The elbow is a hinge joint made up of 3 bones – humerus, radius and ulna. The bones are held together by ligaments to provide stability to the joint. The important ligaments are the Medial collateral ligament (MCL) or Ulnar Collateral Ligament (UCL) on the inside and the Lateral collateral ligament (LCL) or Lateral Ulnar Collateral Ligament (LUCL) on the outside. Muscles and tendons move the bones around each other and help in performing various activities. Elbow dislocation occurs when the bones that make up the joint are forced out of alignment. The elbow usually dislocates to the back. It can dislocate backward and outward or backward and inward.
Elbow dislocations usually occur when a person falls onto an outstretched hand. Elbow dislocations can also occur from any traumatic injury such as motor vehicle accidents. When the elbow is dislocated, you may have severe pain, swelling, and lack of ability to bend your elbow. Sometimes you cannot feel your hand, or may have no pulse in your wrist because the arteries and nerves running along your elbow may be injured.
To diagnose elbow dislocation Dr Bala will examine your arm, check the pulses at the wrist and will evaluate the circulation to the arm. An X-ray or CT scan is necessary to determine if there is a break in the bone.
An elbow dislocation is a serious injury and therefore requires immediate medical attention. At home, you may apply an ice pack to the elbow to ease pain and swelling. However, it is important to see Dr Bala for help.
Dr Bala will put your dislocated elbow back in place by pulling down your wrist and levering your elbow. This procedure is known as reduction. As it is a painful procedure you may be given medications or anaesthetic to relieve your pain before the procedure.
This procedure is usually done with x-ray guidance. After reduction Dr Bala will examine your elbow while you are still under sedation/anaesthesia. This will help him decide if any of the ligaments may be injured as well and if they are partially or fully torn. If the ligaments are only partly injured, he may recommend a hinged elbow brace for 4 weeks to help stabilize the elbow while the ligament is given a chance to heal. If he feels that the tear of the ligament is complete, he may request for an MRI immediately and plan for repair or reconstruction of the ligament.
Rarely the elbow may be so unstable that it does not stay in position even after reduction and a slab. In such instances, Dr Bala may opt to stabilize the elbow temporarily with a frame on the outside (elbow external fixator) or inside (IJO) with pins above and below the elbow.
A check x-ray or check CT is usually necessary to confirm if the elbow joint has been reduced and is articulating congruently in the socket with no loose body. After reduction x-rays may also pick up small subtle fractures which may have been missed in the initial x-rays.
There may be a small fracture of the lower end of the arm bone which can be a coronoid fracture. Br Bala may suggest a 3D CT scan to further evaluate it. If it is not large or displaced, it may be treated conservatively in an arm sling for 4 to 6 weeks but if it is large or displaced and the elbow is unstable due to this fracture Dr Bala may recommend surgery to fix it.
Most of the elbow dislocations are also associated with a tear of one of the ligaments of the elbow usually on the inner (MCL) or outer side (LUCL). These can often be missed and can lead to weakness and disability if not treated in time. Dr Bala examines the elbow again a week after reduction and may recommend an ultrasound or an MRI if he finds instability.
Most of the time following a dislocation the lower end of the arm bone usually damages cartilage while popping out. This injury can cause problems later if undiagnosed or untreated. If you are a professional athlete or a sports person needing your elbow during season Dr Bala might request for an MRI to ensure this is not missed.
After the reduction, you may have to wear a hinged elbow brace to immobilise your arm at the elbow. After a few days, you may also need to do gentle motion exercises to improve the range of motion and strength.
Dr Bala recommends early mobilization to prevent the dreaded complication of heterotopic ossification around the elbow called Myositis ossificans. In the unlikely event that despite all precautions you do develop this, Dr Bala will order for a CT scan and is well versed in early excision to prevent stiffness.