Early functional mobilization for non-operative treatment of simple elbow dislocations: a systematic review

Abstract

Purpose This systematic review aims to elucidate a non-operative rehabilitation program that optimizes recovery based on published approaches and outcomes. Methods Searches of four databases from inception to 1 January 2020 were performed to identify clinical studies addressing the non-operative management of simple elbow dislocations. Results Of 2435 studies that were eligible for title screen, 15 studies satisfied inclusion criteria. Three randomized control studies demonstrated that early mobilization expedited the return of range of motion, function and return to work or activities, however, resulted in increased pain within the six-week rehabilitation period compared to Plaster of Paris casting for 21 days. Patients returned to work sooner after early mobilization (10 vs. 18 days; p = 0.02) compared to Plaster of Paris casting. In all studies, early mobilization resulted in similar re-dislocation rates of 1.3% (3/237) versus 2.2% (12/549) in those with Plaster of Paris casting as well as lower incidence of heterotopic ossification (36% vs. 54%). No significant differences between rehabilitation protocols were determined; however, the large majority of recent papers utilized rehabilitation protocols. Conclusion Early mobilization of simple elbow dislocations results in early return of Range-of-Motion, function and return to work with no increase in complication rates; however, increased pain during the rehabilitation period.

Acute elbow dislocation: a critical appraisal of the literature

“…The rest consisted of level III-V evidence. 4 , 11 , 14 , 32 As is typical for surgical management of orthopedic conditions, it is hard to reduce the risk of bias for surgical interventions. A narrative review is discussed regarding the most current and relevant literature on AED.…”

Investigating the Effects of Physical Therapy Timing, Intensity and Duration on Post-Traumatic Joint Contracture in a Rat Elbow Model

“…After a simple elbow dislocation, a protective brace is often used to lock the elbow at 90° of flexion for the first 1-3 weeks to limit extension and to avoid varus stress on the lateral collateral ligament (8). However, early mobilization after simple elbow dislocation resulted in an expedited return of ROM, function and return to work (25). Importantly, in either scenario, the severity of the damaged structures, motivation of the patient, and pain play a major role in the strategy a clinician chooses.…”

Early Mobilization of Simple Elbow Dislocations

“…A recent systematic review of the literature confirmed early return of range of motion and function, as well as quicker return to work, in patients with early mobilization after dislocation 3 . Animal studies have added to the evidence for this approach to simple elbow dislocation.…”