Dislocation of the elbow – epicondylopathy and instabilities

The dislocation of the joint and the consequences

Dislocation of the elbow – epicondylopathy and instabilities

Instabilities and dislocations are one of the most common injuries to the elbow joint

What is an elbow dislocation?

The most common injuries to the elbow joint include dislocations of the joint and instabilities, which often occur as a result of dislocation. After the shoulder joint, the elbow joint is the second most affected by a dislocation. The most common dislocation in children is the dislocation of the elbow.1

When the joint is dislocated, the ligaments that stabilise the joint are often torn. The joint capsule and muscles are separated. Depending on the extent of the dislocation, the otherwise tightly connected bones in the joint move against each other. In particular, the outer collateral ligament complex, which consists of several collateral ligaments, is usually affected by injuries.

The diagram shows a right elbow joint viewed from the outside. It also shows the external ligament complex, which consists of several ligaments and can tear in the event of a dislocation.

In severe cases, dislocations cause both torn ligaments and a fracture of the bone involved in the joint structure (elbow dislocation fracture). These are humerus, radius and elbow ulna. 

Instabilities of the elbow joint

Instability means that the joint is no longer stable due to injury to the capsule, ligaments and muscles, and thus is limited in its function. It hurts and the articular cartilage may be damaged, which can lead to premature wear (arthrosis) of the joint.

Causes of dislocations and instabilities of the elbow joint

The cause of a dislocated elbow are accidents in which there is a high impact on the joint. Instabilities are usually caused by ligament injuries. These can arise acutely – usually after a dislocation (luxation) or fracture (elbow fracture) has been caused. In almost one third of cases, instabilities of the joint remain after dislocations.

Symptoms and signs: Pain and swelling

If the elbow is dislocated, there is a malposition of the joint, and movement is restricted. The patient suffers from severe pain and the elbow is usually swollen. Often the pain also radiates into the neighbouring regions of the body. If the elbow dislocation is not treated, numbness and sensory disturbances or sensitivity problems may occur, which may spread to the arms and hands.

Risk factors:
Avoid frequently repeated stresses

A frequently recurring load and/or stress, for example in overhead sports, can lead to chronic damage to the ligaments, resulting in instability. Instabilities can be also a consequence of treatment with cortisone injections or surgery on the elbow.

Preventing dislocations and joint weakness

Falls are hardly foreseeable and therefore are difficult to avoid. Therefore, it is difficult to prevent an elbow from becoming dislocated. People with innate instability of the elbow joint or with habitual dislocations (which occur repeatedly when moving and exercising and without any force applied) should spare the joint unnecessary exertion and avoid risks.

Treatment for dislocations and instabilities of the elbow joint

The tendency to develop joint stiffness is higher for the elbow than for other joints. Therefore, early functional treatment of the dislocation and instabilities with rapid mobilisation is crucial. Continuous monitoring by the doctor treating the patient is important in order to adapt the therapy accordingly.

Therapy for dislocations

Treatment for dislocations: Elbow relocation and after-treatment

The most crucial measure after a dislocation is the relocation of the elbow (reposition) to avoid damage – especially to vessels and nerves. This is usually done in a clinic after previous X-ray diagnostics.

What must then be established is the type of damage done to the joint. This can be discovered by a magnetic resonance tomographic (MRI) examination, possibly also by a computed tomography (CT).

Light ligament injuries can be treated as non-surgical (conservative), often using a stabilising brace.

Severe injuries usually have to be operated on. As part of the operation, bones are knit back together again, and ligaments sewn or reinforced by other tendons.

Therapy for instabilities

Therapy for instabilities of the elbow

Depending on the degree of instability, in mild cases treatment is mainly physiotherapy. In severe cases, an operation to stabilise the joint is required to ensure painless use of the joint and prevent further damage.

Physio exercises for treatment after an elbow dislocation

The treatment does not follow a rigid time schedule. Instead, it needs to be adapted individually, depending on the capabilities of the patient. Therefore, discuss the exercises, the variations and the degree of difficulty with your doctor or your therapist. Training also helps you to return to the sport following an elbow dislocation.

The muscles that stabilise the elbow are first trained in isolation from one another. Over the course of the therapy or if it is safely carried out, different muscle groups are integrated into more complex motion sequences. In the final stage, before returning to sport, dynamic exercises are useful.

Training can be done easily at home and requires only household equipment. The exercises should be done three times a day.

Stage 1: Isolation

Bicep curls

Equipment:

  • Hand towel

Starting position:

  • Sitting on a stable seat

How to do it:

  • Pass the towel under your knee.
  • Grasp the two ends of the towel.
  • Lift your leg by bending the elbow with the towel.
  • Do all of this without lowering your leg to the floor.

Variation:

  • none

Frequency:

  • You control the intensity by the pressure of your leg 1 set x 20 repetitions three times a day

Forearm curls

Equipment:

  • 1 kg dumbbell/ alternatively, a drinks bottle with content of approx. 1 l

Starting position:

  • Sitting on a stable seat

How to do it:

  • Lay your forearm on your thigh.
  • Make sure that the palm is facing upwards.
  • Bend the wrist upwards.
  • Then lower the wrist back down onto your thigh.

Variation:

  • Make sure that the palm is facing downwards.
  • Rotation of the wrist by 180°.

Frequency: 

  • 1 set x 30 repetitions (10 repetitions / variation) three times a day

Stage 2: Integration

Bent-over lateral raise

Equipment:

  • 1 kg dumbbell/ alternatively, a drinks bottle with content of approx. 1 l

Starting position:

  • Standing

How to do it:

  • Stand firmly and shoulder-width apart.
  • Your knees are slightly bent.
  • Bend your upper body forwards slightly.
  • Lift your shoulders and upper arms to the side.
  • Stretch and bend your elbows.
  • The movement takes place only from the elbow.

Variation:

  • none

Frequency: 

  • 1 set x 20 repetitions
  • three times a day

Dips

Equipment:

  • none

Starting position:

  • Sitting on a stable seat

How to do it:

  • Lean on an edge for support.
  • Lower your hips in front of the seat.
  • Then raise your buttocks by stretching your elbows.
  • The thumbs should face one another.
  • Keep your knees bent.
  • Keep your feet on the floor.

Increased level of difficulty:

  • Stretch Legs Stretch the hips and legs

Frequency: 

  • 1 set x 20 repetitions three times a day

Stage 3: Dynamics

Punch with some weight

Equipment:

  • 1 kg dumbbell/ alternatively, a drinks bottle with content of approx. 1 l

Starting position:

  • Standing

How to do it:

  • Stand firmly with your knees slightly bent and shoulder-width apart.
  • Lift your hands with the dumbbells to chest height.
  • Make sure that the palms are facing upwards.
  • Stretch out your arms straight ahead.
  • When stretching, turn your palms by 180°.
  • Move your outstretched arms back so that they are now close beside your body.
  • When you do this, turn your palms back by 180°.

Increased level of difficulty:

  • Over the course of therapy, you can increase the impact dynamics and/or the weight.

Frequency: 

  • 1 set x 20 repetitions
  • three times a day

Press-ups

Equipment:

  • Yoga blocks / books

Starting position:

  • Press-up position

How to do it:

  • Place your hands shoulder-width apart onto the floor.
  • Keep your knees on the floor.
  • Lower your upper body.
  • Move your elbows close to your body.
  • Your head is in alignment with your spine.

Increased level of difficulty:

  • Classic press-ups with raised knees 
  • Higher repetitions of press-ups

Frequency: 

  • 1 set x 20 repetitions three times a day

medi products for elbow treatment

 

Source

1 see https://medlexi.de/Ellenbogenverrenkung_(Ellenbogenluxation)

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