Conservative Management of Elbow Dislocations With an Overhead Motion Protocol

• Published in: The Journal of hand surgery (American ed.) Vol. 40; no. 3; pp. 515 - 519
• Main Authors: Schreiber, Joseph J., MD, Paul, Sophia, BA, Hotchkiss, Robert N., MD, Daluiski, Aaron, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2015
• Subjects: Adult; Aged; Cohort Studies; Elbow dislocation; Elbow Joint - injuries; Female; Humans; Joint Dislocations - diagnostic imaging; Joint Dislocations - rehabilitation; Joint Instability - physiopathology; Joint Instability - rehabilitation; Male; Middle Aged; Motion Therapy, Continuous Passive - methods; Orthopedics; overhead motion; Pronation - physiology; Radiography; Range of Motion, Articular - physiology; Recovery of Function; rehabilitation; Retrospective Studies; Supination - physiology; Treatment Outcome; Young Adult; Elbow dislocation; overhead motion; rehabilitation
• ISSN: 0363-5023; 1531-6564
• DOI: 10.1016/j.jhsa.2014.11.016

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.