From the Guidelines
Treatment for an elbow dislocation should begin with closed reduction, followed by immobilization for 5-10 days, and a progressive rehabilitation program lasting 6-12 weeks, as this approach has been shown to result in better outcomes in terms of joint stability and functional recovery 1. The initial management of an elbow dislocation involves closed reduction, which is typically performed by a healthcare provider. After reduction, the elbow is immobilized in a splint or sling for 5-10 days to allow for initial healing. During this period, the RICE protocol (rest, ice, compression, elevation) is recommended, along with pain management using NSAIDs like ibuprofen (400-600mg every 6-8 hours) or naproxen (500mg twice daily).
Rehabilitation Program
A progressive rehabilitation program should be initiated after the immobilization period, typically lasting 6-12 weeks. The program can be divided into three phases:
- Early rehabilitation (weeks 1-3): focuses on gentle range of motion exercises to prevent stiffness and promote healing.
- Strengthening exercises (weeks 3-6): includes light resistance training to improve muscle strength and joint stability.
- Advanced rehabilitation (weeks 6-12): incorporates sport-specific or functional activities to enhance functional recovery and return to normal activities.
Recovery Timeline
Most patients can return to:
- Light activities within 2-3 weeks
- Normal daily activities by 6 weeks
- Sports or heavy labor by 3-4 months However, complete recovery may take up to 6 months. Follow-up appointments are crucial at 1-2 weeks, 4-6 weeks, and 3 months post-injury to monitor healing and adjust treatment, as evidenced by the study on joint stability in patients with simple elbow dislocation 1.
Key Considerations
The study by Schnetzke et al 1 highlights the importance of evaluating joint stability after closed reduction, as patients with mild instability achieved significantly better scores on the Mayo Elbow Performance Scores (MEPS) compared to those with moderate or gross instability. This emphasizes the need for a tailored rehabilitation program to address individual patient needs and promote optimal recovery.
From the Research
Recommended Treatment for Elbow Dislocation
- The treatment of simple elbow dislocation is debated, with options ranging from immobilization in a cast to surgical intervention 2.
- Early functional treatment is the evidence-based therapeutic standard for simple elbow dislocation, enabling patients to return to work earlier and reducing pain initially 2, 3.
- Surgical approaches have shown similar results compared to conservative treatment, leading to improved range of motion (ROM) and Mayo Elbow Performance Score (MEPS) 3.
- Primary surgical repair is recommended as first-line treatment for patients with unstable simple and complex elbow dislocation, independent of age 4.
Recovery Timeline for Elbow Dislocation
- Extended periods of immobilization (> 3 weeks) are associated with poor outcomes, and early active range of motion should be initiated as early as possible 5.
- Brief immobilization can reduce pain initially, but the long-term results of early mobilization and immobilization in a cast are the same 2.
- Early mobilization after conservative treatment strategies has shown improved ROM compared to immobilization for up to 3 weeks after surgery, with less extension deficit in the early mobilization group 3.
- The average time to return to work is reduced with early functional treatment, with a difference of mean values of -2.91 (95% confidence interval -3.18 to -2.64) 2.
Complications and Considerations
- Complications of elbow dislocation can include nerve injury, vascular injury, and compartment syndrome 6.
- The extent of soft-tissue injury is correlated with the clinical outcome, with an inverse relationship between the extent of injury and outcome 2.
- Contracture is the most common adverse sequela of elbow dislocation, with an average of 3° to 8° of extension loss with standard management of simple elbow dislocations 5.