Review Question - QID 3155

Prolonged splinting following simple elbow dislocations of greater than 2 weeks after reduction can lead to chronic stiffness and poor outcomes and should be avoided. All of the remaining answers are appropriate in the rehabilitation of these injuries.

Simple elbow dislocations are second only to the shoulder in rates of joint dislocation. Closed reduction with early rehabilitation has proven the most effective treatment for these injuries when the elbow is stable. Rehabilitation for a simple elbow dislocations should include initial splinting in 90 degrees of flexion with neutral forearm rotation and immediate active and active-assist range of motion through a stable arc. Full extension should be avoided initially in rehab. The patient should be encouraged to use the affected arm for light duty immediately following immobilization.

Mehloff et al. determined that elbows splinted longer than 2 weeks had decreased ROM at 1 year. They further describe the benefits of using the affected arm for light duty after 2 weeks of rest.

Smith et al. describe the effectiveness of immediate active and active-assist ROM exercises after reduction.

O'Driscoll et al. describe how to test an elbow for posterolateral instability, which can occur after an elbow dislocation. They emphasize the elbow is most unstable in extension immediately after injury. Therefore, the elbow should be splinted in 90 degrees of flexion with neutral forearm rotation until therapy begins.

Figure A is a lateral radiograph of the elbow which shows a simple posterior elbow dislocation. The anatomic description is based on the anatomic location of olecranon relative to humerus.