Ortho Dx: Elbow Pain and Deformity Following a Martial Arts Injury

A 34-year-old woman presents to the emergency department (ED) with left elbow pain and deformity after sustaining an injury during a martial arts competition. Anteroposterior and lateral radiographs of the left elbow (Figures 1 and 2) show a posterior elbow dislocation. The dislocation is reduced and the elbow is splinted in the ED. 

Which of the following represents the typical treatment for elbow dislocations?

The elbow is second to the shoulder as the most common site of major joint dislocation. This injury pattern typically results from a fall on an outstretched hand when the elbow is hyperextended, and the forearm dislocates in a posterior...

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The elbow is second to the shoulder as the most common site of major joint dislocation. This injury pattern typically results from a fall on an outstretched hand when the elbow is hyperextended, and the forearm dislocates in a posterior lateral direction relative to the humerus. Acute management of elbow dislocation includes closed reduction and splinting in 90° of elbow flexion to maintain the reduction. The technique for closed reduction involves traction of the forearm, forearm supination, and elbow flexion. Simple dislocations without fracture usually have some degree of osteochondral injury, although surgical treatment is rarely necessary. Neurovascular injury is rare, but a detailed examination should be performed postreduction to rule out this complication. Recurrent instability after simple dislocation of the elbow is rare with an incidence of <1%.

Treatment for elbow dislocation includes a brief period of immobilization, usually 5 to 10 days, to relieve pain and swelling. Immobilization for >3 weeks is associated with chronic elbow stiffness and should be avoided. Early elbow motion can start 1 week after injury with the goal of slowly regaining full flexion and extension. Surgery is indicated when unstable fractures around the joint are identified or the elbow fails to stay reduced.^1,2

Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).

References

1. Cohen M, Hastings H. Acute elbow dislocation: evaluation and management. J Am Acad Orthop Surg. 1998;6(1):15-23.
2. Frank R, Coen M. Elbow dislocation. Ortho Bullets website. https://www.orthobullets.com/trauma/1018/elbow-dislocation?expandLeftMenu=true. Updated July 12, 2017. Accessed January 4, 2019.