Do I need physiotherapy for an elbow dislocation?


Do I need physiotherapy for an elbow dislocation?

The elbow is the second most commonly dislocated joint in the upper body after the shoulder, and dislocation accounts for approximately 10% to 30% of all injuries to the elbow. Our purpose built rehab gym is the best place for starting an appropriate early range of motion rehabilitation program.

Rehabilitation with a sports specific or musculoskeletal physio helps achieve optimal outcomes with both surgical and nonsurgical treatments of elbow dislocations.

How do elbow dislocations occur?

Elbow dislocations commonly occur as the result from a fall onto an outstretched hand. Elbow dislocations occur in all age groups but are more common in younger patients who participate in high-energy sports and activities that generate rotational or compressive forces across an extended elbow joint. The most common athletes who sustain this injury are those in contact and tumbling sports.

Elbow dislocations that result in superficial ligament injury are known as simple dislocations, while fracture-dislocations are commonly known as complex dislocations. These types of elbow dislocation may involve fractures of the distal humerus, radial head and neck, olecranon, or coronoid process.

  • Simple elbow dislocation
  • Complex elbow dislocation
  • Chronic dislocation

Simple elbow dislocations are the most common, representing approximately 74% of all elbow dislocations.[1]

Simple elbow dislocations can be grouped into:

  • Posterolateral
  • Posterior
  • Posteromedial
  • divergent (paediatric injuries), and
  • anterior dislocations.

The most common direction of elbow dislocation is posterolateral.

Does an elbow dislocation require surgery?

Simple elbow dislocations are mostly treated conservatively with the R.I.C.E method and a structured rehabilitation program from a physiotherapist.

Whether or not surgical intervention is required, early motion rehabilitation can be the difference between long term pain and an efficient recovery.

What is the best rehabilitation after an elbow dislocation?

A significant elbow injury can be challenging for even experienced physiotherapists.

Suboptimal management of an elbow dislocation has a high chance of an outcome involving pain, stiffness, instability, and loss of function.

Elbow dislocations treated with early mobilisation are more likely to have a successful outcome following completion of rehabilitation.

Immediate mobilisation with a recumbent overhead regime has been described by Schreiber et al.[2] Above head exercises are performed whilst the patient is lying in a supine position with the shoulder flexed to 90, adducted and in neutral rotation. In this position the posteriorly directed forces are minimised by decreasing the effect of gravity and allowing the triceps to function as an elbow stabiliser.

How will a physio assess my elbow injury?

An assessment of any significant elbow injury begins with a detailed history focussing on the mechanism of dislocation and any subjective feeling of elbow instability. Your physio will likely examine your elbow for bruising, particularly over the medial or lateral sides for an indicator of high-grade injury.

Why is rehabilitation after an elbow injury important?

Early elbow mobilisation has favourable outcomes in most elbow dislocations. Injuries to the elbow can be very painful and this can cause difficulties with completing the required exercises.

The most common complication with nonoperative management has been elbow stiffness. With new advances with early motion rehabilitation protocols, such as early overhead motion protocols, patients have seen a significant improvement in their outcomes.

Weeks 1-4 Goals: Control swelling and pain

  • Elevation and ice
  • Gentle PROM – working to get full extension
  • Splinting/bracing as needed
  • General cardiovascular and muscular conditioning program
  • Strengthen through ROM
  • Soft tissue mobilisation if indicated

Weeks 5-8 Goals: Control any residual symptoms of swelling and pain and work towards Full ROM

  • Active range of motion (AROM) exercises, isometric exercises, progressing to resisted exercises using tubing or manual resistance or weights
  • Incorporate sport specific exercises if indicated
  • Joint mobilization, soft tissue mobilization, or passive stretching if indicated
  • Continue to assess for neurovascular compromise
  • Nerve mobility exercises if indicated
  • Modify/progress cardiovascular and muscular conditioning program

Weeks 9-16 Goals: Gain full range of motion and normal strength and return to pre-injury functional activities

Before returning to sports, you should be able to demonstrate full painless range of motion with strength.

Each elbow dislocation needs specific rehabilitation based on the injury type and nature of surgery performed. For more information on elbow injuries and dislocations, and how to return safely back to sport and work, give us a call to book an appointment.

[1] . De Haan J, Schep NWL, Tuinebreijer WE, et al. Simple elbow dislocations: a systematic review of the literature. Arch Orthop Trauma Surg 2010;130(2):241–9

[2] Schreiber JJ, Paul S, Hotchkiss RN, Daluiski A. Conservative management of elbow dislocations with an overhead motion protocol. J Hand Surg Am. 2015 Mar;40(3):515-9