Understanding Dislocations

What is a dislocation?

A 'dislocation' refers to the slipping out of the bones from their normal positions in a joint. Bone dislocation generally results from a trauma like during a fall, an accident, collision or high-contact/speed sports. Any joint in the body can dislocate (hip, shoulder, knee, elbow, ankle, fingers or toes), but the common sites of dislocation are the shoulder (in adults) and elbow (in children). A dislocation temporarily deforms and immobilizes a joint, causing severe pain and swelling in the area. Immediate medical attention is crucial to return the bones to their normal positions. Sometimes, an incomplete dislocation may occur when the bones of a joint shift out of their normal position, but not totally dislocated. Known as subluxation, it is a more chronic problem till the bone shifts back to their original positions.

What are the causes of the disorder?

Dislocation is most often caused by a sudden impact on the joint, as felt during a fall, an accident or injury during sports. The force tears or stretches the connective tissue (ligament) that holds the bone inside the joint, causing it to protrude or slip out from its fixed place.

What one needs to know about symptoms or signs?

1. A dislocated joint is visible to the eye in form of a bulge or an indention in or near the socket that looks deformed in comparison to the same joint on the other side.
2. The joint area could be discoloured or misshapen.
3. The person will experience severe pain and will be unable to move that joint.
4. There could be swelling and bleeding within the joint that may cause a bruise.
5. Nerve damage could result due to the stretching of the nerves around the dislocated bone.

Which specialist should be consulted in case of signs and symptoms?

A person who feels that s/he may have dislocated a joint should seek emergency medical help at the earliest. First aid should be administered to help stabilise the injury till medical assistance arrives.

What are the screening tests and investigations done to confirm or rule out the disorder?

Dislocation is confirmed through:

1. Physical examination - The doctor examines the affected joint for tenderness, swelling and deformity. The affected limb or area will be cool to touch if an artery is injured at the time of dislocation, as warm blood is unable to reach the site. The doctor will also try to move the affected area to determine the range of motion available in the joint.
2. Imaging tests - An x-ray or MRI is conducted to examine the affected joint more closely and gauge the extent of dislocation. Imaging tests also help ascertain or rule out any broken bones.

What treatment modalities are available for management of the disorder?

A trained physician brings a dislocated joint back to its normal position. The joint is manipulated back into its original position under sedation. Sometimes, a surgery is necessitated if the doctor is unable to physically move the bones into their position, or if there is additional damage to the neuromuscular structures around. The intense pain felt by the patient reduces once the dislocated bone is brought back to its right place. However, a sling or splint is provided to keep the joint immobilised for few weeks, depending on the nature and position of the dislocation. Pain-relieving medications and/or muscle relaxants are given to ease discomfort. A crucial aspect of dealing with a dislocated bone is the time period between the occurrence of injury and the arrival of medical help. The victim must be provided first aid to prevent any further damage to the joint. The following points must be followed:

1. The victim must be kept still.
2. If a bone broken during dislocation bruises the skin above, care must be taken to prevent any form of infection. It should not be breathed upon, washed or probed. A sterile dressing may be placed over it.
3. The injured body part should be immobilised using a splint or sling, in the SAME position as it was found.  Bringing the dislocation to its original position is the responsibility of a trained medical staff; first aid should be limited only to immobilisation of the joint.
4. Circulation to the affected area should be checked.
5. Ice packs can help ease pain and swelling.
6. The victim should not go under shock. A coat or blanket may be used to cover the victim, while taking care to not move him/her too much, especially if a head, back or leg injury is suspected.

What precautions or steps are necessary to stay healthy and happy during the treatment?

Once the sling or splint is removed, a gradual rehabilitation programme will be initiated to restore the joint's strength and range of motion. Sudden movements and moving the joint too soon after injury should be avoided.

What are the physical activity requirements during the course of the treatment?

Chances of recurrences in the same joint increase after first-time dislocation. The doctor and the team of physiotherapists can guide the patient through strength and stability exercises for complete recovery.

How can the disorder be prevented from happening or recurring?

A dislocated joint is a painful experience. Reducing its chances of occurrence would involve:

1. Realising one's exertion levels and stopping a physical activity when pain is experienced.
2. Exercising muscles and joints of the body regularly.
3. Using ice treatments after physical activity.
4. Including protective padding during sports or activities to protect from falls and impact.
5. Removing hazards around home and office like haphazard mats or electric cords that could promote falls.

Preventing dislocations in children involves:

1. Creating a safe play and living environment for children at home.
2. Providing close supervision over kids by keeping windows closed and preventing falls from staircases.
3. Educating young children about safety and looking after themselves.

Sources:

"Dislocation: First aid," MayoClinic.com, Mayo Clinic Staff, https://www.mayoclinic.org/first-aid/first-aid-dislocation/basics/ART-20056693"Dislocation," MedlinePlus, NLM, NIH, https://www.nlm.nih.gov/medlineplus/ency/article/000014.htm"How to Recognize and Deal with: Dislocation," Kaohsiung Medical University Chung-HoMemorial Hospital, https://www.kmuh.org.tw/www/Administration/medicaltravel/eng/images/Patient%20Education%20Information/Microsoft%20Word%20-%20Dislocation.pdf"Understanding Dislocation -- the Basics," WebMD.com, https://www.webmd.com/a-to-z-guides/understanding-dislocation-basics