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# Elbow dislocation

An elbow dislocation is when the forearm bones come out of the elbow joint, nearly always backward; it is the second most dislocated large joint in adults.

Updated 2026-10-29

## Structures involved

Tap one to see what it is and open it in 3D.

- [Elbow capsule](https://durgical.com/en/anatomy/elbow-joint-capsule/)
- [Ulna](https://durgical.com/en/anatomy/ulna/)
- [Humerus](https://durgical.com/en/anatomy/humerus/)
- [UCL (elbow)](https://durgical.com/en/anatomy/ulnar-collateral-ligament-of-the-elbow/)
- [Radius](https://durgical.com/en/anatomy/radius/)
- [Radial head cartilage](https://durgical.com/en/anatomy/cartilage-of-the-radial-head/)
- [Brachial artery](https://durgical.com/en/anatomy/brachial-artery/)
- [Median nerve](https://durgical.com/en/anatomy/median-nerve/)
- [Ulnar nerve](https://durgical.com/en/anatomy/ulnar-nerve/)

## What it is

Loss of contact between the [humerus](https://durgical.com/en/anatomy/humerus/) and the [ulna](https://durgical.com/en/anatomy/ulna/) and [radius](https://durgical.com/en/anatomy/radius/) at the elbow, nearly always with the forearm bones displaced backwards (posterior dislocation). It is the second most common major joint dislocation in adults after the shoulder.

## Who gets it

Typical in young adults and adolescents after falls during sport, and in older people after simple falls. In children, supracondylar fractures are more common than dislocations after a similar fall.

## Causes

- Fall onto an outstretched hand with the elbow extended
- Combined axial load, valgus and supination of the forearm
- High-energy trauma such as traffic accidents

## Risk factors

- Contact sports, gymnastics, skating and cycling
- Falls in older adults
- Ligamentous laxity
- Previous elbow dislocation

## Pathophysiology

Injury usually progresses from lateral to medial (Horii circle): the lateral ulnar collateral ligament fails first, then the capsule, and finally the medial collateral ligament. Simple dislocations involve only soft tissues; complex ones include fractures. The [brachial artery](https://durgical.com/en/anatomy/brachial-artery/) and the median and ulnar nerves cross the elbow and can be stretched or trapped.

## Classification

- By direction: posterior or posterolateral (most common), anterior, medial, lateral, divergent
- Simple (no fracture) versus complex (with fracture)
- Terrible triad: elbow dislocation with radial head fracture and coronoid process fracture, highly unstable
- Other complex patterns: dislocation with medial epicondyle fracture in adolescents

## Symptoms and signs

- Severe pain and obvious deformity after a fall
- Elbow held in partial flexion, unable to move
- Prominent olecranon at the back of the elbow
- Swelling and later bruising

## Red flags

- Absent or weak radial pulse, cold or pale hand (brachial artery injury)
- Numbness or weakness in the median or [ulnar nerve](https://durgical.com/en/anatomy/ulnar-nerve/) territory, or a new deficit after reduction
- Pain out of proportion or tight forearm (compartment syndrome)
- Open dislocation
- Elbow that redislocates easily after reduction (complex instability)

## Diagnosis

**Clinical**
Deformity with loss of the normal triangle between the epicondyles and the olecranon. Clinicians check radial and ulnar pulses, capillary refill, and median, ulnar and [radial nerve](https://durgical.com/en/anatomy/radial-nerve/) function before and after reduction, and examine the shoulder and wrist.

**Tests**
Not usually needed. Pulse oximetry or Doppler of the hand if circulation is in doubt.

**Imaging**
X-rays before and after reduction in two views to confirm direction, look for fractures (radial head, coronoid, epicondyles) and confirm a concentric reduction. CT for complex fractures; angiography if arterial injury is suspected.

## Differential diagnosis

- Supracondylar humerus fracture (especially in children)
- Radial head or olecranon fracture
- Monteggia fracture-dislocation
- Radial head subluxation in young children
- Isolated radial head dislocation

## Goal of treatment

Reduce the joint promptly, protect the artery and nerves, restore a stable elbow and recover motion while avoiding stiffness.

## Treatment

**Acute**
Prompt closed reduction under analgesia or sedation, followed by checks of pulses and nerves and post-reduction X-rays.

**Conservative**
Simple stable dislocations: short immobilisation in a splint for comfort, then early protected movement to avoid stiffness.

**Surgical**
Surgery for complex dislocations (terrible triad: fixation or replacement of the radial head, coronoid fixation and lateral ligament repair), irreducible or unstable joints, and arterial injury.

**Rehabilitation**
Physiotherapy to regain flexion, extension and forearm rotation.

## Complications

- Stiffness and loss of full extension (the most common)
- Recurrent instability
- Heterotopic ossification
- Brachial artery injury
- Median or ulnar nerve injury, sometimes with nerve trapped in the joint
- Compartment syndrome and post-traumatic arthritis

## Prognosis

Simple dislocations usually do well with early movement, though a small loss of extension is common. Complex injuries, especially the terrible triad, carry more risk of stiffness, instability and arthritis.

## Prevention

- Protective technique and equipment in sport
- Fall prevention in older adults

## Test yourself

Think of the answer, then tap the question to see it.

## What is the most common direction of elbow dislocation?

Posterior (or posterolateral): the ulna and radius move backwards relative to the humerus.

## What is the terrible triad of the elbow?

Elbow dislocation with a radial head fracture and a coronoid process fracture; it is highly unstable and usually treated surgically.

## Which artery and nerves must be checked before and after reducing an elbow dislocation?

The brachial artery (radial and ulnar pulses) and the median, ulnar and radial nerves.

## Which ligament usually fails first in a posterolateral elbow dislocation?

The lateral ulnar collateral ligament, at the start of the lateral-to-medial injury sequence (Horii circle).

## What is the most common complication after a simple elbow dislocation?

Stiffness, especially loss of full extension, which is why early movement is encouraged.

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## Related conditions

- [Supracondylar humerus fracture](https://durgical.com/en/conditions/supracondylar-humerus-fracture/)
- [Acute compartment syndrome](https://durgical.com/en/conditions/acute-compartment-syndrome/)
- [Cubital tunnel syndrome (ulnar neuropathy at the elbow)](https://durgical.com/en/conditions/cubital-tunnel-syndrome/)
- [Shoulder dislocation](https://durgical.com/en/conditions/shoulder-dislocation/)
- [Distal radius fracture (Colles)](https://durgical.com/en/conditions/distal-radius-fracture/)
- [Radial head subluxation (pulled elbow)](https://durgical.com/en/conditions/radial-head-subluxation/)
- [Olecranon bursitis](https://durgical.com/en/conditions/olecranon-bursitis/)
- [Humeral shaft fracture](https://durgical.com/en/conditions/humeral-shaft-fracture/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Posterior Elbow Dislocation](https://www.ncbi.nlm.nih.gov/books/NBK470574/) (StatPearls (NCBI Bookshelf), 2023).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/conditions/elbow-dislocation/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/elbow-dislocation/