- From Hippocrates to the Eskimo - a history of techniques used to reduce anterior dislocation of the shoulder. More than 90% of elbow dislocations are posterior dislocations. The elbow is a synovial hinge joint and posterior dislocation of the ulna relative to the distal humerus is the most common type of dislocation, with the coronoid process of the ulna moving posteriorly away from the humeral trochlear. Elbow dislocations typically occur when a person falls onto an outstretched hand. Specific attention should be paid to looking for open wounds which would suggest a complex dislocation. Ligamentous elbow dislocation . Elbow dislocation; Radial head fracture; Coronoid fracture; Clinical Features. Elbow held in 45 degree of flexion; Olecranon is prominent posteriorly; Anterior dislocation. Anterior dislocations occur much less frequently as a result of direct trauma to the flexed elbow. The vast majority of dislocations are posterior. This injury is frequently confused with anterior Monteggia lesions by virtue of the readily apparent radiocapitellar dislocation. Elbow dislocations can be either simple or complex. Examination reveals a loss of the triangular orientation between the medial and lateral epicondyles of the humerus and the olecranon process of the ulna . Ulnar nerve palsy has been reported in 14% of adult elbow dislocations, and the incidence is much higher in paediatric elbow dislocations with an associated medial epicondyle fracture. Posterior Dislocation of the Elbow with Fractures of the Radial Head and Coronoid. On a basic level, the elbow is comprised of the articulation between the distal humerus with the proximal radius and ulna. Swelling initially is usually less with a dislocation than with a type III supracondylar humeral fracture. It is important to look for associated ligamentous and musculotendinous injuries in this pattern. With both injuries, the elbow is held semiflexed and swelling may be considerable. Elbow dislocations frequently occur due to trauma such as falls from heights or motor vehicle collisions. The rate of elbow dislocation is 6-13 cases per 100,000 people, and this injury occurs more frequently in males than in females. This case demonstrates typical appearances of a simple posterior elbow dislocation. Coronoid fractures are often the result of posterior elbow dislocation, which needs to be kept in mind during rehabilitation of these injuries. Management of Simple Elbow Dislocation Bradford O. Parsons David M. Lutton DEFINITION Simple elbow dislocation is a dislocation of the ulnohumeral joint without concomitant fracture. Anterior elbow dislocations tend to be a clinical diagnosis and are confirmed by radiographic images. Simple Elbow Dislocation • No associated fractures • Complete or near complete capuloligamentous injury • Extensive muscle injury • Nearly always stable after reduction • No advantage to surgery if stable • No more than 2 weeks immobilization . Elbow Dislocation Rehabilitation Protocol Elbow Dislocation The Elbow Joint is the most complex joint in the body. Posterior splint immobilization for three weeks is frequently preferred. 3 Stability of the elbow to valgus stress, with the forearm pronated after reduction of the posterior dislocation indicated that early motion could be permitted because the anterior portion of the medial collateral ligament was intact. Anterior elbow dislocation without periarticular fracture (simple dislocation) is an extremely rare injury and is usually caused by distraction or torsional forces. People with dislocated shoulders typically present holding their arm internally rotated and adducted, and exhibiting flattening of the anterior shoulder with a prominent coracoid process. Posterior elbow dislocation: Initial position with shoulder and elbow flexed to 90°C. Elbow dislocations are described by the direction of the proximal ulna relative to the humerus. 14 The brachialis muscle, in its position between the anterior capsule and the more superficial neurovascular structures, is at risk during dislocation of the elbow but is particularly liable to be torn if hyperextension forces are applied in order to achieve reduction of the joint . A chronic dislocation is defined as a case in which the diagnosis was missed for several days to weeks after initial dislocation 2. Posterior elbow dislocations are painful; IV analgesia may be given prior to x-rays, and PSA—alone or combined with intra-articular anesthesia—is usually given for the procedure. When the hand hits the ground, the force is sent to the elbow. Of all elbow dislocations, 10-50% are sports related. Closed reduction has commonly been performed, except in cases involving soft-tissue interposition or buttonholing of the radial head through the capsule that have prevented it[8,9]. Most anterior dislocations have been manually reduced by the patient or by the surgeon in the emergency department. E-Stim and ice PRN for edema and pain Exercises: With the splint on, full active flexion and extension to the extension block. Complex instability denotes the presence of a fracture associated with dislocation. It is important that this be carefully carried out under the supervision of a therapist. Elbow dislocations are generally more common in women and in the non-dominant arm. The functionality of the elbow joint should be assessed by observing a range of movements. The joint was successfully reduced in the emergency department. Posterior (about 90% of all elbow dislocations) Anterior; Lateral; Partially displaced; In young children (ages less than about 4-5 years), the elbow dislocation is termed a radial head subluxation or nursemaid's elbow. Elbow dislocations may occur in several directions: (1) posterior (the proximal forearm dislocates behind the distal humerus), (2) anterior, and (3) much more rarely, medial or divergent (the distal humerus gets interposed between proximal radius and ulna). 1 However, some authors have reported good clinical outcomes of early active motion. A number of injuries can present as elbow pain, such as a distal humerus fracture, fracture of the radial head, fracture of the olecranon, or purely ligamentous injuries. An elbow dislocation occurs when the bones of the forearm (the radius and ulna) move out of place compared with the bone of the upper arm (the humerus). Anterior elbow dislocations occur most often as a fracture-dislocation in which the distal humerus is driven through the olecranon, thereby causing a complex, comminuted fracture of the proximal ulna. They may be caused by strength imbalance of the rotator cuff muscles. This can drive and rotate the elbow out of its socket. Clinical features include pain and swelling of the joint and an inability to flex/extend the elbow . 1 Elbow instability is typically described as being either ‘perched’ or ‘complete’. Anterior elbow dislocation without periarticular fracture (simple dislocation) is an extremely rare injury and is usually caused by distraction or torsional forces. Anterior elbow dislocations are held in extension, and the upper extremity appears elongated. An elbow dislocation is not difficult to diagnose; the elbow deformity is readily evident and is associated with a marked pain, swelling, and tenderness of the elbow. Complex proximal ulna fractures (e. g. Monteggia-like injuries) are frequently associated with persisting disability. Simple elbow dislocations are usually treated non-surgically. Usually, there is a turning motion in this force. The functionality of the elbow joint should be assessed by observing a range of motion. Posterior elbow dislocations often present with an upper extremity that is flexed and appears shortened. Closed reduction was attempted in this case, but it … The elbow is the second most commonly dislocated large joint. Anterior elbow dislocations are held in extension, and the upper extremity appears elongated. The operator places both hands around the distal humerus such that the fingers rest on the anterior aspects of the medial and lateral supracondylar ridges of the distal humerus and the thumbs rest on the posterior aspect of the olecranon process. Higher energy elbow dislocations are often associated with fractures of various parts of the elbow. However, when a patient presents after a trauma with elbow pain, there are other diagnoses that need to be considered. There are many nerves that exist around the elbow, and whose function can be compromised by an elbow dislocation. … Disruption of the posterior capsule may also occur and contribute to the risk of recurrent dislocation. Elbow Dislocation Overview. casos; MSK - Clinical Conditions - Elbow; Anterior shoulder dislocation; Upper limb fractures (iOS pack) Rotorua Teaching - Elbow Radiographs ; Related Radiopaedia articles. An elbow dislocation occurs when the bones of the elbow (ulna, radius, and humerus) come out of their normal positions. Anterior dislocations of the elbow among children were often associated with fractures around the elbow, and some cases included neurovascular injury[6,7]. Medial oblique compression fracture of the coronoid process of the ulna. Open wounds would suggest a complex dislocation. Regional anesthesia may be used (eg, axillary nerve block) but has the disadvantage of limiting post-reduction neurologic examination. FA pronation/supination These higher energy injuries are defined as “complex” elbow dislocations. An anterior elbow dislocation is relatively uncommon compared to posterior dislocation and is mostly associated with a transolecranon fracture dislocation. Although anterior transolecranon fracture dislocations are well recognized in adults 13, they have been reported in only a small series of children 8. Associated fractures often occur with elbow dislocations. Posterior elbow dislocations often present with an upper extremity that is flexed and appears shortened. However, anterior elbow dislocations are a rare injury in both adults and children. In order for it to recover to its best function consistent rehabilitation is essential in order to obtain the optimal outcome after injury. The radial nerve runs in the posterior compartment of the arm in the radial groove of the humerus and wraps laterally to its position near the elbow, where it is anterior to the lateral epicondyle. Neurapraxia has been reported to occur in approximately 20% of elbow dislocations and usually involves the anterior interosseous branch of the median nerve and/or the ulnar nerve. 90% of elbow dislocations are posterior dislocations, most of which are simple posterior dislocations that follow a predictable sequence of soft tissue disruptions that eventually lead to a frank dislocation as described by O’Driscoll [1]. “Posterior Elbow Dislocation” Protocol Sequence Phase I: Days 3-5 Sling immobilization progressing to extension blocking (custom splint or articulated brace) locked at 30 degrees of extension. The elbow joint is the second most commonly dislocated joint in adults, after the shoulder. Posterior elbow dislocations must be differentiated from extension-type supracondylar fractures of the distal humerus. With a ‘perched’ injury the elbow is subluxed, but the coronoid process is impinged on the trochlea. Elbow dislocations can also happen in car accidents when the passengers reach forward to brace for impact. The mechanism of injury includes a combination of axial loading, supination and, valgus (forearm moving away from midline) forces. Complex elbow dislocations have an associated fracture, while simple elbow dislocations do not. Transverse Coronoid Fracture: When Does It Have to Be Fixed? Posterior dislocations are uncommon, and are typically due to the muscle contraction from electric shock or seizure. It is important to look for associated ligamentous and musculotendinous injuries in this pattern. A complete dislocation generally occurs in a posterior and lateral direction. 5 public playlist includes this case. 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