The elbow dislocation
The elbow dislocation
Treatment for elbow instability
Elbow dislocation, also known as elbow dislocation, is an injury to the elbow joint in which the two forearm bones (radius and ulna) temporarily protrude from their normal position in the humerus. This injury can result in significant pain, swelling and limited range of motion . Elbow dislocations often occur due to falls, sports injuries or accidents where a strong force is applied to the elbow.
Suffered an elbow dislocation, still suffering from the effects of it and looking for a specialist?
Importance and frequency
Elbow dislocations are a comparatively common musculoskeletal injury. They can affect people of all ages, but especially those who are active in sports and those who work in physically demanding jobs. The significance of this injury is that it can cause significant pain and impairment of arm function, resulting in significant limitations in everyday life or in performing certain activities.
Statistics show that elbow dislocations are one of the most common dislocations in the body. They account for about 10 to 25 percent of all dislocations. In many cases, dislocation of the elbow occurs in conjunction with other injuries, such as broken bones or torn ligaments. The incidence of elbow dislocation varies depending on the age, sex, and activity level of the individual.
Because of the potentially serious effects of elbow dislocation , it is important to recognize this injury early, make an accurate diagnosis, and initiate appropriate treatment to minimize potential complications and allow for optimal recovery.
What happens in elbow dislocation?
Elbow dislocation is a relatively common injury. First, the outer collateral ligament is torn. If the acting force is not exhausted, the anterior and posterior stabilizing structures are affected. With sustained force, the most important stabilizing structure, the medial collateral ligament, is torn. If the collateral ligaments have not healed after the original injury, the remaining stabilizers will not be sufficient to provide stability to the elbow. When this happens, the instability turns into a chronic condition.
Types of elbow dislocation
There are different types of elbow dislocations, classified according to the direction of dislocation of the elbow. The three most common types of elbow dislocations are:
Posterior luxation (posterior dislocation)
In posterior dislocation, the forearm slips backward out of the elbow joint. This form of dislocation is the most common and occurs in about 90 percent of cases. It can be caused by a strong backward force on the flexed elbow, such as occurs in falls on the outstretched hand or in certain sports injuries.
Anterior luxation (anterior dislocation)
In an anterior dislocation, the forearm slides forward out of the elbow joint. This type of dislocation is less common than posterior dislocation and may be caused by a strong forward force on the elbow, as occurs in accidents or direct impacts on the flexed arm.
Lateral luxation (lateral dislocation)
In a lateral dislocation, the forearm moves laterally out of the elbow joint. This type of dislocation is less common than posterior and anterior dislocation, but also occurs with certain traumas or accidents.
It is important to note that elbow dislocations can often be accompanied by concomitant injuries, such as broken bones, torn ligaments, or damage to nerves and blood vessels. Dislocation of the elbow can also be one of the causes for the development of osteoarthritis in the elbow joint.
An accurate diagnosis by a medical professional, usually using X-rays or other imaging techniques, is required to determine the exact nature of the dislocation and to initiate appropriate treatment.
A special type of dislocation of the elbow joint - throwing elbow.
A special category of chronic instability is the so-called throwing elbow, which is an impairment of the medial collateral ligament in throwers and players in overhead activities (handball, tennis, javelin throwing, etc.). To illustrate this disease, it is best described with a pitcher in baseball. During the throw, the elbow is subjected to a lot of stress and the inner lateral ligament is thus subjected to excessive tensile stress. Such repetitive stress can lead to ligament tears and gradual internal instability of the elbow, manifested by pain during throwing, loss of swing speed and throwing accuracy, and loss of strength. Loss of elbow stability can lead to a number of other conditions, such as wear and tear of the articular cartilage and the development of osteoarthritis or the formation of bony bodies in the joint.
Often one encounters chronic insufficiency of the external collateral ligament because the internal collateral ligament heals better and even in the final phase of dislocation is injured only with greater force. However, elbow instability causes more significant problems for sufferers.
Symptoms of elbow instability
With elbow insufficiency, various complaints and symptoms occur, which can vary depending on the cause and severity of the insufficiency. The patient’s symptoms are often disparate, ranging from pain to snapping and locking to feelings of the joint “falling out.” Instability is most commonly experienced when rising from a chair using the upper limbs. In extreme cases, painful recurrent partial dislocations may occur. The degree of chronic instability is directly proportional to the severity of the initial ligament injury or the intensity of overuse during overhead athletic activity.
In general, the following complaints may occur:
Pain
Pain is a common symptom of elbow insufficiency. The pain may be dull, stabbing, or throbbing and may increase when the elbow is moved.
Movement restrictions
Elbow insufficiency can lead to limitations of mobility in the elbow joint. Affected individuals may have difficulty bending or extending the elbow.
Instability
The elbow joint may become unstable, resulting in a feeling of unsteadiness or “slipping away.” This can affect the ability to use the arm normally and perform certain activities.
Joint noises
Elbow insufficiency may cause grinding, cracking or rubbing sounds in the joint.
Power loss
Weakened muscles around the elbow can lead to a loss of grip strength and overall arm strength.
Swelling and inflammation
Inflammation and swelling may occur around the elbow joint, resulting in visible swelling and redness.
Numbness or tingling sensation
In some cases, elbow insufficiency can cause numbness or tingling in the arm or fingers, especially if nerve structures in the elbow area are affected.
Pain
Pain is a common symptom of elbow insufficiency. The pain may be dull, stabbing, or throbbing and may increase when the elbow is moved.
Movement restrictions
Elbow insufficiency can lead to limitations of mobility in the elbow joint. Affected individuals may have difficulty bending or extending the elbow.
Instability
The elbow joint may become unstable, resulting in a feeling of unsteadiness or “slipping away.” This can affect the ability to use the arm normally and perform certain activities.
Joint noises
Elbow insufficiency may cause grinding, cracking or rubbing sounds in the joint.
Power loss
Weakened muscles around the elbow can lead to a loss of grip strength and overall arm strength.
Swelling and inflammation
Inflammation and swelling may occur around the elbow joint, resulting in visible swelling and redness.
Numbness or tingling sensation
In some cases, elbow insufficiency can cause numbness or tingling in the arm or fingers, especially if nerve structures in the elbow area are affected.
It is important to note that the symptoms and complaints of elbow insufficiency can vary depending on the underlying cause. Among the most common causes are injuries,
Osteoarthritis
, nerve compression, inflammation or overuse. An accurate diagnosis by a medical professional is required to determine the cause of the insufficiency and initiate appropriate treatment.
How is elbow instability diagnosed?
Diagnosis of elbow insufficiency usually requires a thorough clinical examination as well as imagingstudies to confirm and evaluate the extent of the insufficiency.
First, the doctor will take a detailed medical history to obtain information about symptoms, the onset of symptoms, and any injuries or previous illnesses. A physical examination of the elbow is performed to assess for swelling, deformity, limited range of motion, pain, and instability.
Imaging techniques can help diagnose the disease in more detail. To detect irregularities of the bones, joint misalignments or signs of osteoarthritis in the elbow, X-rays can help. An MRI scan can provide detailed images of soft tissue structures such as ligaments, tendons, cartilage and nerves. This can be helpful in assessing ligament tears, nerve compression, or other damage.
After diagnosing elbow insufficiency, the doctor can discuss the results with you and recommend an appropriate treatment strategy. Accurate diagnosis is important to identify the cause of the insufficiency and initiate appropriate therapy, whether conservative (such as physical therapy) or surgical.
Treatment of elbow instability
Why should I have surgery on my elbow for elbow instability?
Surgery may be considered for elbow insufficiency when conservative treatment methods do not provide sufficient improvement in symptoms or when certain structural problems are present in the elbow that require surgical correction. There are several reasons why surgery may be considered for elbow insufficiency:
Stabilization of the joint
In cases of severe dislocation or recurrent instability, surgery may be required to stabilize the elbow joint. This can be accomplished by repairing or reconstructing ligaments, tendons, or bone structures to restore normal function and stability to the joint.
Improve mobility and function
In some cases, elbow insufficiency can lead to significant movement limitations. Surgery can help correct prevented ranges of motion, repair injured tissues and restore elbow mobility. This can help you use your arm better and perform everyday activities.
Pain relief
If conservative treatment approaches such as medications, physical therapy or injections do not provide sufficient pain relief, surgery may be considered. Correcting structural problems in the elbow can reduce or completely eliminate pain.
Improving the quality of life
Elbow insufficiency can cause significant limitations in everyday life and certain activities. Surgery can help restore elbow function and stability, which can lead to improved quality of life and return to normal activities.
The operation
Patients with chronic instability of the elbow usually come to us with a clear desire to solve their unpleasant problems or return to sports, and usually do not refuse the offered surgery. To date, several procedures have been proposed to replace the collateral ligaments. As early as 1966, Osborne and Cotterill published their own technique for strengthening the stabilizing structures of the external collateral ligament. Jobe was the first to use a tendon in the shape of an “8” for reconstruction of the internal collateral ligament in 1986. However, these and similar techniques contained a number of disadvantages. Nowadays, anatomical techniques for reconstruction of the collateral ligaments are being advanced for elbow instabilities.
Our approach
We have been operating on elbow instabilities since 2000. During surgeries, we use anatomical techniques to reconstruct the collateral ligaments, but we only use tendon grafts, not synthetic fibers. The tendon grafts gradually remodel in the body after loading and fully assume the function of original collateral ligaments.
Such operations are technically demanding and are performed only in a few clinics and by trained specialists. We have already operated on dozens of patients and observed no significant complications. Patients return to work, original activity or sports activity after an average of three months. Subjectively, most patients are very satisfied with the result. No new dislocation occurred in any of our patients after surgery.
The development of chronic instability of the elbow after unsatisfactorily treated dislocations is not uncommon. In athletes, the lateral ligaments of the elbow are also frequently affected. The anatomical reconstruction of the lateral ligaments has a logical justification on the elbow, as well as in other anatomical areas (knee, upper ankle). The functional results of anatomic reconstructions with tendon grafts are good and patients are generally very satisfied after the operations.
