Elbow Dislocations

In adults, the elbow is the second most dislocated joint in the body, succeeding shoulder dislocations. Most elbow dislocations occur in the posterior direction, which causes a disengagement of the “coronoid process of the ulna from the trochlea of the humerus” (Chicharoen, Kwon, Windle, & Lovato, 2014). Typically, the mechanism of injury is falling on an outstretched hand (FOOSH) with the elbow in an extended position upon impact. For example, an athlete participating in the first practices for two-a-day fall football was running a defensive back contact drill, and upon collision of the ground, the athlete extended his arm to catch himself. This case study, as like many previous athletes, presented with a shortened forearm that was held in

The first three days the elbow will be immobilized by hinged braces, plaster cast, and slings at 90 degrees. The pain can be managed by NSAIDS’s, Ice, and IFC, and the athlete should avoid passive elbow ROM. After three days, the athlete will be positioned approximately “30-90 degrees of flexion” in a hinged braced for four to two weeks (Houglum, 2005). The athlete is instructed to increase extension by five degrees and ten degrees of flexion each week. Active movement will be initiated with slow, gradual shoulder isometrics and grip strength. Grip strength exercises can be performed by therapeutic putty, hand grips, therapeutic bands, or isometric contraction exercises. Shoulder isometrics are done along a wall focusing on abduction, extension, and flexion. Isometrics of the elbow include actively pushing against a table, specifically working on flexion, extension, supination, and pronation. However, the athlete should stay away from external rotation and internal rotation to prevent the risk of re-injury. During the acute inflammatory phase of the healing process, modalities that can be utilized to help control pain are ice, interferential current, and effleurage. Grade I and grade II anterior joint mobilization can be performed to help combat pain. Posterior joint mobilizations for the elbow joint would be a contraindication

Therapeutic goals for the fourth phase of rehabilitation include using full range of motion and strength capabilities of the entire affected arm, pain-free participation, and restore their functional abilities to pre-injury level. The previously stated isotonic elbow activities should be continuous to maintain strength in the surround musculature. More complex plyometric activity, such as push-ups, BAPS board, UE ladders, and UE step ups, can be used to progress upper extremity stability. Maintaining core strength while injured is a vital key for transitioning back into the desired sport. Ways that core strength can be achieved is by planks, Russian twist, crunches, and leg lifts. Additionally, cardiovascular fitness can be specifically tailored to their sport. In this phase, more sports specific skills are becoming incorporated into the rehabilitation process. Some modalities during this phase, and through returning the athletes to their sport, are a type of warm modality, such as a heat pack before activity, and a cold modality after activity. The athlete may return to play once they have full range of motion, no pain, full strength, true proprioceptive control, and an adequate cardiovascular fitness level (Houglum,