Elbow dislocations occur when the lower end of the upper arm bone (humerus) loses contact with the tops (heads) of the forearm bones (radius and ulna). Elbow dislocations may be complete (the ends of the bones do not touch) or partial (part of the bones still touch). Partial dislocations are called subluxations.
Most elbow dislocations result from a fall on an extended arm. They may be accompanied by fractures, nerve injuries, and sometimes injury of an artery.
Elbow dislocations are common. However, for an elbow to be completely dislocated, significant force is usually required. Partial elbow dislocations (subluxations) are common among toddlers and usually result from much less force. Subluxations occur in but are much less common among infants, older children, and adults.
X-rays can confirm the diagnosis of an elbow dislocation.
(See also Overview of Dislocations.)
Treatment of a Dislocated Elbow
Usually maneuvers to put the joint back in place (reduction)
Treatment of an elbow dislocation usually involves the following:
Giving the person a sedative and a pain reliever
Having the person lie down facing up
Bending the elbow and gently rotating the forearm so that the palm faces up
Holding the upper arm down
Pulling the wrist up until the joint is back in place
After being put back in place, the joint is checked for stability, and an x-ray is taken to make sure no fractures were missed. Then the joint is usually immobilized, typically with a splint, for up to 1 week until pain and swelling go away. Then range-of-motion exercises are started, and a sling is worn for 2 to 3 weeks.
Radial Head Subluxation (Nursemaid's Elbow)
Radial head subluxation is partial separation of the bones in the elbow. The end of one forearm bone (radius) slips out of place at the elbow.
Radial head subluxation, which is common among toddlers, can occur when a caregiver pulls a toddler forward or catches a toddler by the wrist.
The only sign may be a toddler's refusal to move the injured arm.
Doctors suspect radial head subluxation based on the description of how the injury happened, symptoms, and results of a physical examination.
Doctors can usually manipulate the bones back in place without making an incision and without needing to use sedatives or pain relievers.
This injury typically occurs in toddlers (who are about 2 to 3 years old). In toddlers, the head of the radius (one of the forearm bones) is small enough to slip through the ligaments that hold the elbow in place. The head of the radius can slip through the ligaments when a parent or other caregiver pulls a reluctant toddler forward or catches the toddler by the wrist during a fall—actions many caregivers do not remember. As children grow, the head of the radius enlarges, so that eventually, the head of the radius is too big to easily slip out of place.
Symptoms of Radial Head Subluxation
The elbow may be only mildly tender. Because toddlers usually cannot describe their symptoms, the only sign of this injury may be unwillingness to move the arm. The arm may dangle down by the side of the body, sometimes turning slightly inward. Or toddlers may hold the arm in a bent position against their body. Parents or other caregivers should not try to move the arm.
Toddlers may cry when the injury happens but then calm down and continue to act normally except that they do not use the injured arm.
Diagnosis of Radial Head Subluxation
A doctor's evaluation
If toddlers have symptoms that suggest elbow subluxation, parents or other caregivers should take them to a doctor. If they think the elbow has slipped back into place, the toddler will have full ability to move the elbow normally. If the toddler cannot move the elbow fully, they need to be seen by a doctor.
Doctors suspect this injury based on the description of how it happened, symptoms, and results of a physical examination.
X-rays do not show the injury and so may not be taken.
Prevention of Radial Head Subluxation
To prevent elbow subluxation in toddlers, parents and other caregivers should
Not suddenly jerk the hand, wrist, or forearm of toddlers
Not lift toddlers by one arm, wrist, or hand only
Not swing children by their hand or forearm
Lift toddlers from under their arms or from both arms
Treatment of Radial Head Subluxation
Usually maneuvers to put the joint back in place
Doctors usually attempt to put the joint back in place (called reduction). Usually, no sedatives or pain relievers are needed. When the bone is slipped back in place, a soft pop or click may be heard. Toddlers may start to move their elbow after about 10 to 20 minutes. If they do not move it, doctors may take x-rays of the elbow. If toddlers move the joint, the joint does not need to be x-rayed or immobilized.
If after 24 hours toddlers continue to have pain or if they still cannot use their arm, the joint may not be completely in place or a bone may be fractured. In such cases, toddlers should be seen by a doctor again.
With treatment, most toddlers recover completely. However, 20 to 40% of them dislocate their elbow again.
