Can a Dislocated Elbow Reoccur After Being Casted?

Will there be another dislocation after having a cast applied?

After having a cast applied, is it possible to dislocate the joint again? I dislocated my right elbow in a car accident yesterday.
Initially, the bone was protruding significantly, and the doctor at Mackay Memorial Hospital asked me to get an X-ray.
Because my hand moved during the X-ray, it seemed like the bone had relocated itself.
However, when I went to the outpatient clinic, the doctor confirmed it was only a dislocation, and he helped to reduce it and applied a cast.

When I returned home and tried to sleep, I moved my arm and heard a cracking sound, as if the joint had split open again, and the pain was so intense that I broke out in a cold sweat; I couldn't move my entire arm.
The next day, it felt like there was fluid moving inside my elbow joint, so I went to the emergency room to check if the joint had shifted.
The X-ray showed no bone displacement, but since I already had a cast, why was there a cracking sound, as if the bone was moving? Additionally, any slight movement of my arm causes excruciating pain.
Is this normal? Thank you, doctor.

Anan, 60~69 year old female. Ask Date: 2020/12/19

Dr. Chen Yongxue reply Orthopedics

Hello, in the case of an elbow dislocation, generally, after reduction, simple splinting is sufficient to reduce swelling.
However, if the injury is severe or accompanied by ligament damage, it can lead to joint instability.
Even with the protection of a cast, it may not be able to maintain the reduction.
Sometimes, surgery may be necessary.

Reply Date: 2020/12/19

More Info

Dislocated elbows can indeed be a concern even after being casted. When an elbow is dislocated, the bones that form the joint are forced out of their normal positions. Treatment typically involves realigning the bones, which is often done through a process called reduction. After the elbow has been successfully reduced, a cast is applied to immobilize the joint and allow for healing.

However, there are several factors that can contribute to the risk of re-dislocation after the initial injury and treatment. First, the surrounding ligaments and soft tissues may be damaged during the dislocation, which can lead to instability in the joint. If the ligaments do not heal properly or if they are overly stretched, this can increase the likelihood of the elbow dislocating again, even after being casted.

In your case, the "cracking" or "popping" sound you hear when moving your arm could be a sign of several things. It might indicate that the joint is not moving smoothly due to swelling, inflammation, or the presence of fluid in the joint space. This can happen after an injury and may be accompanied by pain, as you described. The pain and inability to move your arm could also suggest that there is still some underlying issue, such as inflammation or even a potential re-dislocation, despite the X-ray showing no movement of the bones.

It's important to note that while some discomfort and noise can be normal during the healing process, severe pain, especially if it is accompanied by swelling or a feeling of instability, should not be ignored. The presence of fluid in the joint, which you mentioned, could indicate an effusion, which is often a response to injury or inflammation. This can lead to increased pressure in the joint and contribute to pain and limited mobility.

Given your symptoms, it is crucial to follow up with your healthcare provider. They may recommend further imaging studies, such as an MRI, to assess the soft tissues around the elbow, including ligaments and tendons, to determine if there is any damage that needs to be addressed. Depending on the findings, treatment options may include physical therapy to strengthen the muscles around the joint, or in some cases, surgical intervention may be necessary to repair any damaged ligaments or stabilize the joint.

In summary, while a cast is an important part of the healing process for a dislocated elbow, it does not guarantee that re-dislocation will not occur. The risk factors include the extent of soft tissue damage, the quality of the healing process, and the stability of the joint post-treatment. If you are experiencing significant pain and instability, it is essential to seek medical attention promptly to ensure proper evaluation and management of your condition.

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