Treatment of elbow dislocation

Seeking medical help is an important and necessary step that cannot be ignored. After all, a dislocation requires mandatory reduction, and, in addition, this injury may be accompanied by other disorders - for example, a fracture or pinched ulnar nerve.

Further treatment is prescribed in stages:

• the displaced joint is repositioned;
• medications are used to relieve pain, eliminate swelling and stop the development of the inflammatory process;
• measures are taken to restore the damaged joint and restore its functionality;
• Prevention of contractures and other complications is carried out.

Conservative therapy most often involves the use of non-hormonal anti-inflammatory drugs, as well as drugs with chondroprotective properties, designed to maintain and restore cartilage. [ 1 ]

Corticosteroids may be prescribed to slow down the inflammatory process, but sometimes it is possible to do without them. Both analgesics and non-steroidal anti-inflammatory drugs are suitable for pain relief.

What to do if you dislocate your elbow?

Even if you are absolutely sure that the injury you have received is a dislocated elbow, you should not attempt to reposition it yourself. Inept actions can seriously harm your health, affect blood vessels and nerve fibers. It is better to seek help from doctors who are familiar with the techniques for correcting such injuries and have sufficient practice for this. In addition, you must first make sure that the elbow dislocation is not combined with a fracture.

The following actions can be taken by the victim of a dislocated elbow:

• relieve pain (for example, take an Analgin or Ortofen tablet);
• immobilize the joint using a non-rigid immobilizing bandage on the limb (sling);
• apply cold to the injured area;
• go to the emergency room;
• Before visiting a traumatologist, it is not advisable to consume any food or drink, since general anesthesia may be required to correct a serious injury.

How to fix a dislocated elbow?

Self-reduction of elbow dislocation is prohibited!

Reduction of a fresh displacement is performed by a traumatologist during the provision of first medical aid. The type of reduction is determined by the doctor during the initial diagnosis.

A fresh traumatic displacement without a fracture is reduced under general anesthesia. This is necessary not only for pain relief, but also for complete muscle relaxation. The procedure is performed by medical specialists - a doctor and his assistant. The elbow joint is slowly straightened. The doctor supports the lower segment of the humerus and shifts the upper part of the olecranon to the required side. After this, a fixing bandage is applied: the elbow remains fixed for about a week and a half.

A dislocation that is not fresh, which has been occurring for less than two weeks, may be amenable to reduction, but in this case the doctor's actions must be especially careful. If you rush and perform an incorrect reduction, you can break the neck of the humerus.

If the displacement is old, then its correction is not carried out: surgical treatment is required, since it is no longer possible to correct such a dislocation without negative consequences.

A posterior dislocation is reduced using anesthesia. The elbow joint is bent at an acute angle, a posterior plaster cast is applied, which the patient must wear for a week. Then a course of exercise therapy is prescribed in combination with physiotherapy (thermal exposure).

If an anterior dislocation is reduced, the forearm is extended, bringing it to an obtuse angle, after which a posterior plaster cast is applied with the forearm supinated for approximately one and a half weeks.

In the process of restoring the elbow joint after its reduction, it is important to consider that any intense impact on the damaged area can aggravate the contracture and cause the development of painful changes in the tissues. Such undesirable impacts can be:

• intensive massage;
• attempts to forcibly eliminate stiffness;
• high-temperature and other abrupt procedures.

Plaster for elbow dislocation

After the elbow dislocation has been reduced, the patient undergoes an additional X-ray examination. This is necessary to confirm the correct fixation of the joint. After this, bone immobilization is performed.

The plaster cast is applied to the damaged area for a period of 25 to 30 days. For elderly or weakened patients, the plaster cast may be removed earlier, at the doctor's discretion. This is due to the fact that with prolonged immobilization, such people have an increased likelihood of developing atrophic muscle processes.

The use of plaster is not always indicated: sometimes the use of bandages and slings such as "kerchiefs" or Dezo is recommended.

For young patients, fixation is performed more rigidly, including the practice of applying a plaster splint. The approximate term of immobilization is 4 weeks. Painful sensations with rigid fixation usually disappear within a few hours after reduction. [ 2 ]

Medicines that a doctor may prescribe

During the rehabilitation period, patients with elbow dislocation do not need to stay in hospital. The doctor prescribes an individually selected set of exercise therapy exercises for the victim, and prescribes analgesics and anti-inflammatory drugs.

Analgin (metamizole sodium)	An analgesic and anti-inflammatory drug, a pyrazolone derivative. Effectively eliminates pain, but the use of the drug is limited to 2-3 days. Dosage: 250-500 mg 1-2 times a day, after meals, with water. Analgin is not used to treat children under 12 years of age.
Diclofenac	A representative of non-steroidal anti-inflammatory drugs. The drug is taken after meals, 25-50 mg three times a day. In some cases, an increase in dosage is allowed. Diclofenac is not prescribed if the patient suffers from a peptic ulcer of the stomach, allergic reactions. It is contraindicated during pregnancy and lactation. Possible side effects: nausea, abdominal pain.
DeepHelp	External gel, the composition of which is represented by Ibuprofen and badyaga, as well as essential oils. The gel is applied to the affected area, lightly rubbing, up to three times a day. The course of treatment is 7-10 days. When using the gel for the first time, it is necessary to make sure that there is no allergic reaction to the drug.
Traumeel S	A safe and effective drug that is available in the form of an ointment, tablets and injections. In case of elbow dislocation, an ointment drug is most often prescribed, which has an anti-inflammatory, analgesic, anti-edematous and reparative effect. The ointment is applied in a thin layer to the elbow area up to three to five times a day (it can be under a bandage). The duration of treatment is up to one month. Take 1 tablet three times a day under the tongue, between meals. Duration of treatment is up to one month. Traumeel S is administered as intramuscular injections once every three days, one ampoule at a time, for 14-28 days. Side effects in the form of allergies are extremely rare.
Thrombocid	An external preparation that enhances capillary blood circulation, has an anti-inflammatory and analgesic effect, and reduces tissue swelling. The gel is applied to the elbow area and adjacent areas, rubbed in a little, three times a day. Possible side effects: hypersensitivity, dry skin in the area of application.
Reparil gel	An external agent based on escin and diethylamine effectively relieves pain caused by elbow dislocation. The gel can be rubbed into the skin several times a day. Allergic reactions to the drug are rare.

Surgical treatment

Sometimes, to correct a dislocated elbow, a doctor is forced to seek help from a surgeon. During surgery, the displaced bones are returned to their anatomical position, fixed using pins, tendon suturing or plastic surgery. At the same time, the joint capsule is strengthened, and the tissues that are between the joint surfaces are removed. [ 3 ]

Surgical treatment is especially recommended for patients with repeated elbow dislocations, when it is necessary to restore joint stability.

Many joint problems are solved with the help of arthroscopy – a minimally invasive surgical technique. Thanks to this procedure, it is possible to examine the condition of the joint from the inside, to identify violations that are not detected on X-ray images.

Another surgical procedure used for elbow dislocation is arthroplasty. The method involves correcting defects in the cartilage covering the elbow joint.

Open reposition, or osteosynthesis, is performed in cases of combined injuries when fixation of the injury with the help of pins and other devices is required.

Arthroscopy is performed under local anesthesia, and osteosynthesis is performed under general anesthesia. The recovery period after surgery varies and depends on the complexity of the injury and the scale of the surgical intervention.

For patients who have undergone open reduction, further rehabilitation is somewhat more complicated and is carried out in a clinical setting, under medical supervision. [ 4 ]

Rehabilitation and recovery after elbow dislocation

Rehabilitation after an injury such as an elbow dislocation is divided into two stages:

• stage of complete immobilization;
• stage of relative immobilization.

The duration of each stage is determined individually, depending on the treatment being carried out and the nature of the injury.

If we are talking about an uncomplicated elbow dislocation that was treated conservatively, then the first stage of complete immobilization can last up to four days, and the second stage – about two weeks. [ 5 ]

Let us consider each of the indicated periods in more detail.

• The first stage involves exercise therapy starting on the second day after the plaster cast is placed. General, ideomotor and breathing exercises are practiced, freely moving joints are used, and the shoulder and forearm muscles are periodically strained and relaxed. Due to the increased degenerative vulnerability of the shoulder muscles, appropriate exercises are recommended. The muscles are rhythmically strained, bending and unbending the fingers of the affected limb. Any exercises that cause pain, as well as lifting and carrying heavy objects, are contraindicated.
• The second stage lasts about two weeks. Its goal is to restore the previous joint mobility, stabilize muscle performance. The patient is additionally prescribed physiotherapy procedures, and changes are made to the diet. The emphasis is on the completeness and balance of the diet, the consumption of sufficient amounts of magnesium and calcium.

Massage is not recommended in most cases.

How to develop an elbow after a dislocation?

During the entire treatment and recovery phase after an elbow dislocation, it is necessary to avoid physical activity and movements that cause pain in the joint. You cannot hang or lean on your elbow: such exercises can worsen tissue swelling and cause joint deformation.

Approximately on the fourth or fifth day after the joint has been reduced and immobilized, the victim can begin performing special exercises designed to optimize the restoration of functionality of the injured arm. The duration of the development course depends on the complexity of the injury: in particularly severe cases, the doctor may recommend postponing exercise therapy for several weeks.

Exercises for developing the elbow after injury are carried out to prevent the development of contractures, as well as to maintain an adequate state of the muscular system of the limb.

At first, you should perform light movements without excessive physical activity. Over time, they can be complicated, after consulting with a doctor.

Gymnastics is performed at home, no special conditions are required for this. The duration of the exercise therapy course is usually several months, until the joint function is fully restored.

The most simple and accessible exercises for independent elbow development are considered to be the following:

• place a rolling pin on the table and roll it back and forth with your hand (you can use a toy car instead of a rolling pin);
• They hit a tennis ball many times (for example, three times a day for a quarter of an hour).

Approximately one month after the cast is removed, the patient is allowed to swim, using flexion, extension and rotational movements of the limb.

Sample exercises for elbow dislocation

Complex exercises are carried out at the second stage of relative immobilization. Most often, the complex is represented by the following exercises:

1. The patient sits on a chair, puts his hands on the table. Bends and unbends his fingers at least ten times.
2. In a sitting position, place a sliding surface under the forearms. Bend and straighten the arm at the elbow, sliding the limb away from you, forward, at least five times.
3. The patient sits on a chair, hands on the table. The forearm is directed vertically upward. The hand of the healthy limb supports the forearm of the injured hand. The forearm is flexed and extended up to ten times.
4. The patient places his hands on the table. Performs supination and pronation of the forearm, trying to touch the surface of the table with the palm and back of the hand. The number of repetitions is up to 10 times.
5. The patient presses each finger of the affected limb alternately on the surface of the table, holding one pressure for several seconds.
6. Performs rotations of the hands in the wrist joint, left and right, with the maximum possible, but comfortable amplitude.
7. The patient sits across the chair, places the shoulder of the injured limb on the back (the forearm is lowered down). Performs pendulum-type oscillations, simultaneously bending and straightening the elbow with a small amplitude. The number of repetitions is at least 10.
8. The patient straightens the forearms, then turns them inward. Repeats at least 10 times.
9. Hands – on the table surface. The patient clenches his fists, holds them for a few seconds, then relaxes the muscles. Number of repetitions – 4.
10. Spreads and brings together fingers without bending or straightening the wrist.
11. Place the affected elbow on the table, fully extend the forearm and hold the position for several seconds. Repeat up to ten times.

How long does it take to recover from an elbow dislocation?

Full restoration of arm functionality after elbow dislocation takes approximately 4-5 months. To speed up and fully restore the arm, therapeutic exercises are performed according to principles similar to rehabilitation after elbow joint fractures.

The recovery technique is determined depending on the condition of the muscles and the degree of dislocation. In case of muscle spasm, exercises are performed to relax it. It is forbidden to load the injured limb or lift weights: such actions cause an increase in muscle tone and the development of contracture.

During the day, it is advisable to elevate the injured arm to optimize blood and lymph flow and reduce swelling. Massage procedures are only permitted 6-8 weeks after the elbow dislocation.

For a more comfortable recovery, therapeutic exercises are initially performed 2-3 times a day for 10-15 minutes, gradually increasing the duration of the exercises to half an hour.

Physiotherapy treatment

Physiotherapy procedures that are prescribed at the stage of recovery after an elbow dislocation:

• low-intensity thermal effects, electrophoresis;
• mud therapy;
• paraffin treatment;
• point massage;
• ozokerite;
• ultrasound therapy;
• interference therapy.

The main purpose of physiotherapy is to reduce pain and eliminate swelling. Thermal effects reduce the feeling of stiffness, relieve contractures, optimize blood flow and lymph movement. In addition, as a result of physiotherapy, the effectiveness of other therapeutic measures increases significantly. [ 6 ]

In case of severe intra-articular bleeding, the use of physiotherapy is contraindicated!

Today, many modern orthopedic and therapeutic centers use innovative methods of treating elbow dislocation. Among them:

• autoplasma therapy, which allows activating venous and lymphatic outflow from the damaged area;
• shock wave, ultrasound and laser treatment to stimulate regeneration and eliminate local disorders;
• ozone therapy, which accelerates the restoration of sensitivity and improves trophic processes in tissues.

Medicinal electrophoresis, low-frequency magnetic therapy, paraffin and ozokerite applications, myoelectric stimulation – all these methods become active assistants for the patient’s speedy and comfortable recovery. [ 7 ]