An elbow dislocation should be considered an emergency injury. The goal of immediate treatment of a dislocated elbow is to return the elbow to its normal alignment. The long- term goal is to restore function to the arm.
The normal alignment of the elbow can usually be restored in an emergency department at the hospital. Before this is done, sedatives and pain medications usually will be given. The act of restoring alignment to the elbow is called a reduction maneuver. It is done gently and slowly.
Simple elbow dislocations are treated by keeping the elbow immobile in a splint or sling for 1 to 3 weeks, followed by early motion exercises. If the elbow is kept immobile for a long time, the ability to move the elbow fully (range of motion) may be affected. Physical therapy can be helpful during this period of recovery.
Some people will never be able to fully open (extend) the arm, even after physical therapy. Fortunately, the elbow can work very well even without full range of motion. Once the elbow’s range of motion improves, the doctor or physical therapist may add a strengthening program. X-rays may be taken periodically while the elbow recovers to ensure that the bones of the elbow joint remains well aligned.
In a complex elbow dislocation, surgery may be necessary to restore bone alignment and repair ligaments. It can be difficult to realign a complex elbow dislocation and to keep the joint in line.
After surgery, the elbow may be protected with an external hinge. This device protects the elbow from dislocating again. If blood vessel or nerve injuries are associated with the elbow dislocation, additional surgery may be needed to repair the blood vessels and nerves and repair bone and ligament injuries.
Late reconstructive surgery can successfully restore motion to some stiff elbows. This surgery removes scar tissue and extra bone growth. It also removes obstacles to movement.
Over time, there is an increased risk for arthritis in the elbow joint if the alignment of the bones is not good; the elbow does not move and rotate normally; or the elbow continues to dislocate.
Treatment for simple dislocations is usually straightforward and the results are usually good. Some people with complex dislocations still have some type of permanent disability at the elbow. Treatment is evolving to improve results for these people.
One of the areas being researched is the best time to schedule surgery for the treatment of a complex dislocation. For some patients with complex dislocations, it seems that a slight delay for final surgery may improve results by allowing swelling to decrease. The dislocation still needs to be reduced right away, but then a brace, splint, or external fixation frame may rest the elbow for about a week before a specialist surgeon attempts major reconstructive surgery.
Moving the elbow early appears to be good for recovery for both kinds of dislocations. Early movement with complex dislocations can be difficult, however. Pain management techniques encourage early movement. Improved therapy and rehabilitation techniques, such as continuous motion machines, dynamic splinting (spring-loaded assist devices), and progressive static splinting can improve results.