The results of treatment after closed reduction of elbow dislocation vary. Twenty consecutive patients with closed posterior elbow dislocations were treated prospectively on a rapid motion, nonimmobilized functional regimen. This treatment protocol emphasizes immediate active range of motion under close supervision. No slings or splints were employed. Final range of motion averaged -4 degrees to 139 degrees. All patients attained final extension within 5 degrees of the contralateral side. Each patient achieved his final range of motion within an average of 19 days after reduction of the dislocation. Arm circumference returned to normal at an average of 6.5 days. There was one redislocation. After treatment, all patients met qualification for graduation from the U.S. Naval Academy and were able to pursue unrestricted athletic and career options. Our findings suggest that an aggressive immediate motion rehabilitation allows nearly full final elbow motion and an excellent functional outcome.

Placing and holding the knee in 120 degrees of flexion immediately following a quadriceps contusion appears to shorten the time to return to unrestricted full athletic activities compared with reports in other studies.

In brief Quadriceps contusions can frustrate athletes, because the time away from athletic activity is variable and unpredictable. The determining factor in returning the patient to play safely is whether the patient has regained 120° or more of knee flexion. Immobilization for the first 24 hours in 120° of knee flexion- which preserves the needed flexion and minimizes intramuscular bleeding and spasms- accomplishes this goal quickly. Muscle stimulation and stretching also help the athlete recover quickly.

Context:Acute lateral patellar dislocation is a common injury sustained by athletes, and often requires several months to recover and return to play.Objective:To describe a novel protocol for the treatment of acute lateral patellar dislocation that returns patients to play far sooner than traditional treatment protocols.Design:Case series and review of the literature.Setting:Division I NCAA institution.Patients:Two collegiate athletes who sustained first-time acute lateral patellar dislocations.Interventions:Traditional standard of care for acute lateral patellar dislocation after reduction involves 1–7 weeks of immobilization in full extension. Knee stiffness commonly results from this method, and return to full activity typically takes 2–4 months. We used a protocol involving immobilization in maximal flexion for 24 hr, with early aggressive range of motion and quadriceps strengthening in the first week after injury.Main Outcome Measures:Time to return to play.Results:Immediate on-site reduction of the patella followed by 24 hr of immobilization in maximal knee flexion was performed. Following an accelerated rehabilitation regimen, patients were able to return to sport an average of 3 days postinjury. Neither patient has experienced a recurrent dislocation.Conclusions:Our protocol is based on anatomic studies demonstrating reduced tension on the medial patellofemoral ligament, reduced hemarthrosis, and reduced soft tissue swelling in maximal knee flexion. This method apparently bypasses the knee stiffness and deconditioning commonly seen with traditional nonoperative regimens, allowing return to sport weeks or months sooner.

In brief The clinical diagnosis of anterior shoulder dislocations can be made by evaluating the mechanism of injury and noting limited arm adduction and shoulder rotation. In addition, the shoulder loses its normal rounded contour, and the acromion is unusually prominent. Prereduction x-rays are not always necessary but will confirm the clinical diagnosis. Reduction of the dislocation should be performed as quickly, gently, and safely as possible. Linear force via a self-reduction technique or a simple, passive traction technique will lead to a successful reduction in the vast majority of patients.