Elbow dislocation

Anatomy of the elbow – why the joint is stable yet vulnerable

The elbow consists of three joint parts: upper arm bone (humerus) with ulna and radius. These form the hinge joint (humeroulnar joint), the ball hinge (humeroradial joint) and the proximal radius-ulnar joint (radioulnar joint).

A strong ligament system stabilizes: on the inside the ulnar collateral ligament (MCL), on the outside the lateral collateral ligament complex (LCL) including the annular ligament (annular ligament) around the head of the radius. The capsule, muscles and the bony form act as additional security.

Important nerves (ulnar, median, radial) and vessels (brachial artery with branches) pass close to the joint. In the event of a dislocation, these structures can be irritated or rarely injured - therefore neurovascular control in the acute phase is essential.

• Stability triad: bone shape – capsule/ligaments – muscles
• Internal stability: MCL; External stability: LCL complex (including ring ligament)
• Structures at risk: ulnar nerve (elbow side), brachial artery

What is an elbow dislocation?

An elbow dislocation is a complete dislocation of the joint: the articular surfaces of the humerus, ulna and radius are no longer aligned correctly. In contrast, a subluxation refers to an incomplete dislocation with partial contact between the joint partners.

A distinction is made between simple dislocations (without accompanying bone fractures) and complex dislocations (with fractures). Simple dislocations can often be treated conservatively after professional reduction. Complex injuries are more likely to require surgery.

Typical symptoms and warning signs

• Sudden, severe pain and limited mobility
• Visible misalignment or “dislocation”, deformation of the elbow
• Swelling, bruising, warmth
• Numbness, tingling or weakness in hand/fingers (indication of nerve contact)
• Cold, pale hand or weak pulse (circulatory disorder - emergency!)
• Blocked joint: active and passive movement hardly possible

Attention: Immediate medical attention is necessary if there are significant problems with circulation, sensation or strength. Please do not try to adjust it yourself.

Causes and mechanisms

The most common cause is falling onto an outstretched hand with valgus/rotational forces, for example when cycling, running, winter sports or ball sports. More rarely, direct impacts or traffic accidents lead to dislocation.

• Fall onto the hand (hyperextension + rotation moment)
• Powerful pulling/twisting movement on the forearm
• Contact and fall sports (handball, football, skateboard, skiing)
• Concomitant factors: ligament laxity, previous instability

Classification and levels of severity

• Direction: usually posterior/posterolateral (forearm slips backwards), less often anterior, medial or divergent
• Simple vs. complex: without vs. with fractures (e.g. coronoid, radial head, epicondyles)
• Ligament injury pattern: lateral collateral ligament (LCL) more common, possibly combined with MCL tear
• Instability spectrum: from transient dislocation to chronic posterolateral rotational instability (PLRI)

Diagnostics: This is how we find the cause

After anamnesis and examination, we check blood circulation and nerve function in the hand and fingers. Imaging is important even in the acute phase.

• X-ray in two planes: confirms dislocation, assesses accompanying bony injuries
• After reduction: Control X-ray to check position and stability
• CT: if complex fractures are suspected (e.g. coronoid, radial head)
• MRI: with unclear ligament/cartilage involvement and chronic instability
• Ultrasound: soft tissue, joint effusion, dynamic assessment of individual ligaments

It is important to differentiate from other causes of a blocked elbow, for example a blockage caused by free joint bodies or a blocked radio head.

First aid and emergency procedures

• Immobilize the arm, leave the elbow in position, put on the splint/sling
• Cool gently (no ice directly on the skin)
• No independent adjustment attempts
• Painkillers after consultation (if available, e.g. paracetamol)
• Seek medical advice as quickly as possible, especially if you have circulatory or sensory problems

Conservative treatment: reduction, protection, early movement

Conservative treatment is standard for simple elbow dislocations. First, the joint is professionally reduced under adequate analgesia/sedation and stability is checked. This is followed by a short period of immobilization and then early functional rehabilitation.

• Reduction under controlled conditions (analgesia/sedation)
• Neurovascular control before and after reduction
• Short-term immobilization (usually 5-10 days) in an upper arm splint bandage or functional orthosis
• Early functional mobilization in a low-pain area to avoid stiffness
• Pain relief, swelling reduction (elevation, cooling, anti-inflammatory medication if necessary)
• Physiotherapy: mobilization that is gentle on the joints, coordination, gradual strength building
• Orthosis with movement stop for residual instability and in everyday life/sports return

Early, controlled movement is crucial: immobilization for too long increases the risk of persistent movement restriction. The load is increased gradually - based on pain, swelling and stability.

Surgical therapy: When surgery makes sense

Surgery is considered if the dislocation cannot be stably reduced, if there are relevant accompanying fractures or if vascular/nerve damage needs to be treated. The goal is to restore stability and joint geometry.

• Refixation/suture of the LCL/MCL in cases of persistent instability
• Osteosynthesis of fractures (e.g. coronoid, radial head) using screws/plates
• External joint fixation (hinge fixator) in cases of severe instability or soft tissue damage
• Accompanying neurovascular decompression/care as needed

Regenerative procedures (e.g. PRP) do not play a routine role in acute elbow dislocation. They can be discussed additionally in selected cases with persistent ligament problems. The evidence is limited; individual explanation is required.

Rehabilitation, return to everyday life and sport

The rehabilitation plan is individually adapted to stability, pain and everyday requirements. The goal is to regain mobility early while respecting ligament healing.

Many patients achieve good function. A small stretch deficit is not unusual. The prognosis depends on the severity of the injury, stability after reduction, accompanying injuries and consistent therapy.

Possible complications and long-term consequences

• Restriction of movement (especially stretch deficit) if immobilized for too long
• Persistent instability (e.g. PLRI) in ligamentous insufficiency
• Heterotopic ossifications (calcifying soft tissue)
• Nerve irritation or injury (often temporary, rarely persistent)
• Osteoarthritis development in complex injuries/cartilage damage
• Rare vascular complications

Prevention and recurrence prevention

• Sport-specific technique training and fall prevention
• Strengthening the forearm and shoulder girdle muscles
• Protective orthoses in high-risk sports in the early return phase
• Consistent rehabilitation after the initial event to avoid residual instability

Special features in children and recurrent instability

True elbow dislocations are less common in children than in adults; Subluxation of the radiohead (so-called “nursemaid’s elbow”) is more common. Dislocations in children must be carefully examined for accompanying bony injuries and growth plate involvement.

Recurrent instability after initial dislocation may occur as posterolateral rotational instability (PLRI). Here, precise functional diagnostics and – depending on the extent – ​​targeted stabilizing physiotherapy or surgical ligament stabilization make sense.

When should you seek medical attention?

• After a fall with severe pain and misalignment of the elbow
• For numbness, tingling, loss of strength in the hand/fingers
• If the hand becomes pale/cold or the pulse is faintly palpable (emergency)
• Persistent restriction of movement or feeling of instability after first aid
• Repeated “bending events” of the elbow

Your path to diagnosis and treatment in Hamburg

In our orthopedic practice at Dorotheenstrasse 48, 22301 Hamburg, structured evaluation and follow-up treatment after elbow dislocation takes place - with a focus on conservative therapy and early functional rehabilitation. If necessary, we coordinate further imaging and interdisciplinary care.

We advise you transparently on the treatment options, discuss the benefits and risks and create an individual therapy and rehabilitation plan. A second opinion is possible at any time upon request.

Related topics

Not every blockage or dislocation of the elbow is the same. Different causes require different treatment strategies. You can also find out about the following clinical pictures: