A dislocated shoulder occurs when the humerus separates from the scapula at the glenohumeral joint. The shoulder joint has the greatest range of motion of any joint in the body and as a result is particularly susceptible to subluxation and dislocation. Approximately half of major joint dislocations seen in emergency departments involve the shoulder. Partial dislocation of the shoulder is referred to as subluxation. Posterior elbow dislocation (PED) occurs when the radius and ulna are forcefully driven posterior to the humerus. Specifically, the olecranon process of the ulna moves into the olecranon fossa of the humerus and the trochlea of the humerus is displaced over the coronoid process of the ulna. PED is classified as simple or complex and staged according to severity. Significant pain, sometimes felt along the arm past the shoulder. Inability to move the arm from its current position, particularly in positions with the arm reaching away from the body and with the top of the arm twisted toward the back, numbness of the arm, visibly displaced shoulder. Some dislocations result in the shoulder appearing unusually square and no palpable bone on the side of the shoulder. The estimated incidence of elbow dislocations in the U.S. population is 5.21 per 100,000 person-years, with use of a national database. Adolescent males are at highest risk for dislocation. Nearly half of acute elbow dislocations occurred in sports, with males at highest risk with football, and females at risk with gymnastics and skating activities.
Elbow dislocations are common, and account for 10-25% of all elbow injuries in the adult population. Most elbow dislocations are closed and are most frequently posterior (sometimes posterolateral or posteromedial) although anterior, medial, lateral and divergent dislocations are also infrequently encountered). Posterior dislocations typically occur following a fall onto an extended arm, either with hyperextension or a posterolateral rotatory mechanism.
An elbow dislocation should be considered an emergency injury. The goal of immediate treatment of a dislocated elbow is to return the elbow to its normal alignment. The long- term goal is to restore function to the arm. The treatment is of two types: Nonsurgical Treatment and Surgical Treatment. Treatment for simple dislocations is usually straightforward and the results are usually good. Some people with complex dislocations still have some type of permanent disability at the elbow. Treatment is evolving to improve results for these people. One of the areas being researched is the best time to schedule surgery for the treatment of a complex dislocation. For some patients with complex dislocations, it seems that a slight delay for final surgery may improve results by allowing swelling to decrease. The dislocation still needs to be reduced right away, but then a brace, splint, or external fixation frame may rest the elbow for about a week before a specialist surgeon attempts major reconstructive surgery. Moving the elbow early appears to be good for recovery for both kinds of dislocations. Early movement with complex dislocations can be difficult. Pain management techniques encourage early movement. Improved therapy and rehabilitation techniques, such as continuous motion machines, dynamic splinting (spring-loaded assist devices), and progressive static splinting can improve results. Radiographs and CT scan are the advanced treatment methods.