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| Joint dislocation |
| Synonyms |
Latin: luxatio |
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| A traumatic dislocation of the tibiotarsal joint of the ankle with distal fibular fracture. Open arrow marks the tibia and the closed arrow marks the talus. |
| Classification and external resources |
| Specialty |
emergency medicine |
| ICD-10 |
T14.3 |
| ICD-9-CM |
830-848 |
| MedlinePlus |
000014 |
| MeSH |
D004204 |
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[edit on Wikidata]
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A joint dislocation, also called luxation, occurs when there is an abnormal separation in the joint, where two or more bones meet.[1] 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.[2] Dislocations can occur in any joint major (shoulder, knees, etc.) or minor (toes, fingers, etc.). The most common joint dislocation is a shoulder dislocation.[1]
Treatment for joint dislocation is usually by closed reduction, that is, skilled manipulation to return the bones to their normal position. Reduction should be done only by trained people, because it can cause injury to soft tissue around the dislocation.
Contents
- 1 Causes
- 2 Symptoms
- 3 Treatment
- 4 Epidemiology
- 5 Gallery
- 6 See also
- 7 References
Causes
Joint dislocations are caused by trauma to the joint or when an individual falls on a specific joint.[3] 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.[4] 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.[5]
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.[6] The loosened or stretched ligaments in the joint provide little stability and allow for the joint to be easily dislocated.[1]
Symptoms
The following symptoms are common with any type of dislocation.[1]
- Intense Pain
- Joint instability
- Deformity of the joint area
- Reduced muscle strength
- Bruising or redness of joint area
- Difficulty moving joint
- Stiffness
Treatment
A dislocated joint usually can be successfully reduced into its normal position only by a trained medical professional. Trying to reduce a joint without any training could substantially worsen the injury.[7]
X-rays are usually taken to confirm a diagnosis and detect any fractures which may also have occurred at the time of dislocation. A dislocation is easily seen on an X-ray.[8]
Once a diagnosis is confirmed, the joint is usually manipulated back into position. This can be a very painful process, therefore this is typically done either in the emergency department under sedation or in an operating room under a general anaesthetic.[9]
It is important the joint is reduced as soon as possible, as in the state of dislocation, the blood supply to the joint (or distal anatomy) may be compromised. This is especially true in the case of a dislocated ankle, due to the anatomy of the blood supply to the foot.[10]
Shoulder injuries can also be surgically stabilized, depending on the severity, using arthroscopic surgery.[8]
Some joints are more at risk of becoming dislocated again after an initial injury. This is due to the weakening of the muscles and ligaments which hold the joint in place. The shoulder is a prime example of this. Any shoulder dislocation should be followed up with thorough physiotherapy.[8]
After care
After a dislocation, injured joints are usually held in place by a splint (for straight joints like fingers and toes) or a bandage (for complex joints like shoulders). Additionally, the joint muscles, tendons and ligaments must also be strengthened. This is usually done through a course of physiotherapy, which will also help reduce the chances of repeated dislocations of the same joint.[11]
Epidemiology
Each joint in the body can be dislocated, however, there are common sites where most dislocations occur. The most commonly dislocated is the shoulder joint.[12] The most common type of shoulder dislocation is anterior dislocation, which occurs 95% of the time.[12] The next most common shoulder dislocation is posterior dislocation, which only occurs 3% of the time. Other common areas for dislocations include the following:
- Dislocated shoulder
- Knee: Patellar dislocation
- Many different knee injuries can happen. Three percent of knee injuries are acute traumatic patellar dislocations.[13] Because dislocations make the knee unstable, 15% of patellas will re-dislocate. [14]
- Elbow: Posterior dislocation, 90% of all elbow dislocations[15]
- Wrist: Lunate and Perilunate dislocation most common[16]
- Finger: Interphalangeal (IP) or metacarpophalangeal (MCP) joint dislocations[17]
- In the United States, men are most likely to sustain a finger dislocation with an incidence rate of 17.8 per 100,000 person-years. [18] Women have an incidence rate of 4.65 per 100,000 person-years. [18]The average age group that sustain a finger dislocation are between 15 to 19 years old.[18]
- Hip: Posterior and anterior dislocation of hip
- Anterior dislocations are less common than posterior dislocations. 10% of all dislocations are anterior and this is broken down into superior and inferior types. [19] Superior dislocations account for 10% of all anterior dislocations, and inferior dislocations account for 90%. [19] 16-40 year old males are more likely to receive dislocations due to a car accident. [19] When an individual receives a hip dislocation, there is an incidence rate of 95% that they will receive an injury to another part of their body as well. [19]
- Foot: Lisfranc injury
Gallery
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Dislocation of the left index finger
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Radiograph of right fifth phalanx bone dislocation
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Radiograph of left index finger dislocation
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Depiction of reduction of a dislocated spine, ca. 1300
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Dislocation of the carpo-metacarpal joint.
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Radiograph of right fifth phalanx dislocation resulting from bicycle accident
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Right fifth phalanx dislocation resulting from bicycle accident
See also
- Projectional radiography
- Trauma
- Physiotherapy
- Buddy wrapping
References
- ^ a b c d Dislocations. Lucile Packard Children’s Hospital at Stanford. Retrieved 3/3/2013. [1]
- ^ Smith, R. L., & Brunolli, J. J. (1990). Shoulder kinesthesia after anterior glenohumeral joint dislocation. Journal Of Orthopaedic & Sports Physical Therapy, 11(11), 507-513.
- ^ Mayo Clinic: Finger Dislocation Joint Reduction
- ^ U.S. National Library of Medicine - Dislocation
- ^ Pubmed Health: Dislocation – Joint dislocation
- ^ Ruemper, A. & Watkins, K. (2012). Correlations between general joint hypermobility and joint hypermobility syndrome and injury in contemporary dance students. Journal of Dance Medicine & Science, 16(4): 161-166.
- ^ Bankart, A. (2004). The pathology and treatment of recurrent dislocation of the shoulder-joint. Acta Orthop Belg. 70: 515-519
- ^ a b c Dias, J., Steingold, R., Richardson, R., Tesfayohannes, B., Gregg, P. (1987). The conservative treatment of acromioclavicular dislocation. British Editorial Society of Bone and Joint Surgery. 69(5): 719-722.
- ^ Holdsworth, F. (1970). Fractures, dislocations, and fracture dislocations of the spine. The Journal of Bone and Joint Surgery. 52 (8): 1534-1551.
- ^ Ganz, R., Gill, T., Gautier, E., Ganz, K., Krugel, N., Berlemann, U. (2001). Surgical dislocation of the adult hip. The Journal of Bone and Joint Surgery. 83(8): 1119-1124.
- ^ Itoi, E., Hatakeyama, Y., Kido, T., Sato, T., Minagawa, H., Wakabayashi, I., Kobayashi, M. (2003). Journal of Shoulder and Elbow Surgery. 12(5): 413-415.
- ^ a b Malik S, Chiampas G, Leonard H (November 2010). "Emergent evaluation of injuries to the shoulder, clavicle, and humerus". Emerg Med Clin North Am. 28 (4): 739–63. doi:10.1016/j.emc.2010.06.006. PMID 20971390.
- ^ Hsiao, Mark; Owens, Brett D.; Burks, Robert; Sturdivant, Rodney X.; Cameron, Kenneth L. (2010-10-01). "Incidence of Acute Traumatic Patellar Dislocation Among Active-Duty United States Military Service Members". The American Journal of Sports Medicine. 38 (10): 1997–2004. doi:10.1177/0363546510371423. ISSN 0363-5465. PMID 20616375.
- ^ Fithian, Donald C.; Paxton, Elizabeth W.; Stone, Mary Lou; Silva, Patricia; Davis, Daniel K.; Elias, David A.; White, Lawrence M. (2004-07-01). "Epidemiology and Natural History of Acute Patellar Dislocation". The American Journal of Sports Medicine. 32 (5): 1114–1121. doi:10.1177/0363546503260788. ISSN 0363-5465. PMID 15262631.
- ^ Elbow Dislocation
- ^ Carpal dislocations
- ^ Finger Dislocation Joint Reduction
- ^ a b c Golan, Elan; Kang, Kevin K.; Culbertson, Maya; Choueka, Jack. "The Epidemiology of Finger Dislocations Presenting for Emergency Care Within the United States". HAND. doi:10.1177/1558944715627232. PMC 4920528. PMID 27390562.
- ^ a b c d Clegg, Travis E.; Roberts, Craig S.; Greene, Joseph W.; Prather, Brad A. "Hip dislocations—Epidemiology, treatment, and outcomes". Injury. 41 (4): 329–334. doi:10.1016/j.injury.2009.08.007.
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Dislocations/subluxations, sprains and strains
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Joints and
ligaments |
| Head and neck |
- Dislocation of jaw
- Whiplash
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| Shoulder and upper arm |
- GH (Dislocated shoulder)
- AC (Separated shoulder)
- ALPSA lesion
- SLAP tear
- Bankart lesion
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| Elbow and forearm |
- Nursemaid's elbow
- Gamekeeper's thumb
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| Hip and thigh |
|
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| Knee and leg |
- Tear of meniscus
- Anterior cruciate ligament injury
- Unhappy triad
- Patellar dislocation
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| Ankle and foot |
- Sprained ankle (High ankle sprain)
- Metatarsophalangeal joint sprain (Turf toe)
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Muscles and
tendons |
| Shoulder and upper arm |
|
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| Hip and thigh |
|
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| Knee and leg |
- Patellar tendon rupture
- Achilles tendon rupture
- Shin splints
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Trauma
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| Principles |
- Polytrauma
- Major trauma
- Traumatology
- Triage
- Resuscitation
- Trauma triad of death
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| Assessment |
| Clinical prediction rules |
- Revised Trauma Score
- Injury Severity Score
- Abbreviated Injury Scale
- NACA score
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| Investigations |
- Diagnostic peritoneal lavage
- Focused assessment with sonography for trauma
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| Management |
| Principles |
- Advanced trauma life support
- Trauma surgery
- Trauma center
- Trauma team
- Damage control surgery
- Early appropriate care
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| Procedures |
- Resuscitative thoracotomy
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| Pathophysiology |
| Injury |
- MSK
- Bone fracture
- Joint dislocation
- Degloving
- Soft tissue injury
- Resp
- Flail chest
- Pneumothorax
- Hemothorax
- Diaphragmatic rupture
- Pulmonary contusion
- Cardio
- Internal bleeding
- Thoracic aorta injury
- Cardiac tamponade
- GI
- Blunt kidney trauma
- Ruptured spleen
- Neuro
- Penetrating head injury
- Traumatic brain injury
- Intracranial hemorrhage
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|
| Mechanism |
- Blast injury
- Blunt trauma
- Burn
- Penetrating trauma
- Crush injury
- Stab wound
- Ballistic trauma
- Electrocution
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| Region |
- Abdominal trauma
- Chest trauma
- Facial trauma
- Head injury
- Spinal cord injury
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| Demographic |
- Geriatric trauma
- Pediatric trauma
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| Complications |
- Posttraumatic stress disorder
- Wound healing
- Acute lung injury
- Crush syndrome
- Compartment syndrome
- Contracture
- Fat embolism
- Chronic traumatic encephalopathy
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