DISLOCATED ELBOW

Elbow dislocation occurs when the the elbow bones move out of their correct positions where they meet at the elbow joint.

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Dislocated Elbow

A dislocated elbow refers to a severe injury that occurs when the bones of the forearm become separated from the upper arm bone at the elbow joint. This injury usually occurs as the result of a traumatic incident, such as a fall or a direct impact on the elbow. Understanding the causes, symptoms, diagnosis, treatment options, and expected rehabilitation time is essential for managing this injury effectively.

The highest rate of elbow dislocations in children typically happens during early adolescence, specifically between the ages of 11 and 15.

Dislocated Elbow Description

The elbow joint refers to a complex hinge joint that connects the bones of the forearm to the upper arm bone. The elbow joint contains three bones: the humerus, the radius, and the ulna. A dislocated elbow occurs when one or both of the forearm bones become separated at the elbow joint.

Doctors consider a dislocated elbow as a serious injury that can cause significant pain and discomfort. This injury can also result in significant damage to the surrounding ligaments, tendons, and nerves.

Dislocated Elbow Cause

A dislocated elbow occurs because of a traumatic incident, such as a fall or a blow to the elbow. This injury can occur during sports activities, such as football, hockey, or gymnastics, or during everyday activities. For instance, a fall from a bike or a ladder. Individuals who participate in high-risk activities or have a history of elbow dislocation may incur an increased risk. Certain medical conditions, such as Ehlers-Danlos syndrome, can also increase the risk of a dislocated elbow.

How Do Posterior Elbow Dislocations in Children Typically Occur?

Posterior elbow dislocations in children often happen as a result of a fall. The most common scenario is when a child lands on an outstretched hand. In this position, the forearm is usually positioned with the palm facing upward—known as supination—and the elbow is either fully extended or only slightly bent. This combination of actions and positions creates a force that can lead to the dislocation of the elbow joint toward the rear, or posteriorly.

QUESTIONS AND ANSWERS

What is a dislocated elbow in children, and how does it occur?

A dislocated elbow in children refers to the displacement of the bones that make up the elbow joint, typically the radius and ulna (forearm bones) in relation to the humerus (upper arm bone). This often happens due to a sudden and forceful pull or twist on the arm, often during a fall or direct impact. In children, the ligaments supporting the elbow joint are relatively loose, making them more prone to dislocations.

What are the common symptoms of a dislocated elbow in children?

Children with a dislocated elbow may experience severe pain, swelling, and limited movement in the affected arm. The arm may appear deformed or bent in an abnormal way at the elbow. They may be unwilling or unable to move the arm due to the pain and discomfort. Numbness or tingling sensations may also be present if nerves around the elbow are affected..

How do doctors diagnose and treat a dislocated elbow in children?

Diagnosis involves a physical examination and often an X-ray to confirm the dislocation and assess any associated fractures or injuries. When diagnosing elbow dislocations in children, several radiographic considerations are crucial:

Delayed Ossification: The ossification of the medial epicondyle can be delayed until age 5. This delay can lead to the associated displacement of the apophysis of the medial epicondyle being overlooked.
Misidentification Risks: An entrapped medial epicondyle may be mistaken for the trochlear ossification center, complicating the diagnosis further.
Injury Confusion: Distal humerus epiphyseal separation injuries can often be confused with elbow dislocations. This is particularly common in children under 2 years of age, making careful examination and interpretation of radiographs essential.

These factors underscore the importance of a thorough and careful analysis of X-ray images to avoid misdiagnosis and ensure appropriate treatment, especially in young patients.

If your son or daughter is suffering with elbow problems, make an appointment with us

Dislocated Elbow Symptoms

The symptoms of a dislocated elbow can vary depending on the severity of the injury. Common symptoms include severe pain, swelling, and bruising around the elbow joint. The elbow may also appear deformed or out of place. Individuals with a dislocated elbow may have difficulty moving their arm or may experience a decreased range of motion. The injured arm may also feel numb or tingly, and the individual may experience weakness or a loss of grip strength.

When evaluating posterior dislocations of the elbow in children, it’s vital to conduct a comprehensive assessment to identify any accompanying fractures or neurovascular injuries. Here’s a structured approach to guide the assessment:

Key Assessment Steps

Physical Examination:

Begin with a thorough visual inspection of the affected area. Check for obvious deformities, swelling, and discoloration.
Assess the range of motion carefully, being cautious not to exacerbate any pain or existing injury.

Neurovascular Evaluation:

Test the integrity of the blood flow and nerve function in the injured limb. Look for signs of compromised circulation or nerve entrapment, such as numbness, tingling, or weakness.
Pay particular attention to the median nerve, as it can be susceptible to entrapment in these cases.

Imaging Studies:

Order appropriate imaging, such as X-rays, to confirm the dislocation and rule out any associated fractures.
In some instances, advanced imaging like MRI may be necessary for a more detailed view of soft tissue and neurovascular structures.

Literature and Case Studies:

It may also be beneficial to consult relevant medical literature and case studies to learn about similar cases. Knowledge sharing from other practitioners’ experiences can provide useful insights for rare or complicated situations.

By following these steps, healthcare professionals can ensure a thorough and effective assessment of posterior elbow dislocations in children, minimizing the risk of overlooking critical complications that could affect recovery.

Reducing an Elbow Dislocation in a Child: Technique Overview

Successfully reducing an elbow dislocation in a child requires precision and technique. Here’s a step-by-step guide:

Initial Positioning: The healthcare professional gently encircles the child’s arm with their fingers. This offers necessary countertraction, stabilizing the arm for the procedure.
Applying Pressure: Using the thumbs, the practitioner applies pressure to the olecranon—the bony prominence of the elbow—moving it downward and then forward. This manipulative action helps in realigning the elbow joint.
Post-Reduction Steps: Once the elbow is repositioned, it’s crucial to flex the elbow acutely. This should be done as much as the child’s swelling allows while ensuring there’s no interference with blood circulation.

Adhering to these steps carefully can result in a successful reduction while minimizing discomfort and preventing complications.

Possible Complications of Closed Reduction of Elbow Dislocations in Children

Closed reduction of elbow dislocations in children can lead to several potential complications. Understanding these risks is crucial for effective treatment and patient care. Here are some complications to be aware of:

Joint Interference:
- The coronoid process of the ulna may become entrapped in the olecranon fossa, hindering proper joint function.
Soft Tissue Damage:
- Displacement may cause the periosteum to strip away from the humerus, leading to potential muscle damage. Additionally, the brachialis muscle might become overstretched during the process.
Bone Fragment Incarceration:
- There is a risk that a portion of the medial epicondyle could become trapped within the joint space during reduction.
Fracture Risks:
- With specific dislocations, such as posteromedial types, there is an increased likelihood of fracturing the lateral condyle.
Vascular and Nerve Injuries:
- Injuries could occur to critical vessels like the brachial artery or nerves such as the ulnar and median, which are essential for arm functionality.
Nerve Entrapment:
- Particularly in children, the median nerve might become entrapped within the joint following a closed reduction, potentially complicating recovery.

These points highlight the importance of careful evaluation and skilled intervention during the reduction process to minimize the likelihood of these adverse outcomes.

Why is the Coronoid Process Significant in Elbow Dislocations in Children?

The coronoid process plays a crucial role in maintaining the stability of the elbow joint, especially in children. This small, bony projection on the ulna acts as a stabilizer, helping to resist backward movement of the ulna when the elbow experiences stress. In children, this structure is relatively smaller, which makes their elbows more susceptible to particular injuries.

Key Points:

Size and Vulnerability: The smaller size of the coronoid process in children means it offers less resistance to certain forces. This makes the elbow joint more prone to dislocation, especially during falls or impacts.
Impact Absorption: When a child falls and lands on an outstretched hand, the force can travel from the wrist up to the elbow. The coronoid process is one of the key structures that absorbs this force, helping to prevent severe injury. If it’s too small, the anterior capsule of the elbow can be torn, leading to dislocation.
Joint Integrity: Despite its small size, the coronoid process is essential in preserving the joint’s integrity. It works alongside other components of the elbow to maintain overall function and prevent posterior displacement of the ulna.

Understanding the significance of the coronoid process underscores the need for careful diagnosis and management of elbow injuries in children to ensure proper treatment and recovery.

Dislocated Elbow Diagnosis

Diagnosing a dislocated elbow typically involves a physical examination and imaging tests. During a physical exam, the doctor will assess the individual’s range of motion, strength, and reflexes. The doctor may also manipulate the elbow to determine if the bones are out of place. Doctors may order imaging tests, such as X-rays or MRIs, to provide a detailed look at the elbow joint. These scans will confirm the diagnosis of a dislocated elbow.

The most frequently occurring type of elbow dislocation in children is the posterior dislocation. This injury involves the displacement of the bones in the elbow joint, where the forearm bones move to a position behind the upper arm bone. Understanding this common type of dislocation is crucial, especially for parents and caregivers, as it often results from falls or trauma typically seen in childhood activities or sports. Early recognition and treatment are essential for proper healing and to prevent potential complications, making it vital to seek medical attention if such an injury is suspected.

When a child experiences an elbow dislocation, there is a concern that a piece of bone, like the medial epicondyle, might become trapped within the joint. This is particularly relevant in pediatric cases because children have growing bones that are more susceptible to injuries.

A CT scan can provide detailed images of the elbow post-reduction to verify whether the medial epicondyle or any other bone fragments are entrapped. This level of precision is crucial because undetected bone entrapment can lead to long-term complications, such as impaired joint function or abnormal bone growth.

Reasons for Ordering a CT Scan:

Detecting Bone Entrapment: Ensures no bone fragments like the medial epicondyle are lodged in the joint.
Assessing Joint Alignment: Confirms that the bones are correctly aligned following reduction.
Preventing Complications: Helps prevent future issues, such as restricted movement or uneven bone development.

By using a CT scan, healthcare professionals can effectively evaluate the success of the reduction and plan any necessary further interventions, ensuring the child’s elbow heals properly.

Treatment

The treatment of a dislocated elbow typically involves reducing the dislocation and stabilizing the joint. Doctors perform this procedure through either closed or open reduction. Closed reduction involves manipulating the bones back into place without surgery. The individual will be given medication to manage the pain. In addition, these patients will have their arms immobilized with a cast or brace for several weeks to allow the joint to heal.

Doctors will conduct open reduction if necessary in more severe cases. However, if the doctor cannot realign the bones through closed reduction. This procedure involves surgery to manipulate the bones back into place and stabilize the joint with screws or pins. After a closed reduction of an elbow dislocation in children, careful follow-up care is essential to ensure proper healing and function.

Following either closed or open reduction, the individual will need to undergo rehabilitation to regain strength and mobility in the affected arm. Rehabilitation may involve physical therapy, exercises, and stretching to improve the range of motion and strength.

Post-Reduction Care Steps:

Stability and Documentation: After reduction, ensure the stability of the joint and conduct a thorough neurovascular exam. Document these findings meticulously.
Radiographic Analysis: Obtain post-reduction radiographs to confirm the success of the procedure and to check for potential complications.
Advanced Imaging: If there’s any concern about an entrapped medial epicondyle, especially common in pediatric cases, order a CT scan to provide a clearer picture.
Timeline for Recovery: Approximately three weeks post-closed reduction, remove the plaster splint. Begin active exercises at this stage to restore normal range of motion.

Incorporating these detailed steps ensures a comprehensive approach to recovery, supporting the overall rehabilitation process.

Time to Rehabilitate

The rehabilitation time for a dislocated elbow can vary depending on the severity of the injury and the type of treatment received. In cases where closed reduction joins the bones together successfully, the rehabilitation time may shorten, typically requiring several weeks or months of rehabilitation to regain strength and mobility.

In more severe cases where open reduction must happen, the rehabilitation time may require several months of rehabilitation to regain strength and mobility. Doctors will recommend rehabilitation may to address any lingering pain or discomfort in the elbow joint.

Conclusion

A dislocated elbow is a severe injury that requires prompt medical attention to ensure proper healing and rehabilitation. Understanding the causes and symptoms and being able to properly diagnose the condition will lead doctors to treat the condition and begin the healing.

Conclusion of Dislocated Elbow

Medical City Children’s Orthopedics and Spine Specialists surgeons are rated and board-certified professionals in elbow treatment. In addition, they have studied and trained in the treatment of elbow conditions in children and adolescents.

Finally, the orthopedic doctors at Medical City Children’s Orthopedics and Spine Specialists with offices in Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX treat children with basic to complicated elbow disorders, including persistent ankle instability. Consequently, using the latest in surgery techniques, our surgeons treat dislocated elbows on a routine basis with outcomes that allow the kids to enjoy being kids again.

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Footnote:

American Academy of Orthopaedic Surgeons: Dislocated elbow

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