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Elbow Dislocation

Second most common dislocation in adults after the shoulder. Posterolateral direction accounts for 90% of cases. Distinguishing simple (without fracture) from complex (with associated fracture) dislocation is essential for treatment and rehabilitation guidance.

Characteristics

Elbow dislocation is the second most common dislocation in adults (after the shoulder) and the most common in children [1]. Annual incidence is 5 to 6-7 per 100,000 inhabitants. The typical mechanism is a fall on an outstretched hand with the elbow in slight flexion and forearm in supination, creating a combined mechanism of hyperextension, valgus and external rotation. Posterolateral dislocation accounts for approximately 90% of cases.

O'Driscoll described the posterolateral instability spectrum in three stages: stage 1 (posterolateral rotatory subluxation with lateral collateral ligament rupture), stage 2 (incomplete dislocation with posterior capsule rupture), stage 3 (complete dislocation with medial ligament rupture) [2]. Simple dislocation (without associated fracture) has a favorable prognosis with brief immobilization of 7-10 days followed by early mobilization. Complex dislocation (with associated fracture of the radial head, coronoid, or medial epicondyle) has a more guarded prognosis and often requires surgical treatment [3].

Residual stiffness and chronic instability are the two main long-term complications.

  • Elbow stability relies on three pillars: bony structures (humeroulnar congruence, radial head, coronoid), ligaments (lateral collateral ligament complex – LUCL, medial collateral ligament – MCL), and dynamic muscular stabilizers (anconeus, biceps, brachialis, common flexor and extensor muscles).
  • Mechanism: fall on outstretched hand with elbow in extension or slight flexion. Combined forces of axial loading, valgus and supination. O'Driscoll's injury spectrum: rupture progresses from LUCL (lateral) to MCL (medial), from outside to inside (Horii circle).
  • Risk factors: sports (gymnastics, football, rugby, martial arts), recreational activities with fall risk, constitutional ligamentous hyperlaxity. Peak incidence between 10-20 years (athletes) and after 60 years (falls on osteoporotic bone).
  • Complications: extension stiffness (most frequent, 10-15%), residual posterolateral rotatory instability (5-10%), heterotopic ossification (3-5%), ulnar neuropathy, complex regional pain syndrome. Chronic instability if ligamentous injuries fail to heal.

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  1. Simple Dislocation

    Elbow dislocation without associated fracture. Purely ligamentous and capsular injuries. Emergency reduction, brief immobilization (7-10 days), then early active mobilization. Generally favorable prognosis with complete recovery in 80-90% of cases. Risk of residual instability if the LUCL fails to heal.

  2. Complex Dislocation

    Elbow dislocation associated with one or more fractures (radial head, coronoid process, medial epicondyle, olecranon). Surgical treatment most often necessary to fix fractures and repair ligaments. Longer rehabilitation under hinged brace. More guarded prognosis with increased risk of residual stiffness and chronic instability.

Medical and Surgical Management

  • Simple dislocation: emergency reduction under sedation (traction along the forearm axis + progressive flexion). Post-reduction stability assessment (valgus, varus, and extension testing). Immobilization with posterior splint at 90° elbow flexion for 7-10 days maximum.
  • Complex dislocation: surgical treatment of associated fractures (radial head, coronoid, medial epicondyle fixation) and ligament repair (LUCL ± MCL). Mobilization under hinged brace with protective stops.
  • Residual chronic instability: LUCL reconstruction with tendon autograft (palmaris longus, gracilis). Anchoring technique on the lateral epicondyle and supinator crest of the ulna. Favorable results in 85-90% of cases.

Physiotherapy treatment

  • Early active mobilization upon splint removal (day 7-10). Active flexion-extension within a protected range (avoid the last 30 degrees of extension for the first 3 weeks). Free active forearm rotation. Multiple daily cryotherapy sessions.
  • Strengthening of dynamic elbow stabilizers: anconeus, biceps, brachialis, epicondylar and epitrochlear muscles. Early isometric exercises then concentric from week 4-6. These muscles compensate for residual ligamentous insufficiency.
  • Progressive closed-chain proprioceptive work: hands weight-bearing on table, then wall, then floor. Dynamic stabilization exercises with light perturbations. Rehabilitation of flexor and extensor co-contraction at the elbow.
  • Functional recovery and progressive return to sports. Normal joint range expected in 8-12 weeks for simple dislocations. Complete muscle strengthening. Return to sports at 3-4 months (simple) or 6-9 months (complex). Protective brace recommended when returning to contact sports.

After the session

You may feel slight fatigue or tightness: this is normal. Continue the exercises taught at home to maintain session benefits.

Questions About Elbow Rehabilitation

When should I start physiotherapy after elbow surgery?

Rehabilitation generally begins between 3 and 21 days after the operation, depending on the type of procedure and the stability of the surgical fixation. For fractures treated with stable internal fixation (screw plate), early mobilization is often authorized from D+3 to D+5 to prevent joint stiffness. In cases of elbow replacement or complex ligament repair, the delay may be extended to 2-3 weeks with initial immobilization in a splint. A systematic review published in the Journal of Shoulder and Elbow Surgery confirms that early mobilization after elbow surgery significantly improves final range of motion without increasing the risk of complications [Hackl et al., 2023] . Your surgeon will advise the optimal timing based on your specific procedure.

What are the goals of elbow rehabilitation?

Elbow rehabilitation pursues several complementary goals, adapted to each phase of recovery. In the initial phase (0-6 weeks), the priority is to restore range of motion in flexion-extension (goal: 30°-130° minimum for daily activities) and in pronation-supination (50° in each direction minimum). In the intermediate phase (6-12 weeks), the focus is on progressive muscle strengthening of the flexors, extensors and rotators of the forearm, as well as restoring joint stability through proprioceptive exercises. In the advanced phase (3-6 months), the emphasis is on functional reintegration: daily activities, work tasks and return to sports. Scientific literature highlights that the minimum functional arc of the elbow (30°-130° of flexion-extension, 50° of pronation and 50° of supination) is necessary to perform 90% of daily activities [Mofidi et al., 2020] . Scar treatment and adhesion prevention complete this comprehensive care approach.

Is elbow rehabilitation painful?

The techniques used are progressive and adapted to your tolerance. The elbow is a joint particularly prone to stiffness and inflammatory reactions: overly aggressive rehabilitation can paradoxically worsen the situation by causing heterotopic ossifications (abnormal bone formations in soft tissues). Exercises must be regular but never forced . The physiotherapist always adapts the intensity to stay below the pain threshold, following the "no pain, more gain" rule specific to the elbow. Gentle, regular active mobilization spread across the day in short sequences is generally preferred to prevent stiffness, with early active mobilization recommended after an elbow injury [Akhtar et al., 2021] . Complementary techniques such as cryotherapy , microcurrents and Novafon vibration therapy also help control pain during sessions.

Scientific sources

Average duration

6 to 12 weeks for simple dislocation, 3 to 6 months for complex dislocation

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