Elbow Dislocation?
Elbow Dislocation: When Your Elbow Pops Out
Elbow dislocation is the second most common large joint dislocation in adults. Here is what to do immediately, how to tell if you need surgery, and why early motion after reduction is the most important factor in full recovery.
When the Elbow Dislocates
An elbow dislocation happens when the bones of the forearm (radius and ulna) are forced out of their normal alignment with the upper arm (humerus). It is the second most common large joint dislocation in adults, most commonly caused by a fall on an outstretched hand or a direct impact during contact sport.
The immediate signs are unmistakable: severe pain, visible deformity with the elbow appearing abnormally angular, inability to move the elbow, and significant swelling within minutes. This is an emergency department injury — reduction (putting it back) must happen the same day.
An elbow dislocation requires same-day reduction in an emergency setting under sedation. Once reduced, follow up with Dr. Chambers within 3–5 days to assess stability and plan early rehabilitation. The elbow stiffens very rapidly without early motion — specialist follow-up is not optional.
Simple vs. Complex Dislocation
Simple Dislocation
No significant fracture accompanies the dislocation. The joint is reduced in the ER, X-rayed post-reduction to confirm alignment, and splinted briefly. Early motion within 1–2 weeks is critical — prolonged immobilisation leads to permanent elbow stiffness that is very difficult to treat. 80% of simple dislocations do not need surgery.
Complex Dislocation (With Fracture)
Fractures occurring with elbow dislocation dramatically increase complexity:
- Radial head fracture: The radial head is a lateral elbow stabiliser. Comminuted (shattered) radial head fractures associated with dislocation require fixation or replacement.
- Coronoid fracture: The coronoid is the primary restraint against posterior dislocation. Even small coronoid fractures with dislocation indicate significant instability. Large fractures need surgical fixation.
- Terrible triad: Dislocation + coronoid fracture + radial head fracture. One of the most challenging injuries in elbow surgery, requiring surgical stabilisation of all three components and ligament reconstruction.
Recurrent Elbow Instability (PLRI)
Posterolateral rotatory instability (PLRI) occurs when the lateral collateral ligament complex is torn during dislocation and does not heal adequately, leaving the elbow prone to re-dislocation or a “giving way” sensation with specific movements. Symptoms: a clunking or giving-way feeling when pushing up from a chair or performing a push-up. Treatment: lateral collateral ligament reconstruction, highly effective for restoring elbow stability. See Elbow Ligament Injuries →
Rehabilitation — Early Motion Is Everything
The elbow is the most stiffness-prone joint in the body. Even after a simple dislocation, failure to begin active range-of-motion exercises within 1–2 weeks results in significant permanent stiffness. Dr. Chambers’ post-reduction protocol emphasises:
- Active range-of-motion exercises beginning within 1–2 weeks of reduction
- Physical therapy focusing on flexion, extension, and forearm rotation
- Dynamic splinting for persistent stiffness beyond 6–8 weeks
- Arthroscopic elbow contracture release for severe stiffness not resolving with therapy
Frequently Asked Questions
An elbow that “pops out” is an elbow dislocation — the radius and ulna have shifted out of their normal articulation with the humerus. It is the second most common large joint dislocation after the shoulder. Simple dislocations (no fracture) are treated with closed reduction (manipulation back into place) under sedation, followed by a brief period of immobilisation. Complex dislocations involve fractures and ligament tears and require surgical management.
No. An elbow dislocation requires urgent reduction — manipulation back into the joint — performed in an emergency room under sedation or anaesthesia. Leaving an elbow dislocated causes rapidly progressive joint damage, vascular compromise, and nerve injury. After reduction, simple dislocations with intact ligaments can be treated non-surgically with early range-of-motion therapy. Complex dislocations involving fractures of the coronoid, radial head, or distal humerus require surgical stabilisation.
Simple elbow dislocation: 6–8 weeks to return to most activities. Full strength and range of motion: 3–6 months. The elbow is the most stiffness-prone joint in the body — early range-of-motion therapy within 1–2 weeks of reduction is critical to prevent permanent stiffness. Complex dislocations requiring surgery: 3–6 months to return to normal activity.
Approximately 80% of elbow dislocations (simple dislocations without major fracture) are treated without surgery — closed reduction, brief splinting, and early motion. Surgery is needed for: terrible triad injuries (dislocation + coronoid fracture + radial head fracture), dislocations with persistent instability after reduction, associated fractures requiring fixation, and chronic posterolateral rotatory instability (PLRI) from recurrent dislocation.
Terrible triad is a specific elbow injury pattern combining dislocation with fracture of both the coronoid process and the radial head — three injuries that together make the elbow highly unstable. It is called “terrible triad” because it is one of the most complex and challenging injuries in elbow surgery. It requires surgical fixation of the fractures and ligament reconstruction. Dr. Chambers has subspecialty experience in this complex injury pattern.
Dislocated Elbow? Early Motion Prevents Permanent Stiffness.
Specialist follow-up within 5 days of reduction is essential. No referral needed.
Stephen Chambers, M.D.
Dual Board-Certified Hand & Upper Extremity Surgeon · Raleigh Orthopaedic