IU Health Bedford Hospital

Disjointed: Signs and Symptoms of Elbow Trauma

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July 05, 2018

“Prevention is the best measure to avoid elbow trauma and dislocation. Take safety measures seriously when performing work from any height — buckle safety harnesses, take small, steady steps, and stabilize ladder bases. In short, always assess the dangers that could result in injuries,” said Tarek Sibai, MD, IU Health Southern Indiana Physicians.

Q: What types of elbow dislocations exist?

Elbow dislocations are generally divided into two categories: simple and complex. A simple dislocation does not have any major bone injury (muscles, ligaments). A complex dislocation can have bone and ligament injuries. In the most severe dislocations, the blood vessels and nerves that travel across the elbow may be injured.

Q: What are the causes?

Elbow dislocations typically occur when a person falls onto an outstretched hand (such as from a scaffold, tree or ladder or from a moving vehicle). The cause of the dislocation, as pictured, involves a direct load going through the wrist and forearm. The energy is then transferred to the elbow region, leading to the dislocation or fracture dislocation.

Q: What are the signs?

Patients typically show obvious deformity, swelling, pain, inability to move the elbow and experience pain that radiates down the forearm or up the shoulder at times. Sometimes there will be subtle nerve deficits with sensation changes, such as tingling, numbness or the inability to move certain muscle groups at the fingers, thumb or wrist. Careful physical examination is required in such settings to make sure that the injury to these important nerves was present initially and not something that was caused at the time of surgery.

Q: How do youth and adult cases differ?

The classic teaching in medicine is that kids are not “small adults.” This also applies to elbow dislocations. The main difference is related to the fact that the pediatric population, unlike the adult population, has open growth plates (soft areas of cartilage around the ends of the bones that allow growth until skeletal maturity). These growth plates fuse and are visible on X-rays at different times in a person’s life between the ages of two and 17. Also, injuries to the elbow can be subtle in the pediatric population. In youth, most of the energy gets transferred onto the growth plate and kids’ elbow injuries typically always fail through the growth plates. Kids in general also do not get as stiff as adults with any form of elbow injury or surgery.

Adults, on the other hand, do not have these open growth plates. Hence, adults will become injured through the bone or the ligaments/muscles that attach to these bones (as described above in simple versus complex dislocations). Adults tend to lose a significant amount of motion with elbow dislocations or any form of surgery around the elbow area. Healing potential and time also tends to be a bit more prolonged in adults versus kids.

Q: How common are the injuries?

Elbow dislocations are not very common. However, in the appropriate setting where the high energy impact occurs, an elbow dislocation should always be carefully evaluated and ruled out.

Q: What is the treatment?

After an acute injury to the elbow, a long arm splint by the Emergency Medical Services (EMS) personnel should be applied to immobilize the elbow. Application of ice to the elbow will help with the post-injury bruising, internal bleeding and pain. The next step would be to get diagnostic images in the emergency room until the appropriate provider is available to evaluate and diagnose the extent of the injury.

Q: Precautions and advice?

Elbow injuries tend to be complex on multiple levels. The rehabilitation process tends to be taxing for both provider and patient. Patients also tend to lose some element of motion in bending or rotating the forearm even with minor elbow injuries.

According to the American Academy of Orthopaedic Surgeons, elbows are the second most dislocated joint, second only to the shoulder.

Featured IU Health Southern Indiana Physicians provider seeing patients for orthopedic and sports medicine injuries involving the hand, wrist, elbow and shoulder:
Tarek Sibai, MD
812.333.BONE (2663)

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