Congenital dislocation of the radial head was described by McFarland. The direction of the displacement of the radial head may be anterior or posterior or lateral.
Condition is often unilateral.
The abnormality is usually not detected at birth, but is diagnosed later on in childhood when the elbow is examined following some minor injury.
Usually the elbows are asymptomatic. A complaint of stiffness may be reason of visit to physician in some cases.
The ulna is bowed, the direction of convexity depending on the type of dislocation
- Anterior dislocation-ulnar bow is forward
- Posterior dislocation-backward
- Lateral dislocations the ulna will bend laterally.
In anterior dislocations the range of elbow flexion is limited and the radial head may be palpated in the cubital fossa; in posterior dislocations the elbow will not extend fully and the prominent radial head may be palpated posteriorly.
Radiographs
In a normal elbow a line drawn through the longitudinal axis of the radial shaft bisects the capitellum of the humerus. This normal finding is absent in this condition. The head of the radius is dome shaped on its superior surface.
It is important to distinguish traumatic from congenital dislocations. The types of injury that cause traumatic dislocation of the radial head are missed Monteggia fracture dislocations, fracture of the radial neck, pulled elbow, and occasionally a primary traumatic dislocation of the radial head with other associated injury.
In the newborn and infant, arthrography of the elbow is helpful in the definitive diagnosis of radial head dislocation.
Treatment
When the diagnosis is made in the newborn or young infant, closed reduction may be attempted.
The posteriorly dislocated radial head is reduced by supination of the forearm and extension of the elbow,
The anteriorly dislocated radial head is reduced by flexion of the elbow.
Reduction is maintained in an above elbow cast for four to six weeks.
Closed reduction is often unsuccessful.
In children up to three years of age open reduction should be carried out.
In the older child it will be impossible to reduce the radial head.
The dislocation is left alone until late adolescence, when if symptoms warrant, the radial head is excised.
My 17 month old son, has brachial plexus injury due to shoulder dystocia during delivery. We were told that usually within 3-6 months of physio therapy, Micah’s arm would be normal. 3 months went by and sure, there were improvements. He no longer had a waiter’s tip and could move his arm slightly and noticed that his left arm wasn’t straight but turned inwards at the elbow.
We’ve been to a few orthopaedics and while 2 have told us Micah would not be able to go for surgery til he is 18, 1 orthopaedic said he would need surgery immediately and he even told us off for delaying it this long.
He currently can lift his left arm about 45 degrees. At 17 months, he is still not crawling as I assume his left arm is just too weak.
I would like to send you an email of Micah’s x ray and was hoping you could let us know your opinion on what would be the best thing to do for Micah. Currently, he goes for physio therapy twice a week.
Dr Arun Pal Singh Reply:
March 8th, 2011 at 2:15 pm
@Michelle M,
What you describe seems to be Erb’s palsy. The treatment depends on whether the injury is complete or incomplete.
You can send me an xray and MRI at contact [at] boneandspine [dot] com.
I had congenital dislocation of the elbow when I was born. It was not noticed until I was around 3 years of age. At that time (1958) Doctors advised my parents nothing could be done until my bones achieved full growth and even then cosmetic surgery (excision of the protruding bone) was the only option. At age 13 (1968) I had cosmetic surgery on the left elbow. The only problem I had following that surgery was an inability to turn my left hand completely palm up. Probably from not doing the physical therapy prescribed.
No other problems surfaced until 2003 when the bone in my left wrist began to protrude and the wrist became very painful. I was lucky to find a very good hand & wrist surgeon who told me that the first surgery had been done before my bones achieved full growth so the ulna continued to grow and the radius did not.
He corrected the problem by excising a small piece of the ulna and placing a metal plate on the bone. I have had no problems since except mild arthritis. My own personal opinion would be not to consider any bone surgery (except those of an emergency nature) until you are into your twenties.
My name is Cory and I was diagnosed with a congenital dislocated elbow when I was 13 I was unable to continue to play baseball but I was able to excell in other sports now that I am 21 I have been starting to have more pain in my elbow and it will sometimes lock-up completly, I now have a son who is 3 months old and I was wondering if I should get him looked at to see if he also has a dislocated elbow as well?
Thanks, Cory
my name is samantha and i have a 4 month old boy Micah. he was a crying baby and i was told that he was colicky. someone mentioned to me that i should take him to a chiropractor maybe he can help. we made an appointmen for saturday and was told that because i had a vacuum delivery two of his bones got dislocated during delivery. the chiropractor cracked his back and he seemed fine. we had to take him for a follow-up yesterday and i was shocked when the chiropractor cracked he’s back again, he then told us that we won’t have to come in to see him unless Micah is still a bit uncomfortable we should give him a call next week wednesday. my question is: am i gonna have to take my baby to the chiropractor every week from now on to crack his back? because the bones seem to stay in place only for a short period. i do not want to put my son in this pain every week as the cracking of his back is painful. please give me some advice on this
Dr Arun Pal Singh Reply:
June 9th, 2011 at 3:16 pm
@samantha bothma,
I am not going to make any comment on this because I am not aware of the practice you are following.
Hello all. I would like to share my story and perhaps receive some feedback/direction. For 42 years now I have been living with what has been diagnosed as “permanent dislocation of the Radial Head” on both of my arms. It was never found out if I was born this way or if something very early on in life caused this although I can recall being different since about age 6. I have mobility in both my arms but cannot rotate my palms face up and my arms do not extend all the way straight. There is about a 30 degree angle on both of them so doing something like yoga or push ups is extra hard. Also because of this my elbows look deformed, protruding out, like the cartoon character Popeye’s elbows. I have obviously lived with this condition my whole life but still long for the day when they will be corrected as I have always been ashamed and embarrassed by them, covered them up and have never gone out in public wearing a short sleeve shirt. As you may see this has really dictated many aspects of my life – being afraid to go to the beach, afraid to go swimming in a pool, getting depressed each time warm/hot weather comes around every year, basically anything that would put my elbows in the public’s view. I understand that with all the problems and troubles everyone else in the world has I really have no right to complain about such a small thing, but I really hate them and how they have dictated my life. I have always felt less of a person because of them and have always felt embarrassed any time I have had to explain them to anyone. I would like to share stories and photos with anyone who has had similar problems and any success you may have had with fixing the problem.
Thanks,
Mike
Mike you and I ARe just alike. U 20 years old and I feel just like you both of my arms were like that from birth I feel so embarrassed my arms lock up they pop and my wrist pop also my fingers hurt I cant turn my wrist to get change they deny me for disability I have history I can’t pick up heavy things. I need help the doctors told me I had wishbones I need help my bones broke reset them and of course therapy.
Mike and Shay,
Join the club mates, I am 40 and both my elbows have congenital dislocations. I can not extend my arms all the way, my wrists wont go flat and I have boney ends on each elbow. As a kid, the “specialist” in my small town didn’t know what was wrong with them, but told me if I didn’t have it corrected by the time I was 18, my hands would be deformed. WRONG! And other Dr’s told me it would be just a cosmetic procedure to fix them.
I too, would wear long sleeved shirts in the summer, and I failed PE, because lifting weights, playing baseball, basketball, or volleyball was PAINFUL….The PE teachers would call me a wimp, and make me run laps, which I couldn’t do either as I have a bad heart valve.
I finally saw a specialist at UCSF about 8 years ago, and she was surprised I didn’t get them “corrected” when I was a kid. (apparently, they can never be normal) She told me that If/when the pain worsens, I could get the excess bone cut off and that MAY give me some mobility back. She gave me some sort of shot in my left elbow, and that eased the pain for years.
I have learned to live with them (and the pain) and I work jobs that don’t require heavy lifting. As far as covering them up, DON’T! Each one of us have flaws…some are just more obvious than others. Most people don’t even notice these days…
I have Congenital Dislocation of the right elbow. Doctor discovered this in 1979 when I 12 years old. I remember a bunch of Orthopedic Doctors from Kaiser looking at my arm and checking me out. None of them knew how the elbow was dislocated and they had told my mom I could have been born that way. I had surgery in 1982 to cut the end of the bone off as it was sticking out a long ways to the point that other people would get sick if they saw such a grotesque thing, I couldn’t even put on a long sleeve shirt. After the bone was removed my right arm stopped growing so know its about 1 inch shorter than my left arm. Whenever I get change handed to me at the store I have to get with my left hand because I cant turn my wrist with palm completely up.
I apologize for the delay in writing back and I am amazed at how many others have this similar situation/problem with dislocated elbows. It is comforting in a way to know that I am not the only one. I would like to hear more and possibly exchange emails with everyone and photos or x-rays of your arms. Would anybody be interested in this?
Mike
Dr Arun Pal Singh Reply:
November 19th, 2011 at 12:20 pm
@Mike,
Please post your at Bone And Spine Forum where you can also befriend others
You would be able to upload images as well. A registration {free} is required before you could post.
Hi!
It is really nice to see this site, I have just been diagnosed with Congenital Dislocation of the Radial Head at 18 years old.. all my life I have played hockey, Lacrosse and have had full movement in both my elbows and was an avid weight lifter.. and has aspirations of joining the Military..
Earlier this year I was playing a hockey game when my left arm went completely numb and began to swell, eventually i went to the hospital to a doctor that did not know what was wrong, after many trips and different doctors I ended up at a specialist that stated I was born with my elbows like this. He stated I should stop hockey, lacrtosse.. working out with weights etc.. which I understand.. however..
why was I able to do all this my entire life? But now because my elbow is swollen I should never do it again? I don’t want to sound like I know better than the doctors (I know I don’t) however I do know I can do push-ups at ease.. I can do almost any workout “stronger” than the average teen.. and also of course.. to hear that a career in the military is “out of reach” when I can do all that an average person can was extremely sad-ning..
anyways.. sorry for the rant, from reading, some people seem to have it much worse then I do.. I simply want this swelling to go away along with the pain, and get back to my life as “normal” as I can..
Thanks
Hello! I am 29 years old, and found out at age 8 that my left elbow has a congenital dislocation of the radial head. At that time, my elbow hurt a lot and I went through a lot of physical therapy. I was scheduled to have surgery to correct the dislocation when I was 10, but I had gained most, if not all, movement back, and the doctor decided not to proceed. He just continued to keep an eye on it as I grew up if it caused me pain. When I was a young teen, I was told that I would not have to have any surgery unless it caused me a great deal of pain in later years, and then they could shave down the bone to help with the pain. There are times that my elbow will hurt, but it is livable. Sometimes it will try to lock up on me, but then feels better after a few days. I guess I’m really lucky to not have all the pain a lot of you experience. I also enjoy showing people my elbow because it is crooked and sticks out funny when I play the trumpet. Hopefully I continue to have good luck with my elbow. Hope all of you find ways to cope with the pain and live a good life full of happiness!
Hi to the other mike, I would be interested in sharing x-rays and so on if you are interested. It is nice to know of others suffering from this quite crap disorder
Cheers!