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Management After Simple Dislocation of the Elbow

David Nolan, PT, DPT, MS, OCS, SCS, CSCS

October 26, 2016

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Question

What is they typical managment for a simple elbow dislocation?  

Answer

A simple dislocation is going to require a closed reduction.  There are no fractures in a simple dislocation.  If the joint is stable after reduction, we can start with immediate active range of motion in a pain free range. We want to get them moving right away, but not cranking into pain. Typically they'll be given compression garments to control swelling, and then we can also start working on gripping. Now, if the joint is deemed to be unstable after reduction, they'll typically be immobilized, in either a cast or a brace.  According to the literature, if immobilization is greater than 14 days, or 2 weeks, we see a much higher risk of stiffness, even in the individuals that have instability after reduction with a simple dislocation. In other words, a dislocation without any fractures is only soft tissue related.  If it's unstable after reduction, they'll be immobilized but for a relatively short period of time, typically no longer than 2 weeks.

It’s also important to work on pronatory and supintory strength to provide stability in and through the joint. When we look at the restraints of both varus and valgus force at the elbow, and think about where those muscles cross-like other parts of the body, if we have damage to the ligamentous structures, we have to start thinking about how can we augment the dynamic structures, or the contractile tissue to be there to help provide some stability. In the elbow, that's going to be working on pronation and supination strength.


david nolan

David Nolan, PT, DPT, MS, OCS, SCS, CSCS

Dr. Nolan is an Associate Clinical Professor at Northeastern University in the Department of Physical Therapy, Movement and Rehabilitation Sciences as well as a Graduate Lecturer in the College of Professional Studies in the transitional Doctor of Physical Therapy Program at Northeastern University.  David is also a Clinical Specialist at the Mass General Sports Physical Therapy Service and the Director of the MGH / Northeastern University Sports Physical Therapy Residency Program. 

Dr. Nolan is a board certified Orthopedic Clinical Specialist and Sports Clinical Specialist through the American Board of Physical Therapy Specialties and a Certified Strength and Conditioning Specialist through the National Strength and Conditioning Association.  He is a past recipient of the “Excellence in Clinical Teaching” award from the New England Consortium of Academic Coordinators of Clinical Education as well as the award for Outstanding Achievement in Clinical Practice by the Massachusetts Chapter of the APTA.  Dr. Nolan was also presented with the 2019 Lynn Wallace Clinical Educator award from the American Academy of Sports Physical Therapy. 


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