskeletal ultrasound: elbow imaging and procedures. Semin Musculoskelet Radiol. 2010 Sep. 14(4):449-60. [QxMD MEDLINE Link].
Mehta JA, Bain GI. Elbow dislocations in adults and children. Clin Sports Med. 2004 Oct. 23(4):609-27, ix. [QxMD MEDLINE Link].
Cohen MS, Hastings H 2nd. Acute elbow dislocation: evaluation and management. J Am Acad Orthop Surg. 1998 Jan-Feb. 6(1):15-23. [QxMD MEDLINE Link].
Ross G, McDevitt ER, Chronister R, Ove PN. Treatment of simple elbow dislocation using an immediate motion protocol. Am J Sports Med. 1999 May-Jun. 27(3):308-11. [QxMD MEDLINE Link].
Schippinger G, Seibert FJ, Steinböck J, Kucharczyk M. Management of simple elbow dislocations. Does the period of immobilization affect the eventual results?. Langenbecks Arch Surg. 1999 Jun. 384(3):294-7. [QxMD MEDLINE Link].
Villarin LA Jr, Belk KE, Freid R. Emergency department evaluation and treatment of elbow and forearm injuries. Emerg Med Clin North Am. 1999 Nov. 17(4):843-58, vi. [QxMD MEDLINE Link].
Macias CG, Bothner J, Wiebe R. A comparison of supination/flexion to hyperpronation in the reduction of radial head subluxations. Pediatrics. 1998 Jul. 102(1):e10. [QxMD MEDLINE Link]. [Full Text].
Coulibaly NF, Moustapha NM, Djoumoi HH, Lamine S, Badara GA, Daniel SA. Management Of Recent Elbow Dislocations: Functional Treatment Versus Immobilization; A Prospective Study About 60 Cases. Open Orthop J. 2017. 11:452-459. [QxMD MEDLINE Link].
Iordens GI, Van Lieshout EM, Schep NW, De Haan J, Tuinebreijer WE, Eygendaal D, et al. Early mobilisation versus plaster immobilisation of simple elbow dislocations: results of the FuncSiE multicentre randomised clinical trial. Br J Sports Med. 2017 Mar. 51 (6):531-538. [QxMD MEDLINE Link].
Duckworth AD, Kulijdian A, McKee MD, Ring D. Residual subluxation of the elbow after dislocation or fracture-dislocation: treatment with active elbow exercises and avoidance of varus stress. J Shoulder Elbow Surg. 2008 Mar-Apr. 17(2):276-80. [QxMD MEDLINE Link].
Micic I, Kim SY, Park IH, Kim PT, Jeon IH. Surgical management of unstable elbow dislocation without intra-articular fracture. Int Orthop. 2009 Aug. 33 (4):1141-7. [QxMD MEDLINE Link].
Jeon IH, Kim SY, Kim PT. Primary ligament repair for elbow dislocation. Keio J Med. 2008 Jun. 57(2):99-104. [QxMD MEDLINE Link]. [Full Text].
Duckworth AD, Ring D, Kulijdian A, McKee MD. Unstable elbow dislocations. J Shoulder Elbow Surg. 2008 Mar-Apr. 17(2):281-6. [QxMD MEDLINE Link].
de Haan J, Schep NW, Zengerink I, van Buijtenen J, Tuinebreijer WE, den Hartog D. Dislocation of the elbow: a retrospective multicentre study of 86 patients. Open Orthop J. 2010 Feb 17. 4:76-9. [QxMD MEDLINE Link]. [Full Text].
Kesmezacar H, Sarikaya IA. The results of conservatively treated simple elbow dislocations. Acta Orthop Traumatol Turc. 2010. 44(3):199-205. [QxMD MEDLINE Link].
Burra G, Andrews JR. Acute shoulder and elbow dislocations in the athlete. Orthop Clin North Am. 2002 Jul. 33(3):479-95. [QxMD MEDLINE Link].
Englert C, Zellner J, Koller M, Nerlich M, Lenich A. Elbow dislocations: a review ranging from soft tissue injuries to complex elbow fracture dislocations. Adv Orthop. 2013. 2013:951397. [QxMD MEDLINE Link].
Sano S, Rokkaku T, Imai K, Saito S, Abe Y, Moriya H. Radial head dislocation with ulnar plastic deformation in children: an osteotomy within the middle third of the ulna. J Shoulder Elbow Surg. 2008 Sep-Oct. 17 (5):768-71. [QxMD MEDLINE Link].
Schreiber JJ, Potter HG, Warren RF, Hotchkiss RN, Daluiski A. Magnetic resonance imaging findings in acute elbow dislocation: insight into mechanism. J Hand Surg Am. 2014 Feb. 39(2):199-205. [QxMD MEDLINE Link].
Bruinsma WE, Guitton T, Ring D. Radiographic loss of contact between radial head fracture fragments is moderately reliable. Clin Orthop Relat Res. 2014 Jul. 472(7):2113-9. [QxMD MEDLINE Link]. [Full Text].
Sormaala MJ, Sormaala A, Mattila VM, Koskinen SK. MDCT findings after elbow dislocation: a retrospective study of 140 patients. Skeletal Radiol. 2014 Apr. 43 (4):507-12. [QxMD MEDLINE Link].

Media Gallery

Posterior and lateral dislocation of the left elbow in a soccer goalie. A small avulsion fracture of the olecranon is present.
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.

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Author

Mark E Halstead, MD Associate Professor, Departments of Orthopedics and Pediatrics, Washington University School of Medicine; Team Physician, Washington University Athletics

Mark E Halstead, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

David T Bernhardt, MD Director of Adolescent and Sports Medicine Fellowship, Associate Professor, Department of Pediatrics/Ortho and Rehab, Division of Sports Medicine, University of Wisconsin School of Medicine and Public Health

David T Bernhardt, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Henry T Goitz, MD Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Joseph P Garry, MD, FACSM, FAAFP Associate Professor, Department of Family Medicine and Community Health, University of Minnesota Medical School

Joseph P Garry, MD, FACSM, FAAFP is a member of the following medical societies: American Academy of Family Physicians, American Medical Society for Sports Medicine, Minnesota Medical Association, American College of Sports Medicine

Disclosure: Nothing to disclose.