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Three bones come together to make up the elbow joint.

• The humerus  is the bone in the upper arm.
• Two bones in the forearm, the radius and the ulna, form the lower part of the elbow.

Each of these bones has a very distinct shape. 

Ligaments connected to the bones keep the elbow joint together and the bones in proper alignment.

(Left) The bones of the elbow and forearm shown with the palm facing forward. (Right) The ligaments of the elbow.

 

Reproduced with permission from J Bernstein, ed: Musculoskeletal Medicine. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2003.

The elbow is both a hinge joint and a ball and socket joint. As muscles contract and relax, two unique motions occur at the elbow.

• Bending occurs through a hinge joint that allows the elbow to bend and straighten. This is called flexion and extension, respectively.
• Rotation occurs though a ball and socket joint that allows the hand to be rotated palm up and palm down. This is called supination and pronation, respectively.

Injuries and dislocations to the elbow can affect either of these motions.

The ligaments of the elbow on the inner side (left) and outer side of the joint (right).

A complete elbow dislocation is extremely painful and very obvious. The arm will look deformed and may have an odd twist at the elbow.

Partial elbow dislocation (subluxation).

Signs of a partial dislocation (subluxation) may include:

• Pain when moving the elbow
• Bruising on the inside or outside of the elbow where ligaments may have been stretched or torn
• A sense of the elbow shifting in and out of place spontaneously (suddenly and on its own)

Physical Examination

During the physical examination, your doctor will:

• Examine your arm, checking for tenderness, swelling, and deformity.
• Evaluate the skin and circulation to the arm, including checking the pulses at the wrist. If the artery is injured at the time of dislocation, the hand will be cool to touch and may have a white or purple hue. This is caused by the lack of warm blood reaching the hand.
• Check the nerve supply to the hand. If nerves have been injured during the dislocation, some or all of the hand may be numb and not able to move.

Imaging Tests

An X-ray is necessary to determine if there is a bone injury. X-rays can also help show the direction of the dislocation.

• X-rays are the best way to confirm that the elbow is dislocated.
• If bone detail is difficult to identify on an X-ray, the doctor may order a computed tomography (CT) scan.
• If it is important to evaluate the ligaments, a magnetic resonance imaging (MRI) scan can be helpful; however, an MRI is rarely required at the time of the dislocation.

After the X-ray confirms the dislocation, the doctor will set (reduce) the elbow. If a CT scan and/or MRI scan is needed, they are usually done after the dislocated elbow has been put back in place.

An elbow dislocation should be considered an emergency injury.

• The goal of immediate treatment of a dislocated elbow is to return the elbow to its normal alignment.
• The long-term goal is to restore function to the arm.

Nonsurgical Treatment

The normal alignment of the elbow can usually be restored in an emergency room (ER) at the hospital. Before this is done, the patient will usually be given sedatives and pain medications.

The act of restoring alignment to the elbow is called a reduction maneuver. It is done gently and slowly. 

Normal alignment after the elbow has been reduced.

After the elbow has been restored to the correct position (reduced), a splint is applied to keep the elbow still. This protects the elbow to avoid further injury. The splint should not be removed until you follow up with a physician.

• Simple elbow dislocations are treated by keeping the elbow immobile in a splint or sling for 1 to 3 weeks, followed by range of motion exercises.
• If the elbow is kept immobile for a long time, the ability to move the elbow fully may be affected. Occupational or physical therapy can be helpful during this period of recovery to guide you in regaining your range of motion without risking a repeat dislocation.
• Once the elbow's range of motion improves, the doctor or physical therapist may add a strengthening program.
• X-rays may be taken periodically while the elbow recovers to ensure that the bones of the elbow joint remain well aligned.

Some people will never be able to fully open (extend) the arm, even after physical therapy. Fortunately, the elbow can work very well even without full range of motion.

Surgical Treatment

If the elbow joint does not remain well-aligned, surgery may be required. Often, a complex elbow dislocation needs surgery to restore bone alignment. If the bone injuries are severe, it can be very difficult to realign a complex elbow dislocation.

A complex dislocation of the elbow. In addition to dislocation, there are multiple fractures of the elbow.

After surgery, the elbow will need to be protected. It may be protected in a splint, or with a hinge on the outside of the arm. These devices protect the elbow from dislocating again.

If blood vessel or nerve injuries are associated with the elbow dislocation, additional surgery may be needed to repair the blood vessels and nerves as well as repair bone and ligament injuries. Physical therapy is often necessary to minimize stiffness. The goal of recovery is to protect the healing elbow while also trying to limit scar tissue and stiffness.  However, some loss of range of motion is to be expected.

If an elbow remains stiff after it has healed, further surgery may be necessary to remove scar tissue, extra bone growth, and obstacles to movement. This surgery, which may occur months after the injury,  can successfully improve motion to stiff elbows, though usually not to a normal range.

Over time, there is an increased risk for arthritis in the elbow joint if:

• The alignment of the bones is not good
• The elbow does not move and rotate normally, or
• The elbow continues to dislocate

Treatment for simple dislocations is usually straightforward, and the results are usually good. Som

Treatment of people with complex dislocations can be challenging, and patients may have some type of permanent disability at the elbow. Treatment advances are helping to improve results for these people.

One of the areas being researched is the best time to schedule surgery for the treatment of a complex dislocation. For some patients with complex dislocations, it seems that a slight delay for final surgery may improve results by allowing swelling to decrease. The dislocation still needs to be reduced right away, but then a brace, splint, or external fixation frame may be used to rest the elbow for about 1 or 2 weeks before a specialist surgeon attempts major reconstructive surgery.

Moving the elbow early appears to be good for recovery for both kinds of dislocations. This movement helps to minimize scar tissue and can improve overall elbow motion. Although early movement with complex dislocations can be difficult, there are ways to help enable early movement, including:

• Improved methods of fixing bones and ligaments 
• Improved pain management techniques 
• Therapy and rehabilitation techniques, such as continuous motion machines, dynamic splinting (spring-loaded assist devices), and progressive static splinting, which can be used in challenging cases to improve results