Joint dislocation

A joint dislocation, also called luxation, occurs when there is an

Joint dislocation
abnormal separation in the joint, where two or more bones meet.[1] A
partial dislocation is referred to as asubluxation. Dislocations are often Synonyms Latin: luxatio
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 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.[3]

Contents
Symptoms
Causes
Diagnosis
Treatment
After care
Epidemiology
A traumatic dislocation of the tibiotarsal joint of
Gallery
the ankle with distal fibular fracture. Open arrow
See also marks the tibia and the closed arrow marks the
References talus.
Classification and external resources
Specialty emergency medicine
Symptoms
ICD-10 T14.3
[1]
The following symptoms are common with any type of dislocation.
ICD-9-CM 830-848
Intense pain MedlinePlus 000014
Joint instability
MeSH D004204
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.[4] 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.[5] 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.[6]

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.[7] The loosened or stretched ligaments in the joint provide little stability and allow for the
joint to be easily dislocated.[1]

Diagnosis
Initial evaluation of a suspected joint dislocation should begin with a thorough patient history, including mechanism of injury, and
physical examination. Special attention should be focused on the neurovascular exam both before and after reduction, as injury to
these structures may occur during the injury or during the reduction process.[3] Subsequent imaging studies are frequently obtained to
assist with diagnosis.

Standard plain radiographs, usually a minimum of 2 views

Generally, pre- and post-reduction X-rays arerecommended. Initial X-ray can confirm the diagnosis as well as
evaluate for any concomitant fractures. Post-reduction radiographs confirm successful reduction alignment and
can exclude any other bony injuries that may have been caused during the reduction procedure. [8]

In certain instances if initial X-rays are normal but injury is suspected, there is possible benefit of stress/weight-
bearing views to further assess for disruption of ligamentous structures and/or need for surgical intervention. This
may be utilized with AC joint separations.[9]
[10]
Nomenclature: Joint dislocations are named based on the distal component in relation to the proximal one.
Ultrasound

Ultrasound may be useful in an acute setting, particularly with suspected shoulder dislocations. Although it may
not be as accurate in detecting any associated fractures, in one observational study ultrasonography identified
100% of shoulder dislocations, and was 100% sensitive in identifying successful reduction when compared to
plain radiographs.[11] Ultrasound may also have utility in diagnosing AC joint dislocations.
[12]

In infants <6 months of age with suspecteddevelopmental dysplasia of the hip(congenital hip dislocation),
ultrasound is the imaging study of choice as the proximal femoral epiphysis has not significantly ossified at this
age.[13]
Cross-sectional imaging (CT or MRI)

Plain films are generally sufficient in making a joint dislocation diagnosis. However, cross-sectional imaging can
subsequently be used to better define and evaluate abnormalities that may be missed or not clearly seen on
plain X-rays. CT is useful in further analyzing any bony aberrations, and CT angiogram may be utilized if
vascular injury is suspected.[14] In addition to improved visualization of bony abnormalities, MRI permits for a
more detailed inspection of the joint-supporting structures in order to assess for ligamentous and other soft tissue
injury.

Treatment
A dislocated joint usually can be successfully reduced into its normal position only by a trained medical professional. Trying to
.[15]
reduce a joint without any training could substantially worsen the injury

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.[16]

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 theemergency department under sedation or in an operating room under a general anaesthetic.[17]

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)
[18]
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.
Shoulder injuries can also be surgically stabilized, depending on the severity, using arthroscopic surgery.[16] The most common
treatment method for a dislocation of the Glenohumeral Joint (GH Joint/Shoulder Joint) is exercise based management.[19] Another
[20]
method of treatment is to place the injured arm in a sling or in another immobilizing device in order to keep the joint stable.

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.[16]

On field reduction is crucial for joint dislocations. As they are extremely common in sports events, managing them correctly at the
game at the time of injury, can reduce long term issues. They require prompt evaluation, diagnosis, reduction, and postreduction
.[20]
management before the person can be evaluated at a medical facility

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
[21]
through a course of physiotherapy, which will also help reduce the chances of repeated dislocations of the same joint.

For glenohumeral instability, the therapeutic program depends on specific characteristics of the instability pattern, severity,
recurrence and direction with adaptations made based on the needs of the patient. In general, the therapeutic program should focus on
restoration of strength, normalization of range of motion and optimization of flexibility and muscular performance. Throughout all
[22]
stages of the rehabilitation program, it is important to take all related joints and structures into consideration.

Epidemiology
Each joint in the body can be dislocated, however
, there are common sites where most dislocations occur
. The
following structures are the most common sites of joint dislocations:
Dislocated shoulder

Shoulder dislocations account for 45% of all dislocation visits to the emergency room.[23] Anterior shoulder
dislocation, the most common type of shoulder dislocation (96-98% of the time) occurs when the arm is in
external rotation and abduction (away from the body) produces a force that displaces the humeral head anteriorly
and downwardly.[23] Vessel and nerve injuries during a shoulder dislocation is rare, but can cause many
impairments and requires a longer recovery process. [23] There is a 39% average rate of recurrence of anterior
[24]
shoulder dislocation, with age, sex, hyperlaxity and greater tuberosity fractures being the key risk factors.
Knee: Patellar dislocation

Many different knee injuries can happen. Three percent of knee injuries are acute traumatic patellar
dislocations.[25] Because dislocations make the knee unstable, 15% of patellas will re-dislocate.
[26]

Patellar dislocations occur when the knee is in full extension and sustains a trauma from the lateral to medial
side.[27]
[28]
Elbow: Posterior dislocation, 90% of all elbow dislocations
[29]
Wrist: Lunate and Perilunate dislocation most common
[30]
Finger: Interphalangeal (IP) or metacarpophalangeal (MCP) joint dislocations

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.[31] Women have an incidence rate of 4.65 per 100,000 person-years.[31] The average
age group that sustain a finger dislocation are between 15 and 19 years old. [31]

Hip: Posterior and anteriordislocation 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.[32] Superior dislocations account for 10% of all anterior
dislocations, and inferior dislocations account for 90%.[32] 16-40 year old males are more likely to receive

dislocations due to a car accident.[32] When an individual receives a hip dislocation, there is an incidence rate of
[32] 46–84% of hip dislocations occur
95% that they will receive an injury to another part of their body as well.
secondary to traffic accidents, the remainingpercentage is due based on falls, industrial accidents or sporting
injury.[24]
 Foot and Ankle: Lisfranc injury

Ankle Sprains primarily occur as a result of tearing the T

AFL (anterior talofibular ligament) in the T
alocrural Joint.
The ATFL tears most easily when the foot isin plantarflexion and inversion. [33]

Gallery

Dislocation of the left index finger Radiograph of right fifth phalanx

bone dislocation

Radiograph of left index Depiction of reduction of a dislocated spine, ca. 1300 Dislocation
finger dislocation of the carpo-
metacarpal
joint.
 Radiograph of right fifth Right fifth phalanx dislocation resulting from bicycle
phalanx dislocation accident
resulting from bicycle
accident

Shoulder dislocation before (left) and after (right) being reduced

See also
Buddy wrapping
Major trauma
Physical therapy
Projectional radiography

References
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