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Health condition

Elbow trauma, from simple dislocation to complex fracture-dislocation.

A single hub for acute elbow injury. Soft tissue, ligament, tendon, bone and nerve, with the assessment and reduction steps that protect your long-term function.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Editorial team

    Written by our editorial team from the UK sources listed on each page.

  • 02

    Sourced from guidance

    Checked against BOAST, BOA and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance on elbow injury assessment, reduction and early mobilisation.

Key facts

Elbow trauma at a glance.

The essentials, in plain English. What it covers, the patterns you need to know, and the priorities that keep the elbow moving.

  • What it is

    A spectrum of acute elbow injury from soft tissue bruising and pulled elbow in children to complex fracture-dislocations in adults.

  • Most common patterns

    Simple posterior dislocation from a fall on outstretched hand, radial head fracture, and paediatric supracondylar fracture.

  • Terrible triad

    Elbow dislocation with radial head and coronoid fractures. Unstable and specialist-managed.

  • Neurovascular check

    Median, ulnar and radial nerves plus brachial and radial pulses must be checked before and after any reduction.

  • Compartment risk

    Supracondylar fractures in children can cause Volkmann ischaemic contracture. Serial checks are essential.

  • Rehab is critical

    Stiffness is the biggest long-term problem. Early controlled mobilisation guided by an upper limb team protects range.

Why this guide matters

Speed protects the elbow.

Elbow injury is unforgiving. The right first hour, the right imaging and an early rehabilitation plan decide how much movement you get back.

  • Neurovascular status is time-critical

    Median, ulnar and radial nerve function plus pulses must be checked, documented and rechecked around any manipulation.

  • Reduce simple dislocations early

    Prompt closed reduction under sedation stabilises the joint and reduces the risk of persistent pain and stiffness.

  • Rehabilitation prevents stiffness

    Early controlled mobilisation with a specialist elbow physiotherapist is the single biggest driver of good long-term function.

How the diagnosis is made

From injury to a clear plan.

The steps a UK emergency and orthopaedic team will follow, in order, so you know what to expect and why.

  1. 01

    Assessing

    Primary survey and analgesia

    ATLS approach in significant trauma. Airway, breathing, circulation, plus opioid or Entonox analgesia and a splint in neutral flexion.

  2. 02

    Assessing

    Focused history

    Mechanism, timing, hand dominance, occupation and sport. FOOSH, direct blow and traction injuries each suggest different patterns.

  3. 03

    Assessing

    Neurovascular examination

    Median, ulnar and radial nerve motor and sensory function plus brachial and radial pulses and capillary refill. Documented before and after any manipulation.

  4. 04

    Confirming

    Inspection and palpation

    Look for deformity, swelling, wounds and skin threat. Palpate the epicondyles, olecranon, radial head and biceps for the hook test.

  5. 05

    Confirming

    Plain X-ray AP and lateral

    Standard first-line imaging. Anterior and posterior fat pad or sail signs point to an occult intra-articular fracture.

  6. 06

    Planning

    CT for complex injury

    For intra-articular, comminuted or preoperative planning, particularly radial head, coronoid and distal humerus fractures.

  7. 07

    Planning

    MRI or specialist review

    For suspected ligament rupture, distal biceps tendon tear or occult fracture. Referral to upper limb trauma or orthopaedics for definitive care.

Typical timeline: from injury to a definitive plan within hours, not days.

Injury types

The spectrum of elbow trauma.

From simple soft tissue injury to complex fracture-dislocation. Each pattern has its own signs and its own priorities.

  • Simple dislocation

    Posterior in over 90 percent. Obvious deformity, loss of triangle between epicondyles and olecranon, unable to move the elbow.

  • Complex dislocation

    Dislocation with radial head or coronoid fracture. The terrible triad is inherently unstable and needs specialist reconstruction.

  • Fractures

    Distal humerus, olecranon, radial head and neck, and coronoid. Often signalled by a positive fat pad sign on the lateral view.

  • Supracondylar (children)

    Common paediatric injury. Gartland I to III grading guides management. High risk of neurovascular compromise.

  • Ligament injuries

    Medial (MCL/UCL) or lateral (LCL/LUCL) collateral tears. Instability with valgus or varus stress or after reduction.

  • Distal biceps rupture

    Weightlifters and eccentric loading. Popeye sign, positive hook test and squeeze test, sudden pop with loss of supination strength.

  • Pulled elbow

    Radial head subluxation under the annular ligament in children under five after a traction pull. Simple reduction manoeuvre restores use.

  • Red flag - neurovascular or open

    Absent pulse, cool pale forearm, expanding haematoma, tense compartments or an open wound. Urgent theatre call.

Treatment

How elbow trauma is treated in the UK.

Immediate reduction and stabilisation, then targeted surgery for complex injuries and structured rehabilitation for everyone.

  • Closed reduction

    For simple dislocation under sedation using Parvin, Meyn or Fowles techniques. Post-reduction neurovascular check and X-ray are mandatory.

  • Above-elbow backslab

    A splint in around 90 degrees flexion for one week after reduction. Longer immobilisation risks stiffness.

  • Surgical fixation

    For displaced fractures, terrible triad and unstable patterns. Options include ORIF, radial head replacement and ligament repair.

  • Distal biceps repair

    Surgical repair within three to four weeks using single or double incision with EndoButton fixation. Specialist upper limb care.

  • Triceps tendon repair

    Selective surgical repair for complete rupture, particularly in steroid users or with functional weakness.

  • Fasciotomy

    Emergency decompression if compartment syndrome develops, especially in paediatric supracondylar injuries.

  • Pulled elbow manoeuvre

    Supination and flexion, or hyperpronation, in the awake child. Reassurance and safety-netting for the family.

  • Structured rehabilitation

    Specialist elbow physiotherapy with early controlled range work, then progressive loading and return to sport or work.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your emergency clinician or orthopaedic surgeon knows your injury and can tell you which parts apply to you. If in doubt, get seen.

  • BOAST. Supracondylar fractures in the humerus in children.

  • BOAST. Open fractures (BOAST 4).

  • British Orthopaedic Association (BOA) standards for trauma and orthopaedics.

  • NICE. Fractures (complex): assessment and management (NG37).

  • Royal College of Emergency Medicine. Elbow injury best practice guidance.

Red flags

When elbow injury needs urgent attention.

Many elbow injuries settle with sensible first aid. These are the situations where waiting is dangerous and specialist care is needed now.

  • Absent distal pulse

    A pulseless, pale or cool forearm after elbow injury is a surgical emergency. Reduce urgently and call the vascular or trauma team.

  • Compartment syndrome

    Disproportionate pain, pain on passive stretch and tense forearm compartments. Volkmann ischaemic contracture can follow within hours.

  • Open injury

    Any wound overlying the elbow points to an open fracture. Antibiotics, tetanus, photograph, saline dressing and urgent theatre per BOAST 4.

  • Nerve injury

    New median, ulnar or radial nerve deficit before or after reduction needs urgent specialist review and consideration of exploration.

  • Terrible triad or complex dislocation

    Dislocation with radial head and coronoid fracture is unstable. Refer to specialist upper limb trauma for reconstruction.

  • Paediatric supracondylar Gartland III

    Displaced supracondylar fractures in children carry high neurovascular risk. Urgent paediatric orthopaedic input.

  • Suspected distal biceps rupture

    Popeye sign with positive hook test needs specialist upper limb review within days. Repair is time-sensitive.

  • Skin threat or tenting

    Pale, blanched or tenting skin over the deformity means the fragment is about to open the skin. Reduce and refer.

  • Persistent stiffness or CRPS features

    Progressive loss of range, disproportionate pain, colour or sweating change. Consider complex regional pain syndrome.

Living with it

Recovery with a plan, not a guess.

Four things that make the biggest difference after an elbow injury. Early movement, staged loading, alert self-monitoring and knowing when to escalate.

A quiet reminder

Range now, strength later.

Get the movement back first. Strength and endurance follow. A stiff elbow is harder to fix than a weak one.

  1. 01 Rehab

    Move early, move well

    Once your team says it is safe, gentle range work protects your long-term function. Stiffness is the biggest late problem.

  2. 02 Load

    Progress under guidance

    Return to work, driving and sport should follow a staged plan from your physiotherapist, not a calendar guess.

  3. 03 Watch

    Know the warning signs

    New numbness, worsening pain, colour change or a cool hand needs urgent review, even weeks after the injury.

  4. 04 Ask

    Do not settle for stiffness

    If range is not improving by six to eight weeks, ask for a specialist upper limb review. Options exist to unlock a stiff elbow.

Frequently asked

Everything we get asked about elbow trauma.

Quick answers on dislocation, terrible triad, pulled elbow, distal biceps rupture and stiffness.

  • What counts as elbow trauma?

    Any acute injury to the elbow, from soft tissue contusion, sprain or pulled elbow through to dislocation, tendon rupture and complex fracture-dislocation. The management ranges from simple reassurance to emergency surgery, so early assessment matters.

  • How do I know if my elbow is dislocated or fractured?

    You often cannot tell without an X-ray. Both cause severe pain, swelling and loss of movement, and they frequently occur together. A plain AP and lateral X-ray, guided by a focused examination, is the first step. Positive fat pad or sail signs suggest an occult fracture even when the bones look aligned.

  • What is the terrible triad of the elbow?

    It is a specific injury pattern of elbow dislocation with a radial head fracture and a coronoid fracture. It is inherently unstable, prone to recurrent dislocation and stiffness, and needs specialist reconstruction of the bones and ligaments.

  • What is pulled elbow in children?

    Radial head subluxation, usually in a child under five, when the annular ligament slips over the radial head after a sudden pull on an outstretched arm. The child holds the arm still and refuses to use it. A simple supination-flexion or hyperpronation manoeuvre restores use quickly.

  • Does a torn distal biceps tendon need surgery?

    In most active adults, yes. Distal biceps rupture causes lasting supination weakness and a Popeye deformity. Surgical repair within three to four weeks, using EndoButton fixation through a single or double incision, gives the best functional outcome. Specialist upper limb review should be arranged early.

  • Why is stiffness such a problem after elbow injury?

    The elbow scars readily and tolerates immobilisation poorly. Prolonged splinting, heterotopic ossification and unrepaired instability all drive stiffness. Early, protected mobilisation with an experienced physiotherapist, and specialist review if progress stalls, are the main protections.

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