Palpate for possible shoulder or wrist fracture or injury to the distal radioulnar joint. Then, gently palpate the elbow for crepitus to detect obvious fractures. Next, do a complete neurovascular exam. Note pulses and check capillary refill. In most cases, vascular impairment will be reversed with reduction of the joint.
Neurologic injury is also uncommon.
The ulnar nerve is most commonly injured, usually in a stretch neurapraxia. At this point, it is necessary to decide whether to reduce the elbow or to splint the joint and send the patient to the emergency department. This decision should be based on the physician's familiarity with reduction and whether radiographs and intravenous sedation are needed before reduction. Advantages of immediate reduction include pain relief and restoration of normal neurovascular status. Immediate reduction is often quite easy because spasm and muscle contracture have not set in and swelling is minimal.