Conservative management of elbow dislocations with an overhead motion protocol

J Hand Surg Am. 2015 Mar;40(3):515-9. doi: 10.1016/j.jhsa.2014.11.016. Epub 2015 Jan 21.

Abstract

Purpose: To report the results of using an overhead motion protocol in 27 patients and to assess final range of motion and incidence of persistent instability in this cohort.

Methods: A total of 27 patients were included who sustained a simple elbow dislocation and were treated nonsurgically with an overhead motion protocol designed to convert gravity from a distracting to a stabilizing force. Motion was initiated within 1 week of injury and average follow-up was 29 months. Final arc of motion and prevalence of instability were the primary outcomes measures.

Results: Final mean arc of extension to flexion was from 6° to 137°, and of pronation to supination was from 87° to 86°. No recurrent instability was observed in this cohort and all patients were fully functional and without limitations at latest follow-up.

Conclusions: The overhead motion protocol was a reliable rehabilitation program after elbow dislocation that allowed for controlled early motion by placing the elbow in an inherently stable position. Prompt initiation of motion in a protected position can optimize final motion and satisfaction outcomes, and when done in a mechanically advantageous position it can potentially limit the risk of recurrent instability.

Type of study/level of evidence: Therapeutic IV.

Keywords: Elbow dislocation; overhead motion; rehabilitation.

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Elbow Injuries*
  • Female
  • Humans
  • Joint Dislocations / diagnostic imaging
  • Joint Dislocations / rehabilitation*
  • Joint Instability / physiopathology
  • Joint Instability / rehabilitation*
  • Male
  • Middle Aged
  • Motion Therapy, Continuous Passive / methods*
  • Pronation / physiology
  • Radiography
  • Range of Motion, Articular / physiology*
  • Recovery of Function
  • Retrospective Studies
  • Supination / physiology
  • Treatment Outcome
  • Young Adult