Elbow dislocation is the second most common large joint dislocation in adults after the shoulder. This injury occurs when the bones that form the joint are forced out of their normal alignment. The elbow joint is a complex structure where the humerus of the upper arm meets the ulna and radius of the forearm. A dislocation is always a result of significant trauma.
Understanding the Mechanics of Injury
The elbow is an inherently stable joint due to the tight fit of its bones and the strong network of surrounding ligaments. An elbow dislocation requires a substantial amount of force to overcome this natural stability. The most common mechanism for this injury is a fall onto an outstretched hand (FOOSH injury), which sends an axial load up the arm.
This axial force is often combined with a twisting motion, which causes the elbow to hyperextend and rotate. The force tears the stabilizing ligaments, starting with the lateral collateral ligament on the outside of the joint, allowing the forearm bones to displace backward or posterolaterally relative to the humerus. Dislocations are classified as simple if they involve only ligament damage, or complex if they also include fractures of the surrounding bones, such as the radial head or the coronoid process. A complex dislocation indicates a more severe injury because the body’s natural bony stabilizers have also been compromised.
Recognizing the Signs of a Dislocation
The signs of an elbow dislocation are immediate and dramatic. The most obvious indicator is severe, intense pain that occurs right at the moment of injury. This pain often makes any attempt to move the arm impossible.
The elbow will have a visibly abnormal shape or deformity, sometimes appearing shortened or twisted compared to the uninjured arm. Swelling around the joint begins almost immediately due to internal bleeding and tissue damage. The patient will have a complete inability to fully bend or straighten the arm, and the joint may feel locked in a slightly bent position.
Immediate Steps and Medical Reduction
If an elbow dislocation is suspected, the immediate priority is to stabilize the arm and seek emergency medical attention. Do not attempt to move the arm or force the joint back into place, as this can cause further damage to surrounding nerves, blood vessels, or soft tissues.
The injured arm should be supported in whatever position is most comfortable. Applying a cold compress or ice pack can help manage the initial swelling and pain while waiting for medical help. Once in a medical facility, a healthcare provider will perform a procedure called a closed reduction.
This reduction is performed under sedation or general anesthesia. After the bones are realigned, X-rays are taken to confirm the joint is properly seated and to check for fractures. The medical team will also assess the arm for neurovascular compromise, ensuring blood flow and nerve function to the hand and fingers are intact. The elbow is then immobilized, usually with a splint placed at a 90-degree angle for a short period.
Recovery and Rehabilitation Timeline
Recovery from a simple elbow dislocation begins with a short period of immobilization, lasting between one to three weeks. Extended periods of immobilization are avoided because they can lead to joint stiffness. The goal is to start gentle, active range-of-motion exercises as soon as the joint is stable enough to tolerate movement.
A physical therapy program is essential for regaining full function and range of motion. The initial rehabilitation phase focuses on gentle movements to prevent the formation of scar tissue and stiffness. Later phases introduce light resistance training to rebuild the strength of the muscles surrounding the joint. A full return to sports or heavy labor takes three to six months.