In light of unexpected retirement of Vontae Davis the reported dislocation of Phillip Gaines elbow that occurred in the Bills’ Sunday’s game against the Los Angeles Chargers is potentially serious, especially given the lack of depth at the cornerback position. Elbow dislocations are potentially serious injuries depending on the structures that are injured when the dislocation occurs.
There are several types of dislocations associated with the elbow. In small children, pulling on a child’s fully extended arm can result in a condition called “Nursemaid’s Elbow”. This is actually a proximal dislocation of the radial head.
In teens and young adults, including most athletes, the most common type of dislocation is the posterior dislocation of the ulna. All dislocations are considered Grade 3 strains and are classified as such because the dislocation occurs because of the complete disruption of at least 1 ligament in the elbow associated with stabilizing the joint.
In addition, the elbow also has many nerves and blood vessels passing thru it. Dislocations are sometimes associated with nerve and or blood flow compromise as a result of the dislocation. Failing to recognize this immediately, can lead to permanent damage to the nerves and or blood supply which could lead to permanent damage. It is for this reason that elbow dislocations can lead to lasting damage that can be catastrophic if it is not addressed rapidly.
In addition to ligament, nerve and blood flow issues, dislocations can be associated with fractures including fractures of the radial head (5% – 10%), avulsion fractures of the medial and lateral humeral condyles (12%), and fractures of the coronoid process (10%) are commonly seen in athletes who experience elbow dislocations.
Elbow dislocations typically occur when an athlete falls on a fully extended arm or are struck by another player with significant force on the medial aspect of the elbow which forces the ulna in a medial direction.
An elbow dislocation is normally diagnosed with an x-ray . Provided no fracture is identified, a closed reduction under local anesthesia is performed and then the elbow is immobilized with a sling for 1-2 weeks. The joint is treated with PRICE – Protection, Rest, Icing, Compression, Elevation.
Generally the immobilization is done for 1-2 weeks and the athlete is only allowed to do minimal isometric exercises to keep the muscles active. If no fracture was identified at the time of diagnosis, the athlete then progresses to gradual strengthening and range of motion to attempt to regain full flexion and extension of the joint. This sounds simple, however up to 50% of athletes who experience an elbow dislocation report limited range of motion for months or longer after the initial injury.
In patients who are also diagnosed with a fracture of one or more of the bones of the elbow, surgery may be needed at the time of reduction to stabilize the bone fragments. This complication greatly increases the time to recover. Once the swelling and pain has subsided and the athlete is able to fully move the elbow, they can return to the playing field.
In most pro athletes with simple dislocations this occurs in 2-3 weeks. The major issue for returning to active participation is free movement without pain of the affected joint. Given the typical 4-6 week minimum for a grade 3 strain , a good estimate for him returning is 3-6 weeks. His status will bear watching over the next few weeks.
Editor’s babble: As if the Bills needed another loss at the cornerback position, ugh! Thanks to Dr. Beth Sullivan for sharing her expertise and terrific contributions to our blog. You can follow Beth on Twitter @GAPeachPolymer.