Generally, elbow dislocation has a "traumatic origin: the typical circumstances in which it occurs, in fact, are falls on an outstretched hand and car accidents in which the injured person leans forward with his hands before the impact" .
Elbow dislocation presents with pain and, if it is particularly severe, also with a deformity of the affected joint and other complications.
For the diagnosis of elbow dislocation, physical examination, medical history and X-rays are essential.
The treatment of elbow dislocation aims, first of all, at restoring normal joint anatomy, and, subsequently, at restoring joint function.
The therapeutic approach varies from conservative to surgical depending on the severity of the injury.
What is a Dislocation? A brief review
In traumatology, the term "dislocation" indicates the permanent loss of mutual relations between the joint heads (or articular surfaces) of a "joint. Traumatic in nature, this unpleasant event is often associated with more or less extensive damage to the joint capsule and a lesion of the ligaments that stabilize the joint surfaces.
Dislocation is different from sprain: in sprain, in fact, there is a temporary modification of the "anatomy of a" joint (in dislocation, the alteration is permanent).
and / or nerves.
Elbow Anatomy: A Brief Review
To fully understand what elbow dislocation consists of, it is of enormous help to know the main aspects of the anatomy of the elbow; here, then, is a brief review:
- The elbow is the joint of the upper limb that connects the arm to the forearm; the elbow, in fact, articulates the distal end of the humerus (arm bone) to the proximal ends of the ulna and radius (forearm bones).
- The distal end of the humerus participates in the elbow joint with the trochlea e capitulum, while the proximal extremity of ulna and radius respectively with trochlear notch and radial head.
By analyzing how these components interact, it emerges that the humeral trochlea is related to the trochlear notch of the ulna, while the capitulum humeral is articulated with the radial capital. - Like any synovial joint, the elbow is equipped with a joint capsule, synovial membrane, ligaments and synovial bags.
- Example of a hinged synovial joint (or ginglimo), the elbow allows flexion and extension movements of the forearm with respect to the arm.
Types of Elbow Dislocation
Partial or Complete Elbow Dislocation
Elbow dislocation can be partial (or elbow subluxation) or complete: partial means that the joint surfaces have only partially lost the contact that joined them; complete, however, that the articular surfaces have separated completely.
Clearly, elbow dislocation is more severe when complete; however, it must be specified that in both circumstances a strain or injury of the articular ligaments can occur.
Simple or Complex Elbow Dislocation
Another classification distinguishes elbow dislocation into simple or complex: it is simple, when the injury is not associated with significant damage to the bone structures; it is complex, however, when combined with bone and / or ligament injuries.
It should be noted that, when particularly severe, complex elbow dislocations can also be characterized by damage to blood vessels or nerves; when this occurs, there is a non-negligible risk of loss of the upper limb.
Elbow Dislocation: Risk Factors
Undoubtedly, engaging in work or physical activities that involve a risk of falling on an outstretched hand increases the likelihood of dislocating an elbow.
Even the young age favors the dislocation of the elbow: in children, the elements that guarantee stability to this joint (ligaments) are more mobile and flexible; as a result, joint surfaces are more likely to separate when certain traumas occur.
Finally, the predisposition to dislocation of the elbow and other synovial joints due to a congenital laxity of the ligaments deserves to be mentioned.
Elbow Dislocation: Epidemiology
In adults, the elbow is the second most dislocated joint in the human body, after the shoulder (whose more correct name is the glenohumeral joint); in children, on the other hand, in this special ranking, it is in first place (the reason for this has been explained a few lines above).
local and swelling.
Elbow Dislocation and Ligament Injury
Ligaments injured during an elbow dislocation may never heal spontaneously; as discussed below, in such situations, a repair surgery is necessary.
Complications of Elbow Dislocation
Various complications are associated with elbow dislocation; in more detail, these include:
- The fracture of the bone components that participate in the joint.
- The crushing / entrapment of the nerves that pass through the elbow. Elbow dislocation alters the anatomy of the joint and this affects neighboring structures, such as nerves.
The crushing / entrapment of the nerves passing near the elbow manifests itself with symptoms such as numbness and / or tingling in the forearm and / or hand. - The injury or squeezing of the blood vessels passing through the elbow. Similar to nerves, blood vessels running through the elbow can also be damaged or pinched as a result of a dislocation.
A lesion of these blood vessels can have serious consequences: it could deprive, in fact, the tissues and bones of the upper limb involved of that amount of blood necessary to keep them alive; therefore, a process of necrosis follows which can lead to , in the most extreme cases, to spontaneous amputation of the upper limb.
Characteristic symptoms of a blood vessel injury due to an elbow dislocation are: cold, cyanotic / purple hand and forearm. - The avulsion fracture. These are bone fractures that occur as a result of traction exerted by a ligament or tendon on the bone surface of insertion.
In elbow dislocation, the avulsion fracture is typically attributable to the action of an articular ligament, which, on the occasion of the event triggering the injury, exerted a sudden traction on the insertion bone area. - Arthrosis of the elbow. It consists in the degeneration of the cartilage that covers the articular surfaces of the elbow, in particular those of the trochlea and the trochlear incisura.
Elbow Dislocation: When to See a Doctor?
A person should contact a doctor or go to the emergency room if, after a fall or any other traumatic event, they experience persistent pain in the elbow; even more so, a medical consultation is advisable if, in addition to pain, the subject also has a deformity in the joint.
or for a nuclear magnetic resonance.
Anamnesis
The anamnesis requires the patient to describe the symptoms felt and to inform the patient about: the injury dynamics and the general state of health.
Physical examination
During the physical examination for an elbow dislocation, doctors assess the extent of pain the patient is experiencing and whether there are local bruising and / or swelling.
Also, look for any signs of vascular damage (cyanosis, cold hand and forearm, etc.) and / or nerve damage (tingling, numbness, etc.).
X-ray
X-rays are the best imaging test for finding an elbow dislocation.
Thanks to them, the doctor is able to confirm the clinical suspicions and to know with extreme precision the anatomical alterations and the damages produced by the joint injury.
Typically, before this manual maneuver, the patient receives pain medication and sedative medications to avoid pain.
After the reduction in conservative mode of an elbow dislocation, a period of immobilization of the joint in 90 ° flexion follows, which lasts from 1 to 3 weeks. It is important not to excessively immobilize, so as not to excessively impair mobility. articulate.
It is very likely that, at the end of the immobilization, the patient will have to undergo an X-ray examination of the elbow, which will ascertain the success of the reduction.
Rehabilitation Physiotherapy
Rehabilitation physiotherapy begins immediately after the period of immobilization of the elbow (provided that X-rays have confirmed the success of the reduction).
The goal of the physiotherapy program is to restore joint mobility in the elbow.
Indispensable to the achievement of this aim are both specific exercises stretching, both muscle strengthening.
Rehabilitation from an elbow dislocation is a long-lasting process, which requires a lot of perseverance and continuity on the part of the patient in what are the therapeutic exercises.
It should be noted that, sometimes, even when the physiotherapy program is appropriate, the patient is unable to recover full joint mobility in extension; Fortunately, this is not such a significant problem: the elbow, in fact, is functional to the needs of the human being even if it does not fully extend.
Elbow Dislocation: Surgical Therapy
Surgery is reserved for the most severe cases of elbow dislocation, characterized by ligament injuries, bone fractures and / or damage to the vascular or nerve structures adjacent to the joint.
Typically, surgery for severe elbow dislocation involves repairing the various compromised joint structures, followed by the reduction maneuver.
At the end of the surgical operation, a period of immobilization of the elbow in flexion at 90 ° follows first and, subsequently, a rehabilitation physiotherapy program aimed at recovering joint mobility.
Clearly, recovery times from a severe elbow dislocation undergoing surgery are longer than those expected for mild dislocation, which involved only conservative therapy.
It should be noted that more severe elbow dislocations may require, after some time, a second surgery, in order to optimize the results of the first.
