Elbow dislocation treatment

Seeking medical attention is an important and necessary step that cannot be ignored. After all, dislocation requires mandatory reduction, and, moreover, this injury can be accompanied by other disorders - for example, a fracture or pinching of the ulnar nerve.

Further, treatment is prescribed in stages:

• the displaced joint is adjusted;
• drugs are used to relieve pain, eliminate edema and stop the development of the inflammation process;
• measures are taken to restore the damaged joint, restore its functionality;
• prevention of contractures and other complications is carried out.

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

Corticosteroids can be prescribed to inhibit the inflammatory process, but sometimes it is possible to do without them. For pain relief, both analgesics and non-steroidal anti-inflammatory drugs are suitable.

What to do with a dislocated elbow?

Even with full confidence that the injury received is precisely the dislocation of the elbow, one should not attempt to reposition it on its own. Inexperienced actions can greatly harm your health, affect blood vessels and nerve fibers. It is better to seek help from doctors who are familiar with the methods of correcting such injuries and have sufficient practice for this. In addition, you must first make sure that the dislocation of the elbow is not combined with a fracture.

Independent actions of the victim with a dislocated elbow may be as follows:

• relieve pain (for example, take a pill of Analgin or Ortofen);
• immobilize the joint using a non-rigid immobilizing bandage on the limb (kerchief);
• apply cold to the damaged area;
• contact the emergency room;
• Before visiting a traumatologist, it is undesirable to consume any food or drink, since general anesthesia may be required to repair serious injury.

How to correct a dislocated elbow?

Self-reduction of elbow dislocation is prohibited!

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

Fresh traumatic displacement without fracture is adjusted under general anesthesia. This is necessary not only for pain relief, but also for complete muscle relaxation. The procedure is carried out by medical specialists - a doctor and his assistant (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 that, a fixing bandage is applied: the elbow remains fixed for about a week and a half. 

A stale dislocation, from the moment of receipt of which no more than two weeks have passed, can be repositionable, but in this case, the doctor's actions should be especially careful. If you hurry and make the wrong reduction, you can break the neck of the humerus.

If the displacement is outdated, then its correction is not carried out: surgical treatment is required, since it is already impossible to correct such a dislocation without negative consequences.

The posterior dislocation is adjusted 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. Further, a course of exercise therapy is prescribed in combination with physiotherapeutic treatment (heat exposure).

If the anterior dislocation was repaired, then the forearm is unbent, bringing it to an obtuse angle, after which a posterior plaster cast is applied with a supinated forearm for about a week and a half.

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

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

Plaster cast for elbow dislocation

After the elbow dislocation is reduced, the patient undergoes an additional X-ray examination. This is necessary to confirm the correct fixation of the joint. After that, bone immobilization is carried out - immobilization.

Gypsum is applied to the damaged area for a period of 25 to 30 days. For elderly or debilitated patients, the plaster cast may be removed earlier, at the discretion of the doctor. This is due to the fact that with prolonged immobilization in such people, the likelihood of developing atrophic muscle processes increases.

The use of plaster is not always indicated: sometimes it is recommended to use bandages and bandages of the "headscarf" or Dezo type.

For young patients, fixation is performed more rigidly, including the practice of applying a plaster cast. The approximate term for 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 dislocated elbows do not need to be hospitalized. The doctor prescribes to the victim an individually selected exercise therapy complex, prescribes analgesics and anti-inflammatory drugs.

Analgin (metamizole sodium)	Anesthetic and anti-inflammatory drug derived from pyrazolone. Effectively relieves pain, however, 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	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	An 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, rubbing lightly, up to three times a day. The course of treatment is 7-10 days. When using the gel for the first time, you need to make sure that there is no allergic reaction to the drug.
Traumeel S	A safe and effective drug that comes in the form of ointments, tablets and injections. In case of elbow dislocation, an ointment preparation is most often prescribed, which has anti-inflammatory, analgesic, decongestant and reparative effects. The ointment is applied in a thin layer to the elbow area up to three to five times a day (you can use a bandage). The duration of treatment is up to one month. Tablets are taken 1 pc. Three times a day under the tongue, between meals. The duration of treatment is up to one month. Traumeel C in the form of intramuscular injections is administered once every three days, one ampoule at a time, for 14-28 days. Allergy side effects are rare.
Thrombocide	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 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 a dislocated elbow. The gel can be rubbed into the skin several times a day. Allergic reactions to the drug are rare.

Surgery

Sometimes, to correct a dislocated elbow, the doctor is forced to seek help from a surgeon. During surgery, the displaced bones are returned to the anatomical position, fixed using wires, tendon filing or plastics. At the same time, the capsule of the joint is strengthened, tissues trapped between the surfaces of the joints are eliminated. [3]

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

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

Another surgical procedure for dislocated elbows is arthroplasty. The method is the correction of cartilage defects covering the elbow joint.

Open reduction, or osteosynthesis, is performed in case of associated injuries, when fixation of the violation with pins and other devices is required.

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

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

Rehabilitation and recovery after a dislocated elbow

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

• complete immobilization stage;
• stage of relative immobilization.

The duration of each of the stages is determined individually, depending on the treatment and the nature of the damage.

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

Let's take a closer look at each of these periods.

• The first stage involves exercise therapy from the second day after the plaster cast. They practice general, ideomotor and breathing exercises, use free moving joints, periodically strain and relax the shoulder and forearm muscles. Due to the increased dystrophic vulnerability of the shoulder muscles, appropriate exercises are definitely recommended. The muscles are rhythmically tense, 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 former articular mobility, stabilize muscle performance. The patient is additionally prescribed physiotherapy procedures, changes in nutrition. The emphasis is on the completeness and balance of the diet, the use of a sufficient amount of magnesium and calcium.

Massage is not recommended in most cases.

How to develop an elbow after a dislocation?

During the entire stage of treatment and recovery after a dislocated elbow, it is necessary to beware of physical exertion and movements that cause pain in the joint. Do not hang or rest on the elbow: such exercises can aggravate tissue swelling and cause articular deformity.

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

Exercises to develop the elbow after injury are performed to prevent the development of contractures, as well as to maintain an adequate condition of the muscular system of the limb.

At first, light movements should be performed without excessive physical activity. Over time, they can be complicated by first consulting a doctor.

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

The most simple and affordable exercises for self-development of the elbow are considered to be:

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

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

Sample exercises for a dislocated elbow

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

1. The patient sits on a chair, puts his hands on the table. Flexes and unbends the fingers at least ten times.
2. In a sitting position, a sliding surface is brought under the forearm area. Bend and unbend 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. Flexion and extension of the forearm is performed up to ten times.
4. The patient puts his hands on the table. Performs supination and pronation of the forearm, trying to touch the table surface with the palmar and back of the hand. The number of repetitions is up to 10 times.
5. The patient alternately presses each finger of the affected limb on the table surface, holding one pressure for several seconds.
6. Performs rotation of the hands in the wrist joint, left and right, with the maximum possible, but comfortable amplitude.
7. The patient sits across the chair, puts the shoulder of the injured limb on the back (the forearm is lowered downward). Performs oscillations like a pendulum, simultaneously bending and unbending 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 are on the table surface. The patient clenches his fists, holds them for a few seconds, then relaxes the muscles. The number of repetitions is 4.
10. It spreads and brings the fingers together without bending or extending the hand.
11. Places the affected elbow on the table, fully extends the forearm and holds the position for several seconds. Repeats up to ten times.

How long does it take to recover from a dislocated elbow?

Full recovery of arm functionality after elbow dislocation takes about 4-5 months. To speed up and complete recovery, therapeutic exercises are carried out according to principles similar to rehabilitation after fractures of the elbow joint.

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

Throughout the day, it is advisable to give the injured arm an elevated position - to optimize blood and lymph flow, to reduce swelling. Massage procedures are allowed only 6-8 weeks after receiving a dislocated elbow.

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

Physiotherapy treatment

Physiotherapy, which is prescribed at the stage of recovery after dislocation of the elbow:

• low heat exposure, electrophoresis;
• mud therapy;
• paraffin treatment;
• acupressure;
• ozokerite;
• ultrasound therapy;
• interference therapy.

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

With severe intra-articular hemorrhage, 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 to activate venous and lymphatic outflow from the damaged area;
• shock wave, ultrasound and laser treatment to stimulate regeneration, eliminate local disorders;
• ozone therapy, which accelerates the restoration of sensitivity and improves trophic processes in tissues.

Medication electrophoresis, low-frequency magnetic therapy, paraffin and ozokerite applications, myoelectrostimulation - all these methods are becoming active helpers for the patient's speedy and comfortable recovery. [7]