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Dislocated Elbow (Slipped Elbow)

  • Medical Author:
    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

  • Medical Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

Elbow Dislocation Related Articles

Facts of and Definition about a Dislocated Elbow

An elbow dislocation occurs when the bones of the forearm (the radius and ulna) move out of place compared with the bone of the arm (the humerus). The elbow joint, formed where these three bones meet, becomes dislocated, or out of joint. It's also called nursemaid's elbow or slipped elbow.

Facts

  • This is common in children under 5 years of age.
  • Treatment is for the physician to reduce the dislocation
  • Specific, serious injuries that can accompany elbow dislocation include breaking of the bones (fractures), injuries to the arteries in the arm (the vessels carrying blood to the hand), and injuries to the nerves that run through the elbow area, impairing movement and feeling in the arm and hand.

What Are the Signs and Symptoms of a Dislocated Elbow?

  • Severe pain in the elbow, swelling, and inability to bend the arm are all signs of an elbow dislocation.
  • In some cases, people may lose feeling in their hand or lose a pulse (can't feel a heartbeat in the wrist).
  • Arteries and nerves run past the elbow, so it is possible a person might have injured them during the dislocation. Consequently, a nerve injury may result in abnormal sensations or inability of normal distal arm or hand functions below the elbow dislocation.
  • Children with nursemaid's elbow will not bend their elbow because of pain and hold their arm slightly bent.

What Causes a Dislocated Elbow?

The cause of most elbow dislocations is usually a fall, most commonly with the arm extended completely. However, any traumatic injury (such as a car crash or fall skiing) can result in an elbow dislocation.

"Nursemaid's elbow" is a particular type of elbow dislocation that most commonly occurs in young children who have had an abrupt yanking of their forearm. The result is a dislocation of the head of the radius bone at the elbow. It is common in children less than 5 years old.

When Should You See a Doctor If You Think You Have Dislocated an Elbow?

A person should go to the doctor's office or hospital's emergency department immediately if they are unable to move their elbow, have severe pain, cannot feel their hand, or have no pulse in the wrist.

What Tests and Exams Diagnose a Dislocated Elbow?

The doctor will begin with an examination. A dislocation of the elbow is a diagnosis that can be made upon examination.

  • The doctor will make sure nerves and arteries are unhurt by checking the pulse, making sure the patient can feel normally, move their fingers and wrist, and make sure that blood is flowing normally to the hand.
  • Next, the doctor will obtain X-rays. Sometimes, breaks in the bone can look like dislocations, and some breaks happen when dislocations occur.
  • If the doctor suspects an injury to an artery, further tests, such as an arteriogram (an X-ray of an artery) may be performed.

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3 First Aid Treatments for a Dislocated Elbow

An elbow dislocation is a serious injury that needs medical care. At home, put ice on the elbow. This will help with the pain and will reduce some of the swelling. However, the most important thing to do is to see a doctor.

It is best that this injury undergo evaluation by a doctor, but at home, a person can also check for a few signs that will show if the artery in the arm and the nerves are intact.

  1. To check for the artery, feel below your thumb at the base of your wrist. You should be able to feel your pulse. Press on the tips of your fingers. They should blanch (turn white) and then return to a normal pink color within three seconds. If either of these tests is abnormal, seek medical care immediately. You can do this on another person or child if they cannot do it themselves.
  2. Three nerves run by the elbow. Each nerve has portions that help with strength and feeling. First check for strength by bending the wrist up as if you were saying, "Stop" (radial nerve function), then spread your fingers apart (ulnar nerve function), then try to touch your thumb to your little finger (median nerve function). If the injured person has trouble with any of these tests, go to the doctor immediately.
  3. Check for feeling or sensory changes by touching all over the hand and arm. If any feeling of numbness results, see a doctor immediately.

What Are the Treatment Options for a Dislocated Elbow?

The doctor will manipulate the elbow back in place (reduce) by pulling down on your wrist and levering your elbow back into place. This is very painful, so powerful medications for pain are generally given before reduction. Many doctors who attempt this procedure will offer the patient "conscious sedation." The patient is given an anesthetic dose that is strong enough to reduce or stop the pain sensation of the elbow reduction technique but the patient remains conscious enough to control their own breathing.

After the elbow is back in place, the doctor will get X-rays and then put the patient in a splint that will keep their elbow bent. The splint will make an "L" around the back of the elbow. It will be make of plaster or fiberglass. Its purpose is to prevent movement of the arm at the elbow. Usually, the arm will be placed in a sling to help the patient hold the splint in a level position and to prevent pressure on the elbow joint.

Nursemaid's elbow, because the developing elbow joint does not have the resistance of the adult joint, can usually be reduced easily without anesthesia by a person trained in the simple technique. However, unless trained, this reduction technique should not be done.

While the patient is being discharged from the doctor's office or emergency department, they will be instructed to follow up with a bone doctor (orthopedist), usually within 24-48 hours.

Wear your splint during the time after discharge and up until the orthopedist office visit. Do not move the elbow. Elevate the elbow as much as possible, and ice it to reduce swelling. Do not apply ice directly to the elbow; wrap the ice in something such as a towel to prevent skin damage. Some clinicians recommend a series of about 15 minutes of "ice" followed by 15 minutes without ice repeatedly.

What Is the Prognosis for a Dislocated Elbow?

Generally, this injury heals well and has a good prognosis. After watching closely for three to five days, the bone doctor will have a patient begin gentle movement exercises of the elbow if there is no fracture. Physical therapy can be required for optimal rehabilitation. Usually, recovery occurs without any lasting effects. Complications of nerve or artery injury can lead to long-term damage to the function of the hand and forearm.

Early reduction yields the best outcomes; even children who do not have nursemaid's elbow reduced are likely to have long-term elbow joint problems.

How Can a Dislocated Elbow be Prevented?

Do not fall on the outstretched arm; if possible, try to put the body and extremities into a ball shape and roll if the fall is unavoidable. Avoid situations that would make falls more common (such as walking at night or being around slippery floors). Many clinicians warn against having "throw" rugs on wood or tile floors as they frequently cause falls.

Do not attempt to pick up or swing a child by their arm to avoid causing nursemaid's elbow.

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Nursemaid's Elbow

What Are the Symptoms of Nursemaid Elbow?

  • Immediately after the injury occurs, the child generally cries in pain and will refuse to use the involved arm.
  • Typically, the arm will be protected against the body and held slightly bent (in flexion) with the forearm turned with the thumb toward the body (in pronation).
  • The child will often support the painful arm with their other hand.
  • The child will usually be calm shortly after the initial event and may return to playing only now without the use of the affected arm.
  • When the forearm is turned with the thumb away from the body to show the palm upward (in supination), the child will resist and cry in pain.
  • A child who is old enough to talk may often describe pain in the wrist or shoulder in addition to, or in place of, any pain in the elbow.
  • Most commonly, your child will appear completely unchanged with the exception that he or she will no longer use the injured arm.
Reviewed on 6/27/2019
References
Medically reviewed by John A. Daller, MD; American Board of Surgery with subspecialty certification in surgical critical care

REFERENCES:

Chorley, J. "Elbow Injuries in the Young Athlete." UpToDate.com. Dec. 20, 2010. <http://www.uptodate.com/contents/elbow-injuries-in-the-young-athlete>.

Halstead, Mark E. "Elbow Dislocation." Medscape.com. Dec. 2, 2011. <http://emedicine.medscape.com/article/96758-overview>.
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