Elbow Dislocation: Causes, Diagnosis, Treatment & Recovery
Elbow dislocation is one of the most common major joint dislocations in children and young adults, often resulting from a simple fall on an outstretched hand. While many cases are “simple” and heal well with prompt care, others hide serious injuries—like TRASH lesions or fractures of the capitulum—that can lead to permanent stiffness or instability if missed. At BoneFractures.org, we provide a comprehensive, evidence-based review to help patients, parents, and clinicians navigate diagnosis, reduction, and recovery.
What Is an Elbow Dislocation?
An elbow dislocation occurs when the bones of the forearm (radius and ulna) are forced out of alignment with the humerus (upper arm bone). Over 90% are posterior dislocations, where the ulna moves backward relative to the humerus. It’s most common in adolescents and young adults (ages 10–20) and accounts for up to 25% of all elbow injuries.
Simple vs. Complex Elbow Dislocation
Classification is critical for treatment:
- Simple dislocation: No associated fractures. Ligaments are torn, but bones are intact.
- Complex dislocation: Accompanied by one or more fractures—most commonly:
- Medial epicondyle fracture (most frequent in children)
- Coronoid process fracture
- Capitulum or radial head fracture
Warning: Up to 50% of elbow dislocations involve bony injury. Never assume it’s “just a dislocation” without thorough imaging.
How Does It Happen?
The classic mechanism is a fall onto an outstretched hand with the elbow extended. This forces the elbow into hyperextension and valgus stress, tearing ligaments and displacing the joint. In children, what appears to be a medial epicondyle fracture may actually be a self-reduced elbow dislocation with the fragment trapped inside the joint.
Clinical Signs & Symptoms
Patients typically present with:
- Severe pain and obvious deformity
- Inability to move the elbow (often held in near-full extension)
- Swelling and bruising around the joint
- Neurological symptoms (numbness/tingling in the ring/little fingers—ulnar nerve involvement)
Note: Some dislocations reduce spontaneously before hospital arrival. Even in these cases, associated fractures or ligament tears may persist.
Diagnosis: X-rays and the Danger of “TRASH Lesions”
All suspected dislocations require AP and lateral X-rays before and after reduction.
Be alert for:
- Loss of ulnohumeral congruence on lateral view
- “Specks” or tiny bone fragments near the joint—these may be TRASH lesions (“The Radiographic Appearance Seems Harmless”)
- Entrapped medial epicondyle: A fragment lodged in the joint space after reduction
If any doubt exists, obtain CT or MRI to rule out occult fractures or ligamentous injury.
Emergency Management: Reduction in the ED
Elbow dislocations require urgent closed reduction in the Emergency Department:
- Analgesia/Sedation: Use Entonox, procedural sedation, or general anesthesia if needed.
- Reduction Technique:
- Apply gentle traction to the forearm while counter-traction is applied to the humerus.
- Flex the elbow to 90°—this engages the triceps and helps maintain reduction.
- Post-Reduction Care:
- Repeat X-ray to confirm concentric reduction.
- Reassess neurovascular status (especially ulnar nerve).
- Immobilize in a backslab at 90° flexion.
When to Refer to Orthopedics Immediately
Seek urgent orthopedic consultation for:
- Irreducible or partially reducible dislocations
- Any associated fracture (medial epicondyle, coronoid, radial head, capitulum)
- Neurovascular compromise
- Suspected “Terrible Triad”
Surgical Treatment for Complex Dislocations
When fractures accompany dislocation—such as a capitulum fracture—surgical fixation is often required to restore joint stability and prevent post-traumatic arthritis. Common techniques include:
- Open reduction and internal fixation (ORIF) using headless compression screws (e.g., Herbert screws)
- Ligament repair (LCL/MCL reconstruction)
- Coronoid or radial head fixation
Recovery & Rehabilitation
Simple dislocations:
- Immobilize for 5–14 days (never >2 weeks—risk of permanent stiffness)
- Start supervised range-of-motion exercises at 2 weeks
- Orthopedic follow-up within 1–2 weeks
Complex dislocations:
- May require surgery (ORIF + ligament repair)
- Rehabilitation starts later and is more cautious
- Full recovery can take 3–6 months
Potential Complications
- Stiffness: Most common—especially if immobilized too long.
- Ulnar neuropathy: Temporary or permanent nerve injury.
- Recurrent instability: Due to missed ligament or bony injury.
- Myositis ossificans: Bone formation in muscle after severe swelling.
- Post-traumatic arthritis: Long-term consequence of joint damage.
Frequently Asked Questions (FAQs)
What is a TRASH lesion?
TRASH = “The Radiographic Appearance Seems Harmless.” It refers to tiny bone fragments or subtle signs on X-ray that actually indicate serious ligament or cartilage injury. Never ignore them—get a CT or MRI if suspected.
Can an elbow dislocation heal on its own?
Some dislocations reduce spontaneously, but associated injuries (like entrapped medial epicondyle) often remain. Medical evaluation and imaging are essential—even if the elbow “looks normal.”
How long does it take to recover from a simple elbow dislocation?
Most patients regain full function within 6–12 weeks with proper rehab. Immobilization should not exceed 2 weeks to avoid stiffness.
Why is early motion so important?
The elbow joint is prone to scar tissue formation. Delaying motion beyond 2 weeks dramatically increases the risk of permanent loss of extension.
When is surgery needed?
Surgery is indicated for complex dislocations with fractures (e.g., capitulum, coronoid), irreducible joints, or neurovascular injury.