Rich Porter’s good manners are a great asset most of the time. They come in handy at his job as a fundraiser with the University of Michigan. But once, his nice guy routine backfired and sent him tumbling into a world of pain.
“The funny thing is, I have had rough falls from my bike before, but I didn’t get hurt,” says Porter, who lives in Atlanta. “This time, a guy in a car let me turn in front of him, so I let go of my handlebars to wave thank you. That’s when I lost my balance and fell.”
And that’s when Porter popped his elbow out of its socket and understood what it must feel like to be Tyler Eifert.
It hurts. A lot.
Eifert, the star tight end for the Cincinnati Bengals, dislocated his elbow during a hard fall in the first quarter of his team’s 2014 season opener, a win against the Baltimore Ravens. The oft-injured Eifert said it was probably the worst pain he’s ever felt. He missed the rest of the season.
A Rough Landing
“As I was falling, I put my right arm down to stop myself,” says Porter, who got hurt in May 2015. He didn't just dislocate his elbow. He also broke the bones in his forearm -- the ulna and radius -- and tore some ligaments.
“It’s natural to put your arm out to break a fall,” says David Marshall, MD, medical director for the sports medicine program at Children’s Healthcare of Atlanta. “But if you fall down on it with too much force, you can dislocate it.”
When a rough landing sends all your weight through your outstretched hand and up into your elbow, it can cause a turning motion that pushes and rotates the joint out of its socket. It’s most likely to happen in sports where it’s easy to lose your balance, like football, gymnastics, or wrestling.
The elbow is the second most commonly dislocated joint, after the shoulder. Still, it’s a fairly rare injury among the weekend warrior crowd.
It happens a lot less often than a dislocated shoulder, says John Green, MD, an orthopaedic surgeon with UW Medicine at the University of Washington in Seattle. “The elbow is a pretty stable joint.”
Different Types of Injuries
There are two basic kinds of elbow dislocation:
- A simple one doesn’t involve a major bone injury.
- A complex one does have broken bones. You might need surgery to fix it.
Porter’s injury was complex -- and then some. He had surgery to repair the damage, and then he developed bone growth in the soft tissue in his elbow. If this happens to you, your doctor may call it “heterotopic ossification.”
That’s not uncommon after joint surgery, says Porter, who will have a second operation to remove the misguided bone. Doctors have told him to expect a full recovery.
What Happens in a Simple Dislocation?
Gabrielle Aguilar was lucky to avoid surgery. The young gymnast from Maryland was performing on the uneven bars during training when she dislocated both her elbows.
“It was a freak accident,” says her mother, Sheryl. “She was flying from the low bar to the high bar, something she’s done a thousand times. She missed the bar and actually landed on her feet. Then she fell badly on her hands.”
In the emergency room, under sedation, Gabrielle received the standard treatment for a simple dislocation. A doctor put her elbows back in place using a process called reduction.
“Usually it’s something that can be done fairly easily. It pops back into place with a high degree of regularity,” Green says.
The Path to Recovery
Getting the elbow back in place is the easy part. Making a full recovery can take different methods of treatment and rehab, depending on your injury.
Even if the doctor can slide your elbow right back into its socket, you should keep it in a sling or splint for a couple of weeks. That stops it from moving while it heals. After that you’ll do some simple exercises to work on your range of motion -- that's the normal amount joints can move in certain directions. This kind of dislocation usually heals well.
Complex dislocations that need surgery are tougher. Sometimes it’s better to delay the operation. This gives the swelling time to go down. It may be best to rest your elbow in a brace or splint for about a week before surgery.
Your physical therapist will create a rehab program just for you. Here’s what a basic post-op routine might look like:
1-4 weeks: Keep your elbow raised. Use ice to lower swelling. Use a splint when you’re still, but you will do some range-of-motion exercises. Your physical therapist may massage the area -- he might call this soft-tissue mobilization.
5-8 weeks: You’ll add exercises with and without weights to your range-of-motion routines. If you’re an athlete, you’ll work in some sport-specific activities, too. And you’ll continue the soft-tissue treatments.
9-16 weeks: By now you'll have full range of motion and normal strength in your elbow. You should be back to doing what you did before the injury.
Sometimes It’s a Kid Thing
You may be more likely to take your kid in for this kind of injury than to get one yourself. There’s a type of partial dislocation called nursemaid’s elbow, or pulled elbow, and it’s common in tots 4 and younger.
It usually happens when you pull a child by his hands. His ligaments are loose because his bones aren’t fully formed. It’s easy for them to slip right over the radial head -- the thing that helps him flex and bend his elbow and forearm -- or get trapped in the elbow joint.
It happened to Bethany Afshar’s daughter Katie twice. The first time was when she was almost 2 and ran behind her big brother into the swimming pool. Her father quickly pulled her out of the pool by her left arm.
“Later, we noticed that she couldn’t pick up a pacifier with that arm and took her to urgent care,” says Afshar, who lives in Georgia. “They gave her a Popsicle, lifted her arm and twisted it real quickly back into place, just like that.”
Katie got the same treatment after it happened again in preschool a year or two later, “probably on the jungle gym,” Afshar says. Katie is 9 now, and it hasn’t happened since. The risk drops as kids get older -- their ligaments tighten and their bones grow.
“Nursemaid’s elbow is one of my favorite diagnoses, because it’s so fixable in the moment,” says Kate Cronan, MD, an emergency room physician at Alfred I. duPont Hospital for Children in Wilmington, DE. “It’s rare that we can fix something that easily and make a child feel all better that quickly.”