The elbow is a very stable joint with bony anatomy that is rigid and locks it in place. In comparison, a shoulder joint can move around in many directions. The elbow flexes or brings the hand towards the face and it also extends which brings the hand away from the face. It has very little side to side motion and rotation.
This jigsaw puzzle piece connection is in contrast to the shoulder which has ligaments that allow it to move in all different planes. The elbow is held in place by its conforming bony structure. It is surrounded by a joint capsule and has ligaments on both sides of the joint, the medial and lateral side with the ulnar collateral and the radial collateral ligaments.
Elbow dislocations occur from falls mostly. The joint dislocates when a ligament or ligaments tear, culminating in the bones shifting out of place. Sometimes there can be a fracture. The appearance of a dislocated elbow joint can be very dramatic depending on the angle of the arm.
When falling onto an outstretched hand the weight of the body is coming down onto a hand that is locked in place. As the elbow is being held in position if the body weight and the force behind it tears the ligaments, then the bones shift and move. It is important to act quickly to try to relocate the dislocation. Nerves can be stretched and injured if the joint is out of position for a prolonged period of time.
Putting it back in place usually involves realigning the angle of deformity and then pulling traction on the lower part or the olecranon. After you distract the bones you can then push them back into position. Imagine a sliding screen door that has slid off its track. You have to lift it up and shift it back in place to make it work again.
After a reduction maneuver, an x-ray is taken to check on the alignment of the bones to make sure there were no fractures as part of the reduction. One also wants to check for stability after reduction to make sure that the elbow will not dislocate again too easily. When the ligaments tear and the reduction is stable, surgery is usually not needed.
When the ligaments tear and the reduction is unstable or muscles have been pulled off, then surgery may be required. Surgery can involve fixing any fractures and repairing any ligaments and tendons that are torn. Sometimes ligaments need to be reconstructed if the native ligament cannot be reattached. If a reconstruction is performed on the inner side of the elbow for the ulnar collateral ligament this is known as the famous Tommy John surgery originally performed by Dr. Frank Jobe on the pitcher Tommy John.
It became legendary in the rehab and sports medicine world because of the improved function and speed that Tommy John was able to deliver after the surgery. Unfortunately, many high school pitchers are now undergoing the procedure at alarming rates.
After surgery, a lot of physical therapy is needed to regain motion and prevent stiffness. The goals of any treatment whether it is non-operative or operative is to regain full range of motion and improve strength. Typically range of motion will be achieved by 4 to 6 weeks. Strength takes many months even up to a year. The goal of any surgery or rehab is to come back just as strong with full range of motion.