14 August 2008

Not for the faint of heart

Hungarian weightlifter Janos Baranyai dislocated his elbow in Bejing, competing in the snatch, while lifting 148 kg (326 lbs) over his head:
More pics (some quite disturbing) visible here, at the Daily Mail. (where else?) What a terrible way to end your Olympics. I feel awful for him.

I've seen lots of dislocated elbows over the years -- in fact, I reduced an elbow just Tuesday. That was dislocated in the more traditional mechanism, a fall from a bicycle, on outstretched hand. I can't recall ever seeing a mechanism of injury like this one. Generally, the radiographic image of a (posteriorly) dislocated elbow will look like this:

There may be associated fractures of the coronoid process or the radial head. Reduction is fairly simple -- after adequate analgesia and sedation (if you're feeling nice), you sit the patient up (as much as possible), with the elbow flexed at about 90 degrees (which is where the patient will likely be holding the arm). You hold the patient's wrist with your ipsilateral hand, and place your contralateral hand on the antecubital part of the forearm, slowly applying downwards traction. As you feel the biceps relaxing, you gently extend, then fully flex the elbow. You may need to have an assitant push the olecranon anteriorly. A definite "clunk" will indicate a positive reduction, and you should immediately be able to take the joint through a full range of motion with little to no resistance. The really challenging part of reducing the joint is overcoming the obligate spasm of the biceps and triceps -- something which I imagine would be even more difficult in a patient capable of lifting 328 pounds over his head! Someone so muscular might even require general anesthesia and neuromuscular paralysis to reduce, I expect.

Recovery is pretty good, but I suspect that Mr. Baranya's weightlifting career may be over -- once those ligaments have been disrupted, they never recover their full strength, and for such a high-intensity sport, it's hard to see performing at a world-class level on a less-than-intact elbow.

Ouch.

6 comments:

  1. I think I would faint from the pain of dislocating my elbow.

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  2. I dislocated my wrist and cracked my radius in three places when I fell of my horse. In Honduras, in 1972. The x-ray machines looked like something out of a 1950's sci-fi horror flick, barn-sized and covered with flaking nile-green enamel.

    And that hurt like hell.

    When I saw this poor weightlifter's elbow, I literally felt queasy. Dear God, that pain must have been blinding. I hope the medical staff were able to give him some pain relief on the spot. *shudder*

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  3. (er, that should be "fell off")

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  4. i saw this happen back in high school, during an arm wrestling contest. standing behind the kid whose elbow was dislocated, i saw the face of the kid who did it. I think I felt equally sorry for both!

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  5. I can't wait to see your pictures, x-rays and MRIs this fall of injuries due to football.

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