PFATS Articles
Posterior Elbow Dislocation in a Professional Football Player
Jim Keller MA, ATC Assistant Athletic Trainer Denver Broncos
OBJECTIVE
The purpose of this presentation is to review the mechanism, diagnosis, management and rehabilitation of a simple posterior elbow dislocation in a professional football player. The presentation will investigate an accelerated rehabilitation protocol attempting to restore early motion, regain full function and decrease time loss.
BACKGROUND
The elbow is a very stable joint but dislocations do occur. The goals of the rehabilitation protocol are to decrease pain and inflammation, restore joint mobility and range of motion, increase strength, endurance and neuromuscular control and return to activity. The athletic trainer must realize the importance of beginning early range of motion in an unstable joint, while avoiding terminal extension. The protocol must follow a rapid progression in working all the elements of the kinetic chain in the upper extremity.
KEY POINTS
Simple vs. Complex: Simple elbow dislocations are dislocations that produce soft tissue injury surrounding the joint, whereas dislocations with associated fractures are listed as complex.
NFL Statistics: Over the past 22 seasons 64 elbow dislocations have been reported during the regular season. Basically there are 1-2 elbow dislocations annually. Of the 64 reported cases, 28 were documented as a posterior elbow dislocation. The average time loss for this injury is 38 days with a median of 30 days.
Pain Control: Pain must be controlled early in the rehabilitation process. Decreasing pain is a must in restoring movement. Use of modalities throughout the day is an essential step in controlling pain.
Immobilization: Athlete comfort is a priority in decreasing pain and inflammation as well as allowing the athlete to move the elbow with normal kinetic movement. Compression and immobilization (hinged ROM brace) must be used and adapted as the athlete improves and gains confidence in the upper extremity.
Soft tissue: Soft tissue massage techniques are a must to help restore soft tissue mobility to the joint and surrounding anatomical structures. Applied techniques must focus on the elbow, as well as tissue distal and proximal to the joint. Soft tissue massage may be used to increase lymphatic flow, increase joint mobility and act as a pain controlling modality.
Stabilization Exercises: Stabilization exercises may be instituted early in the rehabilitation protocol and must be increased appropriately throughout the entire program. These exercises enhance the neuromuscular control of the upper extremity. The progression should be from simple to complex exercises and advancing into more sport specific activities. The athlete should respond favorably to the stabilization exercises and increase their confidence in the entire upper extremity.
Bracing: Athletes with dislocated elbows must wear a functional elbow brace to return to activity. The brace helps withstand the shearing forces the athlete will incur in contact sports as well as increase their confidence. Custom fit braces have evolved into a compact size that protects the joint without compromising the upper extremity. The brace may be preset in a range of motion that avoids terminal extension and decreases the chance of secondary injury.
CLINCAL APPLICATION
Following a complete diagnosis by the team physicians, rehabilitation of a simple posterior elbow dislocation may begin. Studies have shown that an accelerated rehabilitation protocol may be instituted and time loss can be shortened through successful rehabilitation. A positive outcome is based on strict supervision of the medical staff and compliance of the athlete.
REFERENCES
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Miyasaka K.C. Anatomy of the elbow. Orthopedic Clinics of North America. 30(1), 1-13, 1999.
Plancher K.D., Lucas T.S. Fracture dislocations of the elbow in athletes. Clinics in Sports Medicine. 20(1), 59-76, 2001.
Rettig A.C. Traumatic elbow injuries in the athlete. Orthopedic Clinics of North America. 33, 509-522, 2002.
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