What you should know about elbow dislocation in children

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February 11, 2021

Author of the article: Bogatov Viktor Borisovich

Highest qualification category. Doctor of Medical Sciences, Professor of the Department of Traumatology and Orthopedics, First Moscow Medical University. I.M. Sechenov.

Experience: 21 years

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A dislocated elbow joint often causes fear in children and a panic attack in parents. An unpleasant hand injury does not threaten the baby’s life, but requires surgical treatment under the supervision of a traumatologist, rheumatologist or surgeon. Let's figure out what you should know about injuries to the elbow capsules and the accompanying therapy.

Possible causes of injury

The main cause of elbow dislocation in a child is a closed injury of the upper limb. In most situations, it is provoked by an unsuccessful fall of the baby onto an outstretched arm. This is explained by the unstable coordination of human movements at the age of 2-5 years. Children who attend physical education clubs are at risk. Using sports equipment at a young age can result in sprains, dislocations or fractures.

The reason for the violation of the integrity of the tissues in the ulnar bursa may be excessive tension of the ligaments as a result of their overstrain. As an example, consider a child attempting to lift an excessively heavy object. Children experience similar hand overloads from the actions of parents who pull tired or capricious sons and daughters along with them.

The most dangerous cause of injury remains road accidents, which result in open injuries to the upper extremities of injured pedestrians, drivers and vehicle passengers. In this case, dislocation of the elbow joint in children requires immediate treatment.

Causes of dislocations

Damage in adolescents and schoolchildren occurs under increased load, for example, if a child is involved in strength sports and does not successfully pick up a weight, the joint becomes displaced. Sometimes an injury occurs during physical education during incorrect pull-ups on the horizontal bar.

Children from one to five years old land on outstretched arms when falling. The fulcrum becomes the elbow, the ligaments of which cannot support the entire weight and cannot hold the joint in place.

Often parents themselves provoke dislocation in their children by pulling their hands. Due to a sharp jerk, the head of the joint comes out of its cavity.

Symptoms of dislocation

Damage to the joint capsules occurs due to the low strength of the bones of a growing child’s body. The most common type of injury to the upper extremities at the age of 2-7 years is a pulling dislocation of the radius.

Signs of a dislocated elbow joint in a child are typical:

• swelling occurs at the site of injury, quickly spreading to adjacent tissues;
• the patient’s body temperature rises and chills begin;
• pain syndrome occurs, which intensifies with hand movements or palpation;
• The sensitivity of the fingers of the upper limb decreases (with increasing numbness).

Deformation of the joint capsule is clearly visible during visual examination of an injured patient. Complex injuries are often accompanied by a violation of the integrity of the blood vessels, which makes it impossible to feel the pulse on the child’s wrist.

Treatment

Only a qualified traumatologist has the right to reduce a dislocation after an X-ray examination. Under no circumstances should you try to do this yourself or ask your loved ones to do it. This way you risk aggravating your condition and provoking the development of severe complications.

You can take some careful steps on your own that will slightly alleviate the patient’s condition and help transport him safely to a medical facility. Let's find out how to provide first aid for such an injury.

Prehospital care

To relieve pain, you can apply an ice pack to the affected limb and, if possible, give a pain reliever. Before transportation, the hand must be immobilized.

The method of immobilization depends on the type of dislocation:

• rear. The upper limb is immobilized using a special scarf;
• front. For immobilization, a ladder splint is used. If it is absent, the straightened arm is fixed with improvised means.

Reduction

Since such injuries are usually accompanied by a reflex muscle spasm, it is better to reduce them under anesthesia. After the procedure, a plaster splint is applied to the upper limb for 1-3 weeks. After the cast is removed, the patient is prescribed a course of physiotherapy and other necessary rehabilitation measures.

In the absence of medical care, dislocation after 2 weeks is complicated by the development of ossification. After this, it will no longer be possible to straighten it - you will need surgery. Do not under any circumstances delay contacting a doctor.

Posterior dislocations

The patient lies on his back, and his arm is abducted at the shoulder joint and slightly bent at the elbow. The doctor presses the shoulder joint from front to back with his thumbs, while pushing the olecranon forward. At this time, the assistant performs lengthwise traction and flexion of the forearm. After reduction, the joint is immobilized at an acute angle.

Front

The patient lies on his back with his arm straight. The assistant, performing lengthwise traction, slowly bends the forearm. The doctor uses his thumbs to push the humerus forward while moving the forearm backward. Having straightened the dislocation, the limb is fixed at an obtuse angle.

If the dislocation cannot be reduced using the closed method, the patient requires surgical intervention. If it is impossible to restore the structure of the joint using an open method, the patient undergoes arthroplasty. In severe cases, doctors may recommend arthrodesis: fixation and immobilization of the joint.

Isolated dislocations of the radius are difficult to reduce. Even if the procedure is successful, the bone cannot always be kept in the desired position. Therefore, the pathology is often treated by open reduction with plastic surgery of the annular ligament. For recurrent dislocations, the radius can be fixed with knitting needles for up to 3 weeks.

Rehabilitation

After the cast is removed, the patient is prescribed physiotherapeutic procedures, massage, physical therapy, etc. Recovery from a dislocated elbow joint will take about a month. As a rule, a person can return to his usual lifestyle within 20-30 days.

During the rehabilitation period, thermal procedures are strictly contraindicated for patients. They lead to rapid ossification and severe impairment of elbow joint mobility.

Seeing a doctor

The baby’s parents will not be able to cure damage to the joint capsule on their own. If children detect symptoms of a dislocated elbow joint, adults should seek qualified help by taking the injured person to the hospital or inviting an emergency medical team to your home (if there are associated injuries).

Until doctors arrive, parents should ensure that the child's injured limb is immobilized. It is acceptable to apply a cold compress (wet towel) or ice. Taking analgesics or using anesthetics is not recommended, since without diagnostic procedures it is impossible to determine the extent of damage and possible contraindications to certain groups of drugs.

In a clinical setting, treatment of dislocations is carried out by a traumatologist, rheumatologist or surgeon. Doctors carry out the necessary diagnostic measures, develop a treatment strategy and determine the period for which the injured limb will be immobilized.

The ambulance team of JSC "Medicine" (academician Roitberg's clinic) will deliver a small patient with a dislocation to the clinic for diagnostic and therapeutic measures. The team is on call 24 hours a day.

Reduction of the elbow joint in our clinic

In our medical center, we not only treat dislocations, but also monitor the entire process of tissue fusion and develop rehabilitation measures to prevent complications. The rehabilitation program is compiled individually for each child, taking into account his mobility and the severity of the injury. Immediately after removing the plaster, to normalize blood circulation, the traumatologist refers you to physical therapy, offering several procedures to choose from. If negative consequences are identified, for example, nerve plexuses are damaged, then the clinic will provide a full range of services and a neurologist will join the treatment process.

Possible complications

The most common complication of injuries to the joint capsules of the upper extremities is fibrosis. Overgrowth of connective tissue occurs as a result of untimely treatment of a dislocation, a shortened period of immobilization, or significant damage to muscles and tendons.

A dislocation of the elbow joint, accompanied by symptoms of other arm injuries in a child, requires the fastest possible surgical intervention. Thus, an open fracture of the radius of the forearm in combination with damage to the articular tissues can provoke contracture. Restrictions in arm mobility after the child’s recovery can only be avoided if timely medical care is received.

Anterior elbow dislocation

A rare anterior dislocation of the elbow (elbow joint) usually occurs when you fall on your elbow while bending it excessively. A distinction is made between incomplete dislocation, when the olecranon stands against the block of the humerus, and complete dislocation, when it stands in front of the block of the humerus. This often results in a fracture of the olecranon process. Reducing them in the presence of a large tear of the capsule does not present any particular difficulties when traction is applied with pressure from front to back on the bent forearm.

Diverging dislocation (lux. cubiti divergent), resulting in the elbow (elbow joint) with significant forces due to the wedge-shaped insertion of the humerus between the bones of the forearm after rupture of the interosseous and annular ligaments, is very rare. Reduction due to large tears in the bursa is easy. In difficult cases, each forearm bone requires separate reduction: extension and traction for the ulna, direct pressure with rotation for the radius.

Isolated or separate posterior dislocation of the elbow (elbow joint) occurs from a fall on an excessively extended and abducted forearm. It is determined by almost the same clinical signs as dislocations of both bones posteriorly. But, due to the upward displacement of the medial bone while the lateral one remains in place, the arm forms a medial shortening and an angle open medially (cubitus varus). Rotation of the forearm inward (pronation) and outward (supination) is possible.

Dislocation of the elbow with posterolateral displacement of the proximal radius and ulna (lateral x-ray).

A dislocation of the ulna is reduced posteriorly by traction of the outwardly turned (supinated) forearm with simultaneous straightening of the lateral angle and extension of the elbow. All three recent elbow (elbow) dislocations are very rare. Their exact determination is facilitated by fluoroscopy. Of the isolated dislocations of the elbow (elbow joint), the separate dislocation of the radial head, which occurs from a direct blow from behind to front or from the outside, is much more important. But it can also occur with indirect force - due to strong pronation of the forearm (twisting of the arm), and the annular ligament is torn. Most often, the radius is dislocated forward and outward, when its head lies on top of the external condyle of the humerus. Clinically, the forearm stands in a position of flexion and pronation and forms an angle with the shoulder, open outward - cubitus valgus. The head is palpated in the elbow bend - in front of or above the external condyle of the shoulder - and is recognized by its shape and rotation during pronation and supination. The posterior recognition points of the elbow are not displaced. This dislocation of the elbow (elbow joint) is often preceded by a fracture of the upper third of the ulna. Reduction of the elbow is usually easily achieved by extension, external rotation (supination), and traction by the forearm and direct pressure on the head. But with the same ease the head pops up again when moving. The torn parts of the bursa and annular ligament prevent it from being firmly held in place. Holding the head in place is best achieved by a fixation bandage while rotating inward (pronating) and flexing the forearm at a very acute angle at the elbow. In case of irreducible dislocation of the elbow (elbow joint), the obstacle must be removed promptly - sometimes even by resection of the head.

Treatment of dislocations

Diagnosis of damage is carried out by a traumatologist or rheumatologist using radiography, ultrasound, and computed tomography. If the child has no other injuries, the dislocation is reduced under general anesthesia: the joint is stretched, its head is directed into the articular cavity. A splint is applied to the injured arm; the immobilization period is 10–15 days. After removal of the fixing bandage, rehabilitation therapy begins for 3–4 weeks.

Complex dislocations accompanied by fractures require plaster immobilization of the injured limb. The child may require treatment from a neurologist (for nerve damage) or a surgeon (surgical intervention for ruptured tendons, arteries, blood vessels, muscles).

Our clinic provides a full range of diagnostic and treatment procedures for dislocations in children. The clinic is equipped with all the necessary equipment, and its own hospital allows patients to be placed in comfortable rooms for the period of therapy.

Diagnosis of this injury

If you experience a dislocation, you must immediately consult a traumatologist. Diagnostics involves a preliminary examination of the victim and the appointment of a set of studies, namely:

• radiography (based on an x-ray of the joint, the degree of its damage, the likelihood of bone displacement, the presence of damage to soft tissues, muscles or nerve endings are determined)
• arteriogram (X-ray examination of blood vessels or ultrasound)
• consultation with a neurologist (if the hand is immobile)
• pulsometry

Prevention of dislocations

Prevention of dislocations is based on the formation of a balanced menu for the child’s nutrition. A sufficient amount of minerals and vitamins in food will provide the baby’s joints and bones with sufficient strength to painlessly endure falls that are inevitable during childhood activities.

Parents should also take care of the physical development of their growing sons and daughters. Swimming, running, and playing with a ball help improve children's coordination and strengthen skeletal bones and muscle tissue. Moms and dads should remember that babies’ bodies cannot bear the same stress as adults.

Prevention

To reduce the likelihood of injury, it is recommended to regularly do exercises aimed at strengthening the deltoid muscle. If there are diseases associated with the joints, they should be treated. You should also try to avoid situations where hand injury is possible. You should not make sudden movements; it is important to try to walk carefully.

If you undergo proper recovery, you will be able to prevent complications. For this reason, you should not forget about rehabilitation after a dislocated joint.

Make an appointment

You can make an appointment with the children's specialists of JSC "Medicine" (clinic of Academician Roitberg) through the website. The interactive form allows you to select the general specialization of the doctor or the name and surname of a specific employee of the pediatric department.

The clinic covers all areas that can help in the treatment of dislocations: traumatology, surgery, neurology, pediatrics and others. Clinic administrators are ready to accept requests for appointments by telephone; calls are processed around the clock.

Stages of joint rehabilitation

Experts practice dividing the entire recovery period of the elbow joint after a fracture into three stages:

• First - start on the second or third day after removal of the plaster; consists of breathing exercises and careful movements of the joints of the limb recovering from a fracture - bends, periodic muscle tension. In the first period of rehabilitation, the patient undergoes a series of diagnostic procedures that give the attending physician the opportunity to correctly draw up a rehabilitation plan. The doctor may prescribe an arteriogram, x-ray, or consultation with a neurologist, since its treatment depends on the type of fracture. Each patient's pulse, body temperature and blood pressure must be monitored.
• The second is recovery after fractures of the elbow joint due to more thorough loads. Exercises such as “shoulder rolling”, exercises with a ball, stretching of joints are practiced; an important part of the second stage is daily warming baths.
• The third is physical therapy, including compresses, heating, and electrical stimulation. They resort to it if the joints could not recover 100 percent after the first two stages.

In order to quickly heal a fracture, physical activity should be regular, ideally done twice a day, with 5 approaches per exercise. Breaks are permissible only in cases of increased fatigue and severe pain. Rehabilitation of the elbow joint after a fracture is not a quick process and requires a lot of patience not only from patients, but also from doctors. But if all medical prescriptions are followed, it is usually crowned with success.

Diagnosis of joint dislocations

• Posterior dislocation of the forearm. Clinically, posterior dislocation of the elbow joint is determined by its deformation and swelling. The arm is half-bent, movements at the elbow are impossible, the limb is shortened. The elbow is unnaturally positioned posteriorly, and the humerus can be felt in the ulnar fossa.
• Anterior dislocation of the forearm occurs when striking with the elbow when the arm is bent. The elbow joint is unnaturally rounded and swollen. Shoulder shortening and severe pain are detected. Anterior forearm dislocation is often complicated by a fracture of the epiphyses (the rounded end of the bone) and/or damage to the nerves (median, radial or ulnar).

The diagnosis must be confirmed by radiography, but with complicated dislocations of the forearm this is not enough. Computed tomography and magnetic resonance imaging (CT and MRI) are preferred, which visualize the soft tissue in the area of ​​injury and detail the damage. In the Stolitsa network of clinics you can do CT and MRI examinations around the clock by appointment.

Reposition

Schematic representation of the procedure.

For fractures and dislocations, when it is impossible to set or restore the bone, reposition is performed. The operation is an internal restoration of the structure of the joint. To do this, an incision is made along the back surface of the extensor part of the arm, exposing the bones and their joints. Transverse channels are made on the fragment and on the inner surface. All components are assembled in their original position, a spoke is placed along it, which is secured with screws in the made channels. Tendon fibers, which are taken from the lateral sections of the triceps, wire, and other materials, can also be used as fastening. Fasteners are selected depending on the location of the fracture. The attachment process is called “osteosynthesis”. If the tendons were damaged during crushing, their restoration is carried out simultaneously with reposition.

How is the elbow x-ray procedure performed?

An X-ray of the elbow of an adult or a child (if this procedure is unavoidable for diagnosis) does not require prior preparation. It is painless and can be done in just a few seconds.

The patient is seated near the X-ray machine table. Then they place his arm on the table, bending it at the elbow, and take a picture. Next, several more photographs can be taken in other projections (for example, with the arm straightened).

Do not move your hand while scanning. This will harm the quality of the photo.

To protect against unnecessary radiation, the patient is wearing a special lead vest.

Recovery stages

Restoration of joint function begins against the background of immobilization. Early treatment can improve the patient's condition and avoid post-traumatic complications. Therapeutic measures aimed at improving the regenerative abilities of the osteoarticular system are carried out in several stages:

1. The first stage , Initial, is a period of rest, during which the damaged area is firmly fixed. This is necessary to relieve pain and reduce the inflammatory process. The specialist may prescribe drug therapy to eliminate adverse symptoms, as well as physical therapy treatments. Depending on the location of the injury, it takes up to 1.5-2 months.
2. During the second stage, the immobilizing devices are removed. The phase lasts from 2 to 3 weeks. Here you should add a little physical activity. For each anatomical area, there are specific exercises that can be performed. Rehabilitation after a hip dislocation is much more difficult than a small joint injury. Therefore, it is better to conduct the course under the supervision of a professional. In this case, you should periodically wear temporary fixing bandages. Movements should be smooth with a small amplitude.
3. The task of the third stage is to strengthen the muscular frame and ligamentous apparatus. The duration of the period is 2 - 3 months. Therapeutic gymnastics during this period includes active movements aimed at training flexor and extensor muscles. Perform rotations in the joint. Under the supervision of a rehabilitation therapist, resistance and weight training exercises are included. During free time from physical activity, the area of ​​injury is fixed with an elastic bandage.
4. The final, fourth stage lasts from six months to 12 months. The goal of the period is to fully restore function after damage. It is recommended to gradually increase the load, following the exercise therapy technique.

Risks

The risk of x-raying the elbow joint is very low. In recent years, with the advent of digital X-ray machines and new examination protocols, the radiation dose has been significantly reduced and the risk of exposure to ionizing radiation on the human body has been reduced.

In general, the two main risk factors for elbow x-rays are: 1) the possibility of developing cancer due to excessive radiation exposure; 2) harm to the fetus and/or reproductive organs.

• Cancer risk

The risk of cancer due to x-ray imaging increases with repeated, repeated exposure to x-rays or exposure to a large dose of x-rays. As a rule, taking several X-rays of the elbow joint is not enough to provoke the development of cancer.

• Risk during pregnancy

If you are pregnant or even suspect that you are pregnant, you must inform your doctor and radiologist before taking an X-ray of the elbow joint. But the risk of dangerous effects of x-rays is especially high when exposed to the abdominal area. Therefore, if there is a clinical need for an x-ray of the elbow joint, then this examination can be carried out using a special lead apron, which helps protect the abdominal area and reproductive organs from scattered x-ray radiation.

What is a dislocation?

A dislocation is a violation of the congruence of articular surfaces. Persistent separation of anatomical elements occurs in more than 1/2 of the bone structures relative to each other.

In 80% of cases the disease is traumatic in nature. Less commonly, such pathological changes occur against the background of chronic destructive diseases. Violation of the correct configuration of the joint may be accompanied by damage to the ligaments and capsule.

Types of Shoulder Dislocation

In some cases, there is rupture of soft tissues and synovial membranes. This leads to significant dysfunction of the musculoskeletal system and long-term recovery of the body.

Therefore, despite the absence of a fracture of bone tissue, you should pay close attention to injuries that are accompanied by dislocation of the joints. In the presence of such injuries, an integrated approach to treatment is necessary. Rehabilitation measures are carried out from the moment of immobilization. Proper therapy allows you to quickly achieve the desired result.

Rehabilitation methods

The rehabilitation course for a dislocation includes a number of activities that are aimed at restoring lost function. Treatment procedures are carried out for all patients, regardless of the severity of the condition, time of immobilization and age group. Therapy is carried out in the following areas:

1. Therapeutic gymnastics is the main method on the path to recovery. Exercises are performed regularly, starting with simple elements, gradually moving on to more complex workouts.
2. Massage of the injured area is used to improve blood circulation, reduce tissue swelling, and strengthen the muscular-ligamentous apparatus of the upper limb.
3. Physiotherapeutic treatment accelerates cell regeneration and reduces the duration of the recovery period.
4. Use of assistive orthopedic devices .

Restrictions

X-ray of the elbow joint is a fairly informative diagnostic method when it comes to the need to diagnose various injuries to the bones and structures of the elbow joint. However, if changes occur in the morphological structure of soft tissues (muscles, ligaments or tendons), then the capabilities of X-ray are not very high and it is preferable to use other medical imaging methods such as MRI. In addition, a technique such as PET may be needed to diagnose infections or tumors.