Dislocated elbow

Overview

A dislocated elbow occurs when the bones that make up the joint are forced out of alignment — typically when you land on an outstretched hand during a fall. The elbow is the second most commonly dislocated joint after the shoulder in adults, and the most commonly dislocated joint in children.

Toddlers may experience a dislocated elbow, sometimes known as nursemaid's elbow, if they are lifted or swung by their forearms.

If you or your child has a dislocated elbow, seek immediate medical attention. Complications can occur if the dislocated elbow pinches or traps the blood vessels and the nerves that serve the lower arm and hand.

A dislocated elbow can usually be realigned without surgery. However, if your elbow is also fractured, you might need surgery.

Symptoms

Signs and symptoms of a dislocated elbow include:

• Extreme pain
• Obvious distortion of the joint

Toddlers with nursemaid's elbow might experience pain only when the affected elbow is moved. A child often avoids using the arm and holds it slightly flexed next to the body.

Sometimes, the elbow is only partially dislocated. Partial dislocation can cause bruising and pain where the ligaments were stretched or torn.

When to see a doctor

Seek immediate medical attention if you or your child has extreme pain or obvious distortion of the elbow joint.

Causes

In adults, the most common causes of a dislocated elbow include:

• Falls. Falling onto an outstretched hand can pop the upper arm bone out of alignment within the elbow joint.
• Motor vehicle accidents. The same type of impact can occur when passengers in motor vehicle accidents reach forward to brace themselves before a collision.

In children or teenagers, falling onto an outstretched hand is also a common cause of a dislocated elbow.

In toddlers, the injury often occurs when an extra pulling motion is applied to an outstretched arm. The causes of such injuries include:

• Improper lifting. Trying to lift or swing a young child by the arms can cause the elbow to dislocate.
• Sudden pulling. Having the child suddenly step off a curb or stairstep as you're holding his or her hand can pull the elbow out of alignment.

Risk factors

• Age. Young children's elbows are much more flexible than those of adults. So it's easier for younger elbows to become dislocated.
• Heredity. Some people are born with elbow ligaments that are looser than those of most people.
• Sports participation. Many elbow dislocations are sports-related. Sports that require weight bearing with the arms, such as gymnastics floor exercise, are especially risky for elbow dislocations.

Complications

Complications of a dislocated elbow can include:

• Fracture. The force that dislocates the elbow might also cause a fracture in one of the elbow bones.
• Pinched nerves. Rarely, nerves that travel across the elbow can become pinched or trapped between the dislocated bones or within the joint when the bones are realigned. Pinched nerves can cause numbness in the arm and hand.
• Trapped arteries. Rarely, blood vessels that supply the arm and hand can become pinched or trapped between the dislocated bones or within the realigned joint. Lack of blood supply can cause severe pain and permanent tissue damage in the arm and hand.
• Avulsion fractures. In some elbow dislocations, a stretched ligament will pull off a tiny bit of bone from its attachment point. This type of damage is more common in children.
• Osteoarthritis. The dislocated joint may be at higher risk of developing osteoarthritis in the future.

Prevention

Avoid lifting or swinging small children by their arms.

Diagnosis

Your doctor will carefully examine the injured joint and check if the arm or hand is cold or numb — which would indicate a pinched artery or nerve. You probably will need an X-ray to check for fracture in the bones that make up the elbow joint.

Treatment

Some dislocated elbows go back into place by themselves. Most, however, need a doctor to manipulate the bones back into their proper alignment. This procedure is called a reduction.

Medications

Before the reduction you or your child may be given medications to relieve pain and relax muscles.

Therapy

After the joint's bones are back in their normal alignment, you or your child might need to wear a splint or sling for a few weeks. You might also need to do physical therapy exercises to improve the joint's range of motion and strength.

Surgery

You might need surgery if:

• Any of the dislocated bones have also been broken
• Torn ligaments need to be reattached
• Damaged nerves or blood vessels need repair

Preparing for an appointment

You'll probably seek medical attention in a hospital's emergency department or at an urgent care center. You may be referred to an orthopedic surgeon.

What to expect from your doctor

Your doctor is likely to ask how the injury occurred and if the joint has ever been dislocated before.