Outline:  
Dislocation of elbow joint mainly refers to the dislocation of humeral-ulna and humeral-radial articulations. It is most likely to occur in young and middle-aged people. According to direction of the dislocation, it may be divided into anterior dislocation and posterior dislocation. Clinically the former is seen more often, and occasionally the latter is complicated with the fracture of coracoid process. Dislocation of elbow joint is likely to be complicated with myositis ossificans.
 
Major points for diagnosis  
1. There is a typical traumatic history.

2. There is a painful swelling in the elbow joint which is incapable of movement.
 
3. The elbow joint is posteriorly displaced and elastically fixed at the angle of 1200 to 1350. There is fullness in the anterior cubital region. The anteroposterior diameter is enlarged. The forearm becomes shorter. The postcubital olecranon process is elevated. Above the olecranon process there are hollow and depression, showing a deformity of "boot-type". The triangle relationship in the postcubital region becomes abnormal.
 
4. In the case of an anterior displacement, the elbow joint is in hyperextension. The proximal ends of the radius and ulna can be felt in the antecubital region, and the lower end of humerus as well as the fragment of olecranon can be felt in the postcubital region. The forearms are longer than the normal one.
 
5. In the case of a complicated fracture of elhow joint, there may occur bony crepitus.

6. X-ray film can confirm the direction of dislocation and whether there is a complicated fracture.

Treatment
(1) The manipulation of pulling traction and flexing elbow:
Generally, no anesthesia is needed. The patient takes a sitting position. An assistant holds the upper arm of the injured limb with both hands. The operator holds the wrist of the injured limb with hands and keeps the forearm of the injured limb in a supination position. Then he works in coordination with his assistant to perform counter-traction. After counter-traction, the operator continues holding the wrist and pulling the diseased arm with one hand, and presses and pushes the lower end of the humerus forward and upward with the other thumb, with the rest fingers pulling the olecranon anteriorly. Thus the operator's two hands cooperate to flex the elbow joint slowly, when the sound of olecranon entering the cotyle is heard, the reduction is done.
 
(2) The manipulation of pulling traction with the knee:
The patient takes a sitting position. The operator stands by the side of the injured arm. Holding the upper arm of the injured limb with one hand and the wrist with the other band, he puts one of his feet on a stool with the knee against the anterior part of the injured elbow. While doing a traction along the longitudinal axis of the forearm, he slowly flexes the elbow and the reduction can be achieved.
 
Fresh anterior displacement of elbow joint:
The patient takes a sitting position. One assistant fixes the upper part of the injured arm and the other assistant holds the wrist, doing counter-traction. The Operator pushes and presses the lower end of humerus forward with his two thumbs and pulls the upper ends of ulna and radius backward with the rest fingers on the anterior part of elbow, thus the reduction can be achieved.

Old displacement of elbow joint:
If the dislocation has lasted for more than two to three weeks and there is no complication of fracture or myositisossificans, a closed manipulation can be used for reduction. Before reduction, the injured limb should be fumigated and washed for several days so as to promote blood flow to remove the stasis and dredge the meridians. The Shujin Huoxue Lotion can be used. Specifically, Shenjincao ( Herba Lycopodii Japonici ) 9 g, Haitongpi( Cortex Erythrinae ) 9 g, Qinjiao ( Radix Gentianae Macrophyllae ) 9 g, Danggui ( Radix Angelicae Sinensis) 9 g, Duhuo ( Radix Angelicae Pubescentis ) 9 g, Gouteng ( Ramulus Uncariae cure Uncis ) 9 g, Ruxiang (Gummi Olibanum) 6 g, Moyao (Myrrha) 6 g, and Honghua (Flos Carthmi) 6 g. During the period of reduction, a proper analgesia or anesthesia should be given.

The patient takes a sitting position. One assistant holds the upper arm and the other assistant holds the wrist. They cooperate with each other to make the injured elbow do passive movement in all directions, which should be gradually increased in range, with no violence allowed. In this way the adhesion of elbow joint will be well relieved. Then the reduction can be carried out with the abovementioned manipulation for fresh dislocation of elbow joint.

Fixation:
No matter what type the dislocation is, after reduction, the injured elbow should be fixed with paperboard or splints in its functional position for two or three weeks. In the case of a complicated fracture, the time for fixation can be prolonged accordingly so that the recovery of the soft tissues and bone can be guaranteed.

Functional exercise:
In the early stage after the reduction, all the joints except the injured elbow which should be fixed need not be restricted in movement, but active exercise of fist-clenching should be practiced for the diseased elbow. Half a month later, when the swelling and pain are alleviated, the exercise on the wrist joint movement can be conducted. After the removal of the fixation, active exercise on cubital function should be done, in combination with fumigation and washing with Chinese herbal lotion. Anyway, a violent passive manipulation of pulling and stretching is forbidden.

Herbal therapy  
Internal treatment based on syndrome different iat ion  

1. In the early stage
Main symptoms and signs:
Painful swelling in the diseased elbow, which is limited in movement, or with ecchymoses.
 
Therapeutic methods:
Promoting blood flow to remove stasis, relieving swelling to stop pain.
 
Recipe and herbs:
Modified Fuyuan Huoxue Decoction. Specifically, Chaihu (Radix Bupleuri) 12 g, Tianhuafen (Radix Trichosanthis) 12 g, Zhidahuang (Radixet Rhizoma Rhei Praeparata ) 6 g, Taoren ( Semen Persicae) 6 g, Dangguiwei ( Extremitas Radix Angelicae Sinensis) 15 g, Chishaoyao ( Radix Paeniae Rubrae )10 g, Honghua ( Flos Carthmi ) 10 g, Zhechong ( EuPolyphaga seu Steleophaga ) 10g, Chuanshanjia ( Squama Manitis Pentadactylae ) 10 g and Gancao ( Radix Glycyrrhizae ) 3 g.
 
2. In the late stage
Main symptoms and signs:
A swollen elbow, rigidity of the joint, difficulty in extension and flexion.
 
Therapeutic methods:
Relaxing tendons and activating collaterals, freeing joint movement.
 
Recipe and herbs:
Modified Shujin Decoction. The herbs are listed in the treatment of dislocation of shoulder joint in the late stage.

External therapy: Just the same as that in the dislocation of shoulder joint.