Elbow Forearm deformity

Congenital Radial Head Dislocations: Elbow or forearm problem?

I have previously blogged about congenital radial head dislocation at least several times Previous posts .

However, like most upper extremity anomalies, not all patients with a congenital radial head dislocation present alike.  Consider first that most of these dislocate so that the radial head moves in the posterior and lateral (outside) direction.  A smaller number dislocate in the anterior direction.  And anterior dislocations are most likely to block elbow flexion.  These dislocations may be accompanied but limited forearm rotation (i.e., palm up and palm down) and, less commonly, pain.   But, each child presents differently.

In the recent Oberg Manske Tonkin classification scheme for upper extremity anomalies, congenital radial head dislocation is categorized as a malformation (i.e., problem with limb formation while the baby is in the womb) involving the entire limb but in the radial- ulnar (inside, outside) direction (technically a I.A.2.v).  And while our future understanding of these anomalies will undoubtably grow, I believe this grouping is the right place for this condition.  I believe the following child shows why.

Congenital radial head dislocation with a lack of elbow straightening.

Congenital radial head dislocation with good but not perfect elbow bending.

Congenital radial head dislocation with a very limited ability to supinate (turn palms up).

Congenital radial head dislocation with near perfect pronation (turning palm down).
Congenital radial head dislocation x-rays.  Both the right and left side look the same.  Notice that the radial head is dislocated in the anterior direction.

Congenital radial head dislocation x-ray showing the whole forearm.  This problem is not confined to the elbow but really involves the entire relationship between the radius and the ulna.  The ulna is too long compared to the radius (i.e., at the wrist).

Congenital radial head dislocation is often thought of as an isolated problem to the elbow.  But it is more likely to involve a bigger segment of the limb- the relationship between the radius and the ulna.  This case shows that well and, I believe, a new research project we are working on will confirm that theory.  We have previously looked at a wrist problem Madelungs study a found that a large number of these children actually have a problem in the whole forearm.  Additionally, we have previously shown that surgery at the elbow (i.e., removal of the dislocated radial head) can, in a small % of patients, lead to problems at the wrist.  Which, if you believe that Congenital radial head dislocation involves the whole forearm in some patients, makes complete sense.  Surgery Outcome Results

Charles A. Goldfarb, MD
My Bio at Washington University


  1. Thank you for the question. Yes, this would be present at birth but typically is not recognized until the child is older and more functional. There have been various surgeries recommended for children when this problem is recognized early but, in my experience, these are not typically successful.

  2. After knocking his elbow a few weeks ago, we have just discovered that our 12 year old son's left arm has a congenital radial head dislocation in the anterior direction. We were aware that his elbows hyperextended and he was not able to turn his palms up, but we had no idea about the dislocation. We've been advised that there is no treatment other than stabilise and manage the pain with sport to be reintroduced as long as it doesn't hurt. We are surprised that such a benign knock would now cause him this much pain. Do you see a future for 3D printing of elbow joints in adults with this condition, or is this not possible for this condition?

  3. Marie Ann,

    Thank you for the question. Your son's story is not uncommon. And I agree with the recommendation- return to sports when he feels up to it. The challenge we have, in some cases, is distinguishing between kids with a congenital radial head dislocation and those with a new dislocation. Usually that difference can be determined by x-rays but it can be a challenge. Unfortunately, in answer to your question, I think we are long way off before we can 3D print joints. One day yes, but many years from now.

  4. Hello,
    My daughter was diagnosed with bilateral radial head dislocation at the age of one. I noticed when she was a baby that her arms wouldn't fully extend. I took her to the orthopedic and he was able to confirm the diagnosis with an x-ray. I also took her to a geneticist to make sure the condition wasn't linked to any other chromosomal abnormality. Everything else came back negative. My daughter is now four, almost five, and so far hasn't complained at all about pain. My main concern is what limitations she may face in the future. I don't want her to further hurt her elbow with certain physical activities, especially when she begins physical education in school. I am also curious about what causes this condition, since my husband and I don't have anyone else in the family who suffers from this. Any insight would be greatly appreciated.

  5. Thank you for the question. Your daughter's elbow seems to be an idiopathic (unknown cause) radial head dislocation. As your doctors stated, we do not know the cause in such kids although in other children we can identify a cause or at least some associated conditions (such as ulnar deficiency or nail patella syndrome). We would not expect any other kids of yours or your daughter's kids to be affected.

    Pain is unusual in kids with radial head dislocation although occasionally will happen in the adolescent. Kids with pain have markedly prominent radial heads that hurt when bumped. I do not usually limit the activities of my patients as physical activity is so important and we do not know of any negatives in this situation.

    I hope this helps.

  6. I just thought I'd share some information. This condition seems to be fairly uncommon. My 12 year old daughter was diagnosed to bilateral radial head dislocated before she was 1. She also was diagnosed with bicoronal craniosynostosis. Im not sure how often the 2 conditions occur together. She has adapted well to her limitations but she does suffer some discomfort with activities requiring a lot of extension. Such as riding a bicycle or playing basketball. Onset around age 8. We don't set physical limitations but instead allow her to dictate which activities she's comfortable doing and refraining from ones that cause discomfort.

  7. Hi Charles, would you know some colleague who can help with lower extremities. We stay in denmark and my daughter has hemi hypertrophy and osteochondroma on her knees. She is still un-
    diagnosed as all genetic tests done have come negative.

  8. Hello Anjali,
    Thank you for reaching out. I do not know anyone in Denmark to recommend (obviously, there may be physicians there that I just do not know). However, Christianne van Nieuwenhoven and her team at Erasmus in Rotterdam is very knowledgeable. Good luck.

  9. Hey Charles!

    My name is Evelyn and I actually have this condition to different extremes in both of my arms (neither as extreme as the child in the pictures). In December of 2015 I had an ulnar excision on my right wrist to account for the length disparities of my ulna to radius bones.

    I first learned about my defect when I had an x-ray for wrist pain and I'd always wondered about my not being able to fully extend my elbows and the lump in my right elbow that wasn't in my left. I asked them to x-ray my elbows, too, and was immediately sent to an ortho to discuss surgery.

    The surgery went well and I've gained a lot more flexibility (rotation as well) in my right hand. As of now, my left wrist hasn't given me the same trouble as the right.

    It's interesting that I find this article so far after my surgery. Previous to my discovery the only links I could find that described my symptoms were about dogs with dislocated elbows! Thanks for posting this. Hopefully it will help people who aren't quite sure why their bodies are as weird as they seem to be. 🙂

  10. Hello Dr. Charles,

    I am very glad I found this article. I am a female, 30 years old and I too have this condition in both arms with slightly different extremes. I was born with this condition very severely but did lots of physical therapy as a child and teen, which allowed me to be involved in sports and other activities without difficulty. I don’t consider myself disabled or unable to function with my upper body at the moment, however…

    As an adult I can say that in the past 5 years I have noticed severe pain in both arms especially during sleep. My guess is that positioning my arms in one spot for an extended period of time causes strain.

    I would love to hear more about where you are now with your research. I am looking into surgery and any additional information is welcome.

    Thank you.

  11. Thank you Xtnahhh,
    I am glad you have been doing well. Honestly, I am not sure your nighttime pain is related to radial head dislocation but, to me, it sounds it good be nerve related discomfort which often presents at night. I would suggest an evaluation by a hand surgeon.

  12. Hi Dr!

    I have this condition in both of my arms, cannot turn my palms or extend my arms past 90 degrees, I was shocked when we had our newborn daughter last month and she was born with the same condition making this a genetic issue. Bottom line is I suffered a lot if bullying as a kid and want my daughter to have a normal life free of staring eyes. Are there surgical options available? My wife and I are willing to fly anywhere to consult a correction

    1. Ryan,

      Thank you for the question. Unfortunately, there are no “simple” answers. Thankfully, function is generally very good although your situation may have been different. An experienced hand surgeon may provide additional thoughts for you and your family, based upon a discussion and examination. One day, cord blood may prove helpful but, we are not there yet.

  13. Dr Charles,
    My son, age 10, has not been formally diagnosed, but appears to have this condition (elbow extension to 150, lack of supination). He is an avid and very talented baseball player, but unfortunately has devolved pain in his throwing elbow and has been diagnosed with lateral epicondylitis. We are being referred to a pediatric sports med/ortho, but not for a while. I question whether you believe this is consistent with dislocation of the radial head and secondary lateral epicondylitis and what additional course of action we should be taking at this point?

    1. Thomas- thank you for writing. It would impossible for me to predict what might be the issue without xrays and, perhaps, and examination. Certainly possible that this is his diagnosis and there may be interventions which can help. Tennis elbow is unlikely in his age group unless it is related to compensation for his lack of motion.

      1. Dr Charles,,
        Thank you for your response, and certainly I understand those limitations. I would certainly be happy to provide you with images and X-rays I have on hand. The fact that lateral epicondylitis is not generally associated is quite helpful as well. Many thanks- Tom

  14. Hello! I’m so happy to have found this article. I am in my 30’s and have CRHD in both elbows with my left being most prominent. Ive know since I was very young. While I never had much pain growing up, played lots of sports and was very active I am newly having issues with my left elbow locking/catching. This is causing significant pain and limited motion and is happening seemingly out of no where. I haven’t been able to identify exactly what motion is causing it but it is happing more and more frequently. I do have my first x- ray and follow up with ortho in 5+years scheduled in a couple of months I’m curious if you have any suggestions on what may be causing this.

    1. Hello and thank you for the question. Certainly, this is unusual. An x-ray will be helpful to better understand what might be going on. X-ray could identify arthritis or loose fragments of bone. The other possibility is that there could be tendon rubbing on the dislocated radial head. Good luck.

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