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Elbow Luxation 291

Elbow Luxation Client Education
Sheet
VetBooks.ir Chronic Treatment Diseases and Disorders

DIAGNOSIS
BASIC INFORMATION
• Immobilization with elbow bandaged in
Definition Diagnostic Overview extension for 1-2 weeks
Dislocation between brachium (humerus) and Diagnosis is based on history, physical exam, and • Initially, a heavy padded bandage (or more
antebrachium (radius and ulna) radiographs (sedated patient) of the affected limb rigid splint; spica splints preferred for open
to include carpus, elbow, and shoulder joints. reductions and those with severe collateral
Synonym ligament damage), with gradual reduction
Elbow dislocation Differential Diagnosis in bandage thickness/stiffness as swelling
• Distal humeral fracture subsides and stability increases
Epidemiology • Monteggia fracture (cranial displacement of • Gentle, passive range-of-motion (flexion/
SPECIES, AGE, SEX radial head and proximal ulna fracture) extension) physiotherapy instituted after
• Uncommon in dogs; rare in cats • Elbow neoplasia bandage removal
• Any breed, age, or sex for traumatic luxations • Continued use of analgesic/antiinflammatory
• Juvenile dogs for congenital luxations Initial Database agents as needed for patient comfort
• Craniocaudal and mediolateral radiographs
GENETICS, BREED PREDISPOSITION of the elbow Possible Complications
• Congenital luxations generally are more • Survey radiographs for other traumatic • Recurrent luxation/instability: most common
common in small breeds of dogs, but injuries, especially thoracic cavity complication
radial head luxation specifically occurs more • Radiographs of the contralateral elbow in • Articular cartilage damage and secondary
frequently in larger breeds. patients with congenital or developmental osteoarthritis
• Suspected hereditary predisposition luxations • Reduced range of motion from pericapsular
• Chondrodystrophic breeds are prone to • Assess for neurologic injury; check for limb fibrosis
asynchronous growth between radius and withdrawal and pain sensation. • Chronic lameness
ulna, resulting in subluxation.
Advanced or Confirmatory Testing Recommended Monitoring
RISK FACTORS CT scan useful to detect small articular lesions • Postreduction radiographs to confirm restora-
Forelimb trauma or fractures tion of joint congruency
• Weekly bandage check/change until removal
ASSOCIATED DISORDERS TREATMENT • Lameness evaluations 2, 4, and 8 weeks after
Some forms of congenital luxation may be surgery; radiographs at 2 weeks and at 6-8
associated with more generalized joint laxity Treatment Overview weeks if open reduction/implants
syndromes. Goal of therapy is to achieve anatomic reduction
of joint surfaces so normal joint mobility is PROGNOSIS & OUTCOME
Clinical Presentation restored, with eventual return to full weight
DISEASE FORMS/SUBTYPES bearing and elimination of discomfort. • Most dogs and cats with properly treated
• Traumatic traumatic luxations will return to normal
• Congenital, complete Acute General Treatment or near-normal function.
• Congenital, partial (radial head luxation only) • Traumatic elbow luxations are best managed • Chronic fibrosis will result in a permanently
by early closed reduction before muscle thickened elbow.
HISTORY, CHIEF COMPLAINT contraction makes manipulations difficult • More guarded prognosis for congenital/
• Forelimb trauma secondary to motor vehicle (p. 1158). developmental luxations
accident, fall, or rough play/fighting • Patient must be anesthetized for reduction. • Severe complications/failures might neces-
• Spontaneous • Concurrent injuries may result in postpone- sitate salvage surgery (arthrodesis, total joint
• Lameness/deformity in young dog ment of anesthesia and early reduction. arthroplasty, or amputation).
• If closed reduction is not achieved, open
PHYSICAL EXAM FINDINGS reduction and reconstruction of the collateral PEARLS & CONSIDERATIONS
• Traumatic: non–weight-bearing lameness ligaments are indicated.
with antebrachium and paw abducted, elbow • If open reduction is needed, the limb should Comments
flexed, and severe elbow swelling and pain be bandaged to reduce patient discomfort • Early diagnosis is critical for promoting
• Congenital: partial weight-bearing lameness and tissue swelling before surgery. successful closed reduction.
and joint thickening; discomfort during • Use of a modified transarticular external • Closed reduction for a lateral luxation is
range-of-motion maneuvers fixator instead of a splint can maintain joint achieved by flexing elbow (moves anconeal
stability, and it is in place for 3-4 weeks after process caudally), followed by abduction
Etiology and Pathophysiology reduction and/or surgery. of the antebrachium, with the paw flexed
• Majority of traumatic luxations are lateral • Appropriate analgesics should be administered. (moves anconeal process medially, attempt-
(proximal radius/ulna are lateral to distal • Congenital luxations are less amenable to ing to hook anconeal process medial to
humerus). closed reduction, which is best attempted lateral epicondylar crest of the humerus),
• Medial luxations are associated with severe at 4 months of age or younger. followed by adduction and pronation of
soft-tissue derangements. • Congenital luxations may require osteotomies the antebrachium (attempting to snap the
• Traumatic injuries may cause avulsion or ostectomies for treatment. radial head medially to its proper location
fracture(s) of collateral ligament(s). • Surgical intervention for congenital luxations under the capitulum of the humerus as the
• Congenital/developmental luxations and may slow progression of osteoarthritis. anconeal process acts as a fulcrum).
subluxations may be associated with asyn- However, some dogs with radial head luxa- • Can consider temporary pharmacologic
chronous growth of the radius and ulna. tion do well with conservative management. paralysis of the patient (requires ventilation
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