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Jai Ganesh

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Registered: 2005-06-28

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Dislocation

Dislocation

Gist

A dislocation is a separation of two bones where they meet at a joint. This injury can be very painful and can temporarily deform and immobilize the joint. The most common locations for a dislocation are shoulders and fingers, but can also occur in elbows, knees and hips.

Summary

A joint dislocation, also called luxation, occurs when there is an abnormal separation in the joint, where two or more bones meet. A partial dislocation is referred to as a subluxation. Dislocations are often caused by sudden trauma on the joint like an impact or fall. A joint dislocation can cause damage to the surrounding ligaments, tendons, muscles, and nerves. Dislocations can occur in any major joint (shoulder, knees, etc.) or minor joint (toes, fingers, etc.). The most common joint dislocation is a shoulder dislocation.

Treatment for joint dislocation is usually by closed reduction, that is, skilled manipulation to return the bones to their normal position. Reduction should only be performed by trained medical professionals, because it can cause injury to soft tissue and/or the nerves and vascular structures around the dislocation.

Symptoms and signs

The following symptoms are common with any type of dislocation.

* Intense pain
* Joint instability
* Deformity of the joint area
* Reduced muscle strength
* Bruising or redness of joint area
* Difficulty moving joint
* Stiffness

Causes

Joint dislocations are caused by trauma to the joint or when an individual falls on a specific joint. Great and sudden force applied, by either a blow or fall, to the joint can cause the bones in the joint to be displaced or dislocated from normal position. With each dislocation, the ligaments keeping the bones fixed in the correct position can be damaged or loosened, making it easier for the joint to be dislocated in the future.

Some individuals are prone to dislocations due to congenital conditions, such as hypermobility syndrome and Ehlers-Danlos Syndrome. Hypermobility syndrome is genetically inherited disorder that is thought to affect the encoding of the connective tissue protein’s collagen in the ligament of joints. The loosened or stretched ligaments in the joint provide little stability and allow for the joint to be easily dislocated.

Details

What Is a Dislocation?

A dislocation occurs when a bone slips out of a joint. For example, the top of your arm bone fits into a joint at your shoulder. When it slips or pops out of that joint, you have a dislocated shoulder. You can dislocate almost any joint in your body, including your knee, hip, ankle, or shoulder.

Since a dislocation means your bone is no longer where it should be, you should treat it as an emergency and seek medical attention as soon as possible. An untreated dislocation could cause damage to your ligaments, nerves, or blood vessels.

What Causes a Dislocation?

Dislocations typically result when a joint experiences an unexpected or unbalanced impact. This might happen if you fall or experience a harsh hit to the affected area. After a joint dislocates, it’s more likely to dislocate again in the future.

Who Is at Risk for a Dislocation?

Anyone can dislocate a joint if they fall or experience some other type of trauma. However, older persons tend to have a higher risk, especially if they lack mobility or are less able to prevent falls.

Children can also be at a greater risk for dislocations if they are unsupervised or play in an area that hasn’t been childproofed. Those who practice unsafe behavior during physical activities put themselves at higher risk for accidents such as dislocations.

What Are the Symptoms of a Dislocation?

In most scenarios, you’ll easily be able to see a dislocation. The area may be swollen or look bruised. You may notice that the area is red or discolored. It may also have a strange shape or be deformed as a result of the dislocation.

Some of the other symptoms associated with dislocated joints include:

* loss of motion
* pain during movement
* numbness around the area
* tingling feeling

How Is a Dislocation Diagnosed?

It may be difficult to determine whether your bone is broken or a dislocation has occurred. You should go to an emergency room as quickly as possible.

Your doctor will examine the affected area. He will be checking circulation to the area, deformity, and whether the skin is broken. If your doctor believes that you have a broken bone or a dislocation, he will order an X-ray. On occasion, special imaging such as an MRI may be required. These imaging tools will enable your doctor to see exactly what’s going on in the joint or bone involved.

How Is a Dislocation Treated?

Your doctor’s choice of treatment will depend on which joint you dislocated. It may also depend on the severity of your dislocation. According to Johns Hopkins University, initial treatment for any dislocation involves RICE: Rest, Ice, Compression, and Elevation. In some cases, the dislocated joint might go back into place naturally after this treatment.

If the joint doesn’t return to normal naturally, your doctor may use one of the following treatments:

* manipulation or repositioning
* immobilization
* medication
* rehabilitation

Manipulation

In this method, your doctor will manipulate or reposition the joint back into place. You’ll be given a sedative or anesthetic to remain comfortable and also to allow the muscles near your joint to relax, which eases the procedure.

Immobilization

After your joint returns to its proper place, your doctor may ask you to wear a sling, splint, or cast for several weeks. This will prevent the joint from moving and allow the area to fully heal. The length of time your joint needs to be immobile will vary, depending on the joint and severity of the injury.

Medication

Most of your pain should go away after the joint returns to its proper place. However, your doctor may prescribe a pain reliever or a muscle relaxant if you’re still feeling pain.

Surgery

You will need surgery only if the dislocation damaged your nerves or blood vessels, or if your doctor is unable to return your bones to their normal position. Surgery may also be necessary for those who often dislocate the same joints, such as their shoulders. To prevent redislocation, it may be necessary to reconstruct the joint and repair any damaged structures. On occasion, a joint has to be replaced, such as a hip replacement.

Rehabilitation

Rehabilitation begins after your doctor properly repositions or manipulates the joint into the correct position and removes the sling or splint (if you needed one). You and your doctor will devise a rehabilitation plan that works for you. The goal of rehabilitation is to gradually increase the joint’s strength and restore its range of motion. Remember, it’s important to go slowly so you don’t reinjure yourself before the recovery is complete.

How Can I Prevent a Dislocation?

You can prevent a dislocation if you practice safe behavior. General tips to prevent dislocations include:

*Use handrails when going up and down staircases.
* Keep a first aid kit in the area.
* Use nonskid mats in wet areas, such as bathrooms.
* Move electrical cords off the floor.
* Avoid use of throw rugs.

To prevent children from possible dislocations, consider practicing the following:

* Teach children safe behaviors.
* Watch and supervise children as needed.
* Ensure that your home is childproof and safe.
* Put gates on stairways to prevent falls.

If you’re an adult and want to protect yourself from dislocations, you should:

* Wear protective gear or clothing when doing physical activities, such as sports.
* Remove throw rugs from your floor, or replace them with nonskid rugs.
* Avoid standing on unstable items, such as chairs.

What Is the Long-Term Outlook?

Every dislocation has its own unique healing time. Most people experience a full recovery in several weeks. For some joints, such as hips, full recovery may take several months or years and may require additional surgeries.

If your dislocation received prompt treatment, chances are that it won’t worsen into a permanent injury. However, it’s important to remember that the area will be weak and is more likely to dislocate in the future.

The healing time will also be longer if blood vessels or nerves were damaged in the dislocation. On occasion, the blood vessels that supply the bones are permanently damaged.

If the dislocation is severe or isn’t treated in time, there may be permanent problems such as persistent pain or the cell death of parts of bone around the joint.

Additional Information

Dislocation, in physiology and medicine, is displacement of the bones forming a joint, with consequent disruption of tissues.

Dislocations are caused by stresses forceful enough to overcome the resistance of the ligaments, muscles, and capsule that hold the joint in place. A dislocation is called simple when the joint surfaces are not exposed to the air; it is called compound when the joint surfaces are exposed by the destruction of overlying skin or by the end of a bone piercing the skin.

A congenital dislocation is present at birth as the result of defective formation of the joint. A recurrent, or habitual, dislocation (repeated dislocation of the same joint) may be the result of improper healing of an old injury or may be natural, as in “double joints,” common in fingers and toes, which are the result of loose ligamentation. A pathological dislocation occurs as the result of a disease, such as Marfan’s syndrome, which weakens the capsule and ligaments about the joint.

Symptoms of dislocation include pain and tenderness at the site, a sensation of grating or grinding on attempting to use the part, and inability to use the part. Common signs are deformed appearance of the joint, swelling of surrounding tissue, and discoloration of the overlying skin. X-ray examination is useful to indicate the extent of the injury. Simple dislocations are treated by returning the bones to their normal position (reduction) by manipulation or occasionally by traction. The joint is then kept immobile until healing is complete. Recurrent and congenital dislocations are special problems that usually require surgical reconstruction of the joint.

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