Elbow Dislocation: Overview and Evidence Summary

Condition Overview

Elbow dislocation occurs when the ulna and radius are forcibly displaced from their articulation with the distal humerus. It is a dramatic injury—often visually striking, intensely painful, and functionally disabling in the moment it occurs. Yet, compared with other major joint dislocations, the elbow generally has excellent healing potential when managed appropriately.

Elbow dislocations classically result from a fall onto an outstretched hand, where the combination of axial load, valgus force, and supination propels the ulna posteriorly relative to the humerus. Posterior dislocations—where the ulna shifts backward—are by far the most common. Less frequently, the elbow may dislocate anteriorly, medially, laterally, or undergo complex divergent dislocation patterns involving severe ligamentous disruption.

The stability of the elbow relies on a remarkable interplay between bony architecture, capsuloligamentous structures, and surrounding musculature. The trochlear notch of the ulna forms a deep, congruent articulation with the humerus, providing inherent stability even before ligaments or muscles contribute. But when high-energy forces exceed the tolerance of soft tissue stabilizers—particularly the lateral ulnar collateral ligament (LUCL)—the joint can dislocate with surprising speed.

Patients typically describe a sudden, sharp pain accompanied by deformity, instant loss of function, and a sense that the arm is “out of place.” Following reduction, pain often improves significantly, but stiffness, swelling, and guarding remain. Depending on the severity of soft tissue damage, some individuals develop chronic instability, limited extension, or prolonged stiffness, emphasizing the importance of early, structured rehabilitation.

While most elbow dislocations are closed injuries with no associated fracture, a significant subset involves concomitant injuries—the so-called “terrible triad” (elbow dislocation + radial head fracture + coronoid process fracture) being particularly well known for its complexity. Pure ligamentous dislocations generally recover well, whereas fracture-dislocations demand a more cautious and often surgical approach.

A successful outcome depends on timely reduction, early recognition of associated injuries, careful immobilization, and progressive rehabilitation tailored to the integrity of ligaments and overall elbow stability.

Summary of Current Evidence for Elbow Dislocation

Evidence-Based Management Discussion

Understanding Stability: The Pillars of the Elbow Joint

The elbow is often described as a hinge joint, but this simplification undersells its complexity. Stability arises from three primary sources:

1. Bony congruence, especially the deep trochlear notch of the ulna

2. Capsuloligamentous structures, notably the medial collateral ligament (MCL), lateral collateral ligament (LCL) complex, and annular ligament

3. Dynamic stabilizers, including the triceps, biceps, brachialis, wrist flexors, and extensors

Posterior elbow dislocation typically involves sequential failure: the LUCL gives way, followed by anterior and posterior capsule tearing, and finally MCL involvement in more severe cases. The degree of soft tissue injury determines whether the elbow remains stable after reduction or whether it requires prolonged protection or surgical stabilization.

Clinical Presentation and Early Priorities

At the time of injury, deformity is usually obvious, and patients hold the elbow slightly flexed, cradled with the other hand. Swelling develops quickly. Neurovascular assessment is critical—the brachial artery and median nerve are vulnerable in severe dislocations, while the ulnar nerve may be irritated from valgus stress. Fortunately, major neurovascular injuries are uncommon in simple dislocations.

Reduction—often performed in an emergency setting—provides immediate relief. However, a successful reduction is not the end of care; in many ways, it is the beginning. Once the joint is realigned, attention shifts to swelling control, early movement, and protection from re-dislocation.

The Importance of Early Mobilization

One of the defining features of elbow rehabilitation is the need to avoid prolonged immobilization. The elbow is extraordinarily prone to stiffness, and even a week of immobilization can lead to contracture, especially in extension. Historically, many dislocations were immobilized for too long, resulting in long-term functional limitations. Modern protocols emphasize:

• Brief immobilization for comfort (typically 5–10 days for simple dislocation)

• Early, protected movement—especially flexion and controlled extension

• Avoidance of terminal extension early on, where instability risk is greatest

The goal is to balance ligament healing with prevention of stiffness.

Exercise Therapy

Rehabilitation progresses according to stability, pain, and soft tissue healing.

Phase 1: Protection and Assisted Mobility (Week 1)

Once pain is controlled and stability confirmed:

• Gentle active-assisted flexion and extension begin

• Forearm rotation is encouraged early (unless limited by fracture)

• Grip strengthening prevents hand/forearm deconditioning

• Edema management (compression, elevation, gentle movement) is essential

Patients must avoid varus or valgus loading early on, as ligaments need time to heal.

Phase 2: Active Motion and Strength Reintroduction (Weeks 2–4)

With improving stability:

• Active ROM expands carefully

• Light isometric strengthening begins, particularly for biceps, triceps, and forearm muscles

• Functional tasks such as feeding or grooming may resume

The therapist carefully monitors for apprehension or signs of instability.

Phase 3: Strengthening and Functional Training (Weeks 4–8)

As ligaments regain tensile strength:

• Resisted flexion/extension and pronation/supination progress

• Weight-bearing through the arm begins (e.g. closed-chain pressing on a table)

• Proprioceptive training re-establishes joint awareness

Sport- or job-specific movements are gradually reintroduced.

Phase 4: Return to High-Level Function (Weeks 8–12+)

Late-stage rehab focuses on:

• Power and speed for athletes

• Heavier lifting for manual workers

• Full-range motion restoration

• Elimination of compensatory strategies

In many cases, function continues to improve for several months.

Manual Therapy

Manual therapy becomes particularly valuable once early healing has occurred and the elbow demonstrates stable motion. Goals include:

• Restoring extension (the motion most vulnerable to long-term limitation)

• Improving flexion and rotation

• Reducing myofascial guarding in triceps, biceps, brachialis, and wrist musculature

Joint mobilization techniques—especially graded mobilisation in the humeroulnar and humeroradial joints—can meaningfully enhance comfort and movement.

Pain Management and Secondary Issues

Pain often responds well to NSAIDs and heat/ice regimes. Muscle guarding may persist, especially after traumatic injury, and therapists must guide patients through a graded approach that avoids both excessive protection and premature overload.

Heterotopic ossification (HO) is a potential complication—especially after high-energy dislocation or in individuals with delayed mobilization. Early recognition and movement-based prevention strategies are essential.

When Surgery Is Necessary

Surgery is indicated when:

• The elbow remains unstable after reduction

• A fracture compromises stability (radial head, coronoid, olecranon)

• There is a ligament avulsion requiring repair

• Reduction cannot be maintained

• Neurovascular structures are threatened

The terrible triad, in particular, often requires operative stabilization.

Clinical Considerations for Therapists

Therapists have a profound influence on outcome. Their responsibilities include:

• Preventing stiffness through early, appropriate movement

• Monitoring for instability, apprehension, or recurrent subluxation

• Progressing strengthening gradually and safely

• Supporting the patient emotionally after a traumatic event

• Ensuring return to function is meaningful, not merely symbolic

The elbow is resilient—but only when guided through a thoughtful rehabilitation pathway.

References

Josefsson, P., et al. “Elbow Dislocations: Epidemiology and Short- to Long-Term Outcomes.” Acta Orthopaedica, updates 1980–2015.

O’Driscoll, S., et al. “Elbow Instability and the Lateral Collateral Ligament Complex.” Journal of Bone and Joint Surgery, 1992 and modern revisions.

Schreiber, J., et al. “Nonoperative Management of Simple Elbow Dislocations.” Clinical Orthopaedics and Related Research, 2014.

Pugh, D., et al. “The Terrible Triad of the Elbow.” Journal of Orthopaedic Trauma, 2004 and updates.

Taylor, F., et al. “Rehabilitation After Elbow Dislocation: Best Practice Recommendations.” Physiotherapy Journal, 2017.

Disclaimer

The information in this article is intended for educational purposes and is designed for qualified massage therapists, manual therapists, and rehabilitation professionals. It is not a substitute for medical advice, diagnosis, or treatment. Practitioners must work within their legal scope of practice and regional regulations. Hands-on techniques should only be performed by appropriately trained and licensed individuals. Niel Asher Education is not responsible for any injury, loss, or damage resulting from the use of this content.