Massage therapy · Kitchener–WaterlooElbow Dislocation and Fracture

The elbow is both a hinge joint and a ball-and-socket joint. As the muscles relax and contract, two distinct motions occur at the elbow. The hinge joint lets the elbow bend and straighten, known as flexion and extension. The ball-and-socket joint lets you turn your palm up and down, known as supination and pronation (American Academy of Orthopaedic Surgeons, n.d.).

Dislocations and fractures of the elbow usually happen after a trauma such as a fall, a car accident or another serious impact, and need urgent hospital care so the elbow can be put back into place (American Academy of Orthopaedic Surgeons, n.d.).

These treatments are carried out by the hospital team. Always follow their instructions.

Options outside my scope

• Reduction: the hospital team gently moves the bones back into their normal position, usually after giving pain relief and sedation (American Academy of Orthopaedic Surgeons, n.d.).
• Splint, plaster or sling: after the elbow is back in place, it is usually protected in a splint, temporary plaster or sling until your follow-up appointment at the fracture clinic (American Academy of Orthopaedic Surgeons, n.d.; Cambridge University Hospitals NHS Foundation Trust, 2023).
• X-rays and scans: X-rays confirm the dislocation and check for broken bones, and may be repeated while the elbow heals to make sure the bones stay in line (American Academy of Orthopaedic Surgeons, n.d.).
• Surgery: a complex dislocation, or an elbow that will not stay in line, may need an operation to realign the bones and repair the ligaments, and sometimes the nerves and blood vessels. Afterwards the elbow may be protected with a splint or a hinge on the outside of the arm (American Academy of Orthopaedic Surgeons, n.d.).

How I can help (see the My Approach tab)

• Easing the neck, shoulder and upper back while the arm is protected
• Swelling care and gentle movement within your team's limits
• Rebuilding elbow movement and arm strength

The aim is to get the elbow moving as soon as it is safe to do so, and you may be referred to physiotherapy to help with early movement (Cambridge University Hospitals NHS Foundation Trust, 2023). Keeping the elbow still for a long time can limit how well it moves later, so physical therapy can help you regain movement without risking another dislocation. Once movement improves, a strengthening programme can be added (American Academy of Orthopaedic Surgeons, n.d.).

Some people will never be able to fully straighten the arm, even after physical therapy. Fortunately, the elbow can work very well without a complete range of movement (American Academy of Orthopaedic Surgeons, n.d.).

Sleeping propped up on pillows for the first few nights after the injury may help you feel more comfortable. Follow your fracture clinic's advice on when you can drive, cycle or return to contact sports (Cambridge University Hospitals NHS Foundation Trust, 2023).

• Keeping your shoulder, wrist and hand moving
• Easing the neck, shoulder and upper back that work overtime protecting the arm
• Gentle lymphatic drainage away from the injury, and elevation, for swelling
• Going over the gentle elbow movements your team has allowed

• Hands-on work for the arm muscles, and around the scar once it has healed if you had surgery
• Very gentle, prolonged stretching at the end of your range, often straightening before bending
• Gentle joint mobilisation only once your team agrees, and never in the direction the elbow came out
• Light strength work with lots of repetitions

Increasing pain, new swelling, redness or wound changes, or tingling into the ring and little fingers are reasons to contact your doctor or surgeon.