Chiropractic + Wellness

A dislocated elbow is a common injury in adults and children and often happens in tandem with bone fractures and nerve and tissue damage. Can physical therapy help to support recovery and ensure range of motion?

Dislocated Elbow Injury

Elbow dislocations are generally caused by trauma when the elbow bones no longer connect. Individuals falling onto an outstretched hand is the most common cause of the injury. (James Layson, Ben J. Best 2023) Healthcare providers will try to relocate the elbow using a closed reduction. Individuals may require surgery if they cannot relocate the elbow using closed reduction.

Resetting The Elbow

The elbow is made up of a hinge and ball-and-socket joint, enabling unique motions: (American Society for Surgery of the Hand. 2021)

Hinge joint

• The hinge function allows the bending and straightening of the arm.

Ball-and-socket joint

• The ball-and-socket function allows you to rotate the palm of your hand to face up or face down.

A dislocated elbow injury can damage bones, muscles, ligaments, and tissues. (American Academy of Orthopaedic Surgeons. 2021) The longer the elbow remains out of the joint, the more damage can occur. Elbow dislocations rarely reset into their joints on their own and are recommended to be evaluated by a qualified healthcare provider to prevent permanent damage to nerves or function.

• It is not recommended to try to reset the elbow on your own.
• A healthcare provider will work to restore the joint and ensure proper alignment.
• Before the reset, they will perform a physical examination to assess blood circulation and any nerve damage.
• Providers will order an imaging scan to examine the dislocation and identify broken bones. (American Academy of Orthopaedic Surgeons. 2021)

Type of Dislocation

The two types of elbow dislocations are: (James Layson, Ben J. Best 2023)

Posterior Dislocation

• Occurs when there is a significant force on the palm that spreads toward the elbow.
• Falling with the hands stretched out to catch yourself, and the elbow joint pushes backward/posterior.

Anterior Dislocation

• This is less common and results from applied force on a flexed elbow.
• Falling to the ground when the hand is up near the shoulder.
• In this case, the elbow joint pushes forward/anterior.
• X-rays are used to determine the type of dislocation and to identify any broken bones. (American Society for Surgery of the Hand. 2021)
• Depending on the injury, the provider may order a CT scan or MRI to ensure no damage has occurred to nerves or ligaments. (Radiopaedia. 2023)

Signs and Symptoms

A dislocated elbow injury is often caused by trauma. (American Academy of Orthopaedic Surgeons. 2021) General signs and symptoms include: (American Society for Surgery of the Hand. 2021)

• Inability to move the elbow.
• Bruising and swelling around the area.
• Intense pain in the elbow and surrounding area.
• Deformity around the elbow joint.
• Numbness, tingling, or weakness in the arm or hand can indicate nerve damage.

Treatment Without Surgery

• Healthcare providers initially try to treat a dislocated elbow using a closed reduction technique. (American Society for Surgery of the Hand. 2021)
• A closed reduction means that the elbow can be relocated without surgery.
• Before the closed reduction, a healthcare provider will administer medications to help relax the individual and address the pain. (Medline Plus. 2022)
• Once relocated into the correct position, a healthcare provider applies a splint (usually at a 90-degree angle of flexion) to keep the elbow in place. (James Layson, Ben J. Best 2023)
• The objective is to prevent elbow extension, which can cause re-dislocation.
• The splint remains in place for one to three weeks. (American Academy of Orthopaedic Surgeons. 2021)
• A physical therapist will assess motion and prescribe exercises to prevent elbow range of motion loss.

Treatment With Surgery

• Depending on the severity of the dislocation and the success of the closed reduction, surgery may still be necessary. (James Layson, Ben J. Best 2023)
• If any of the following are being experienced by the individual, a healthcare provider may recommend surgery: (American Academy of Orthopaedic Surgeons. 2021)

1. The elbow remains unstable with a slight extension.
2. The bones are not correctly aligning.
3. The ligaments need further repair after a closed reduction.

• Complex elbow dislocations can make it difficult to maintain joint alignment.
• An assistive device, like an external hinge, may be recommended to help prevent re-dislocating the elbow.
• The surgeon will recommend physical therapy after surgery to assist with range-of-motion exercises to optimize and expedite recovery.

Recovery

• Recovery times can vary as every injury is different. (American Society for Surgery of the Hand. 2021)
• The recovery time depends on the elbow's stability after closed reduction or surgery.
• Healthcare providers will initiate active motion exercises. (American Society for Surgery of the Hand. 2021)
• Limiting how long the joint is immobilized will prevent stiffness, scarring, and inhibited movement.
• Healthcare providers don't recommend immobilization for more than a few weeks.

Resuming Normal Activities

Resuming regular activity often depends on the type of treatment for the elbow dislocation: (Ortho Bullets. 2023)

Closed Reduction

• The elbow is splinted for five to ten days.
• Individuals may engage in physical therapy early motion activity to help prevent loss of range of motion.
• Individuals are recommended to do light exercises within two weeks after the injury.

Surgical Reduction

• The elbow may be placed in a brace that allows for a gradual increase in motion.
• It is essential to maintain controlled movement to prevent motion loss.
• The elbow can extend fully within six to eight weeks, although it could take up to five months for complete restoration.
• The healthcare provider will determine when it's safe to resume normal activity.

The Path to Healing Personal Injury

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to discuss the subject matter above further, don't hesitate to contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Layson J, Best BJ. Elbow Dislocation. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549817/

American Society for Surgery of the Hand. (2021). Elbow dislocation.

American Academy of Orthopaedic Surgeons. (2023). Elbow dislocation.

Jones J, Carroll D, El-Feky M, et al. (2023). Elbow dislocation. Reference article, Radiopaedia.org  https://doi.org/10.53347/rID-10501

Medline Plus. (2022). Closed reduction of a fractured bone.

Ortho Bullets. (2023). Elbow dislocation.

If you’ve ever had a rib slip out of place, you know well the extreme pain it can cause. Every breath can be excruciating. Movement and laughing can also be very painful. It can be located in the back, side, or front on of the ribcage. It is often confused with other conditions such as gastroesophageal reflux disease, a heart condition, pleurisy, or heartburn. The area is usually very tender, and sometimes the area will swell, and a lump will form over the joint. Chiropractic care has been proven to be a very effective treatment for this painful condition.

Structure of the Ribcage

Many people believe that the ribcage is a fixed skeletal structure that houses and protects the heart, lungs, and other internal organs. That is only partly true.

The ribcage is somewhat flexible. Note how the chest expands when inhaling. This is because each rib is attached to the spine by three joints in the back, and to the breastbone by one joint in the front. These joints are small but do allow some movement or flexing so that the ribs do not impair breathing. Instead, they rise and fall with each breath.

However, these joints can become inflamed, and that is where the problems start. Because breathing is an involuntary response – and necessary for life – it is impossible to avoid movement in these joints. When there is inflammation in one or several, it can be unbearable.

Causes of a Rib Subluxation

There is any number of reasons for a dislocated rib. Some experience it by doing simple, everyday things like putting dishes in the dishwasher or putting the milk in the refrigerator. Some of the more common causes include:

• Extreme sneezing or coughing – Excessive or severe coughing such as is associated with bronchitis or pneumonia puts a great deal of strain on the ribcage. However, even coughing due to a common cold can add enough stress to cause the rib to dislocate. Sneezing very hard can also cause it. Often the illness associated with coughing and sneezing can make a person more susceptible to rib dislocation due to the weakened state of the muscles.
• Excessive vomiting – Much like sneezing or coughing, vomiting can also cause this condition. While it does not necessarily involve the lungs, the convulsive action of vomiting can cause a rib to “pop.”
• Exercise – Working out can cause the ribs to move out of position, particularly if the person has poor or improper form, or if they do a lot of work with their arms extended in front of them. This is especially true when weights are involved. The muscles involved in the movement may not be strong enough to handle the added weight and movement combination, causing the rib to move out of place.
• Improper Posture – Poor posture puts stress on the body, including the spine which, in turn, puts pressure on the posterior portion of the ribcage. Over time, this can cause ribs to dislocate.
• Pregnancy – As a woman’s body changes toward the end of her pregnancy, her weight shifts to the front. This can create a continual downward pull on her rib cage, increasing her risk of rib dislocation. 

Symptoms of a Dislocated Rib

Some symptoms of a dislocated rib are dependent on how the rib was dislocated. Common symptoms include:

• Pain or discomfort in the area of the chest or back.
• Swelling and bruising in the affected area.
• The formation of a lump over the injured rib.
• Extreme pain and difficulty when breathing, trying to sit up, or while straining.
• Painful sneezing and coughing.
• Pain when moving or walking.
• Difficulty breathing.
• Numbness or paralysis in nearby or surrounding ribs.
• Tenderness in the affected area.

Treatments for a Dislocated Rib

Chiropractic care is considered one of the best, most effective treatments for dislocated or subluxated ribs. Once the chiropractor has determined that the rib is out of place, he or she will often begin by using various techniques that will “loosen” the area, making the muscles more pliable.

They may do this by using stretching, massage, or a vibration tool. They will then apply gentle but firm pressure to “pop” the rib back into place. In some cases stabilization may be used after to keep the area protected, allowing it to heal. The treatment is usually far less painful than the condition, and some patients report not experiencing any pain at all.

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