From the Guidelines
After successful reduction of a dislocated elbow, the initial management should include immobilization in a posterior splint or hinged elbow brace at 90 degrees of flexion for 5-7 days to allow soft tissue healing, as recommended by the most recent guidelines 1.
Initial Management
The goal of initial management is to protect the healing ligaments while preventing joint stiffness.
- Immobilization in a posterior splint or hinged elbow brace at 90 degrees of flexion for 5-7 days is recommended to allow soft tissue healing.
- Pain management should be initiated, including acetaminophen 650-1000mg every 6 hours and an NSAID such as ibuprofen 400-600mg every 6-8 hours for 5-7 days, unless contraindicated 2.
- For more severe pain, a short course of opioids like hydrocodone/acetaminophen 5/325mg every 6 hours for 3-5 days may be considered.
Rehabilitation
Physical therapy should begin after the initial immobilization period, focusing on progressive range of motion exercises, followed by strengthening exercises at 3-4 weeks post-reduction.
- Patients should avoid valgus stress, hyperextension, and weight-bearing activities for 3-4 weeks.
- Follow-up imaging at 7-10 days is recommended to ensure maintained reduction and evaluate for associated fractures, as suggested by the American College of Radiology Appropriateness Criteria 3.
Return to Activity
Most patients can return to normal activities within 6-12 weeks, though athletes may require longer rehabilitation.
- The use of MRI in the assessment of ligamentous and tendinous injury can be helpful in guiding rehabilitation and return to activity, as discussed in recent studies 4.
- A thorough understanding of diagnostic imaging modalities is essential to expeditiously identify the damaged structures and assist in treatment and surgical planning, thus allowing for rapid return to play and activity 1.
From the Research
Workup and Treatment Recommendations for Dislocated Elbow after Reduction
- The initial treatment for a dislocated elbow typically involves closed reduction, which is often followed by short-term immobilization 5.
- After reduction, it is essential to assess the elbow for any signs of neurovascular involvement, as well as associated osseous or ligamentous injuries in the wrist 6.
- Treatment with an early range-of-motion program generally leads to favorable results, and care must be taken to rule out late elbow instability and stiffness 6.
- For simple elbow dislocations, closed reduction with short-term immobilization is a universally accepted method, resulting in excellent functional scores, although it may be associated with significant limitations in joint movements 5.
- Potential late complications of elbow dislocation include posttraumatic stiffness, posterolateral joint instability, ectopic ossification, and occult distal radioulnar joint disruption 6.
Chronic Elbow Dislocation
- Chronic elbow dislocation is defined as a dislocation that has remained unreduced for more than 2 weeks, and treatment is often challenging due to the development of extensive intra-articular fibrotic tissue and contracture of the triceps, collateral ligaments, and elbow capsule 7.
- Treatment typically involves open reduction, often with the use of hinged external fixators, and the role of triceps lengthening or primary collateral ligament reconstruction remains a topic of debate 7.
- An internal fixator is a relatively new option to maintain a stable, concentric reduction and facilitate early range of motion in the treatment of chronic elbow dislocations 8.
Rehabilitation and Outcomes
- Advances in treatment and rehabilitation protocols have been made to help treat elbow dislocations and obtain optimal patient outcomes, with a focus on obtaining elbow stability without leading to long-term elbow stiffness 9.
- The majority of patients with simple elbow dislocations report complaints about their elbows, including sensation of stiffness, pain during strenuous work or sports activities, and limitation of movement, despite excellent functional scores 5.