Dislocated Elbow: Symptoms, Types, Causes and Treatment

A dislocated elbow is a serious injury that can cause immediate pain and long-term complications if not treated properly. As one of the most commonly dislocated joints in both adults and children, understanding the symptoms, types, causes, and best treatment practices for elbow dislocation is essential for patients, caregivers, and healthcare providers alike. In this comprehensive guide, we bring together the latest evidence and clinical insights to help you recognize, classify, and manage this injury effectively.

Symptoms of Dislocated Elbow

A dislocated elbow often presents with dramatic and distressing symptoms. Rapid recognition and early intervention are key to preventing long-term problems. In this section, we’ll highlight the main symptoms to watch for and what they might signal about the injury’s severity.

Symptom	Description	Associated Features	Source(s)
Pain	Sudden, severe pain at the elbow	Worsens with movement	5 9
Deformity	Visible distortion of elbow shape	"Out of place" appearance	5
Swelling	Rapid swelling around the joint	May develop within minutes	5 9
Loss of Motion	Inability to move the elbow	Fixed in abnormal position	5 9
Instability	Feeling of looseness or slipping	Especially during movement	6 8 9
Numbness/Tingling	Sensation changes in hand/fingers	Nerve involvement possible	9
Bruising	Discoloration over elbow/forearm	May appear after swelling	9

Table 1: Key Symptoms

Common Presenting Features

Dislocated elbows usually result in immediate, intense pain. Patients often hold the injured arm cradled against the body, unable to straighten or bend it. Swelling and bruising develop rapidly, and the elbow may appear visibly deformed or "out of joint" 5 9. In some cases, you may notice the lower arm looks twisted or angulated compared to the upper arm.

Neurological and Vascular Symptoms

Beyond pain and deformity, numbness or tingling in the hand or fingers can occur, suggesting nerve involvement. Severe dislocations may also compromise blood flow, leading to pale or cool fingers—this is a medical emergency 9.

Instability and Recurrent Symptoms

After a first dislocation, some patients may complain of persistent elbow instability, a sensation that the joint is "loose" or prone to slipping out again. This is often due to ligamentous damage 8 6.

Late Symptoms and Complications

If not treated promptly or properly, a dislocated elbow can result in:

• Chronic pain, especially on movement or stress (notably with valgus stress)
• Reduced range of motion, often with a permanent flexion contracture
• Ongoing instability or recurrent dislocations
• Residual numbness or muscle weakness if nerves were affected 9 8

Types of Dislocated Elbow

Elbow dislocations are not all the same. The specific type and pattern of injury can greatly influence treatment decisions and prognosis. Let’s clarify the main types and how they differ.

Type	Description	Characteristics	Source(s)
Simple	Dislocation only (no fractures)	Ligament injury, no bone break	2 5 9
Complex	Dislocation + fracture(s)	Involves bone & soft tissue	2 5
Posterior	Ulna moves backward	Most common type	3 1 7
Posterolateral	Ulna moves backward & outward	Rotatory instability pattern	1 3 7
Posteromedial	Ulna moves backward & inward	Less common, different mechanism	3
Recurrent	Repeated dislocations	Due to ligament laxity	8

Table 2: Types of Elbow Dislocation

Simple vs. Complex Dislocations

• Simple dislocations involve only the dislocation of the ulnohumeral joint, with no associated bone fractures. They comprise the majority of elbow dislocations and generally have a better prognosis 2 5 9.
• Complex dislocations are accompanied by fractures of surrounding bones (e.g., radial head, coronoid process). These require more intensive management due to the risk of instability and long-term dysfunction 2 5.

Directional Classification

The direction in which the bones move relative to each other during dislocation is crucial:

• Posterior dislocation (ulna moves backward) is the most frequent, often caused by a fall on an outstretched hand 3 1 7.
• Posterolateral dislocation involves a combination of backward and outward movement, typically resulting from a twisting injury with valgus and external rotation forces 1 3.
• Posteromedial dislocation (backward and inward) is less common and tends to start with injury to the lateral side of the elbow 3.

Recurrent Dislocations

Some patients develop recurrent elbow dislocation, usually due to laxity of the collateral ligaments and secondary joint changes. This pattern is similar to recurrent shoulder dislocation and may require surgical repair 8.

Causes of Dislocated Elbow

Understanding how and why elbow dislocations occur is vital for prevention and targeted treatment. The mechanism of injury, along with underlying joint and ligament integrity, plays a central role.

Cause	Description	Risk Factors/Context	Source(s)
Trauma	Fall on outstretched hand	Sports, accidents, high energy	1 3 4 5 7
Valgus Force	Outward force at elbow	Shoulder abduction, arm extended	1 4 7
External Rotation	Twisting force of forearm	Pathologic rotation injury	1 3 7
Ligament Laxity	Weak/loose elbow ligaments	Genetics, previous injury	8
Muscle Disruption	Tears at muscular origins	Severe trauma/avulsion	6

Table 3: Causes of Elbow Dislocation

Traumatic Causes

The overwhelming majority of elbow dislocations are traumatic, resulting from:

• Falls onto an outstretched hand: This is the classic cause, especially with the elbow extended and the forearm pronated. The body’s weight applies a valgus (outward) and rotational force, leading to ligament rupture and joint displacement 1 4 5 7.
• Sports injuries and accidents: Contact sports, gymnastics, and motor vehicle accidents commonly produce the necessary force for dislocation 5.

Biomechanical Mechanisms

Recent research has clarified the mechanics:

• Valgus and external rotatory torque: A combination of outward force (valgus) and twisting (external rotation) is required to rupture the elbow’s stabilizing ligaments and allow the joint to dislocate 1 7.
• Progressive ligament disruption: Injury often begins on the lateral (outer) side and progresses medially as the dislocation develops, particularly in posterolateral types 1 3.

Predisposing Factors

• Ligament laxity: Some individuals have naturally looser ligaments, increasing their risk for recurrent dislocation 8.
• Muscle and soft tissue injury: Severe trauma can cause avulsion (tearing away) of not only ligaments but also the muscles that stabilize the elbow 6.

Patterns of Injury

• Posterior and posterolateral dislocations result from valgus and external rotation forces, while posteromedial types may stem from varus (inward) stress 3 7.
• Associated fractures can occur if the force is extreme or the coronoid process (a bony prominence) is incompletely disengaged during the injury 3.

Treatment of Dislocated Elbow

Treatment of a dislocated elbow is individualized and depends on the type and severity of the injury. The primary goals are to restore joint alignment, maintain stability, and regain full function while minimizing complications.

Treatment	Description	Indications/Notes	Source(s)
Closed Reduction	Manual repositioning of joint	First-line, most cases	2 5 9
Early Mobilization	Quick initiation of elbow movement	Prevents stiffness, better ROM	9 10
Immobilization	Temporary splinting or casting	Short duration if stable	9 10
Surgery	Ligament/bone repair or fixation	Gross instability, fractures	2 11 12 13
Hinged Brace	Allows motion, maintains stability	Post-reduction/repair	1 11 13
Physical Therapy	Guided rehab exercises	Essential for recovery	9 10

Table 4: Treatment Approaches

Immediate Management: Reduction

• Closed reduction is the immediate treatment for most elbow dislocations. This involves gently manipulating the elbow back into its normal alignment, usually under sedation or anesthesia 2 5 9.
• After reduction, neurovascular status must be checked to ensure blood flow and nerve function are intact.

Immobilization and Early Motion

• Once the elbow is reduced and stable, a brief period of immobilization (typically less than two weeks) in a splint or sling allows for initial healing 9.
• Early mobilization is crucial. Delayed or prolonged immobilization increases the risk of stiffness and contracture, leading to worse long-term outcomes 9 10.
  • Overhead motion protocols and hinged braces can enable safe, controlled movement while protecting the healing joint 10 1.

Surgical Intervention

• Surgery is reserved for:
  • Complex dislocations with fractures
  • Grossly unstable elbows after reduction
  • Failure of conservative treatment 2 11 12 13
• Surgical options include:
  • Repair or reconstruction of torn ligaments
  • Fixation of associated fractures
  • Use of hinged external fixators in cases of instability or chronic unreduced dislocations 11 13

Rehabilitation

• Physical therapy is critical for restoring movement and strength. Early, guided range-of-motion exercises yield the best functional results 9 10.
• Return to sports or heavy activity is typically gradual and based on achieving stability and near-normal range of motion.

Complications and Special Considerations

• Chronic instability or recurrent dislocation may require soft-tissue repair 8.
• Prolonged immobilization is strongly associated with poorer outcomes, including pain and loss of motion 9.
• In cases of moderate to gross joint laxity after reduction, early surgical repair provides better function and reduces the risk of complications compared to conservative treatment alone 12.

Conclusion

Dislocated elbows are common injuries with serious implications if not treated promptly and correctly. Key points to remember include:

• Recognition of symptoms—pain, deformity, swelling, and loss of motion—should prompt urgent evaluation.
• Classification by type (simple, complex, directional) guides treatment decisions and prognosis.
• Most cases result from trauma—especially falls on an outstretched hand, with valgus and rotational forces disrupting ligament stability.
• Immediate reduction and early mobilization are critical to prevent stiffness and maximize recovery.
• Surgical intervention is needed for unstable, complex, or recurrent cases, with advanced techniques (e.g., hinged external fixation) enabling good outcomes even in chronic injuries.
• Early physical therapy is essential for restoring full function and preventing long-term disability.

By understanding the spectrum of elbow dislocation, patients and clinicians can work together to ensure optimal recovery and avoid complications.