dislocation

Quick Overview

• What is a dislocation? A very painful dislocation, with a bone jerking out of the joint.
• Which dislocations are there? Classification according to joint, z. B. shoulder, elbow, knee, finger, hip dislocation. In addition, dislocation due to trauma (traumatic dislocation), generally unstable joint without force (habitual or spontaneous dislocation) or only partial drifting of bone and joint (subluxation)
• What to do in a dislocation? Restrain the joint, cool it, calm the affected person and bring it to the doctor

Attention!

• Never try to make a dislocated joint with your own hands! You could pinch or tear nerves, blood vessels or ligaments! Therefore, leave the restriction to a doctor.
• To cool a dislocated joint, never place ice cubes or cool packs directly on the skin, but always with at least one layer of fabric in between. Otherwise, local frostbite could occur.
• Those who have congenital or acquired connective tissue weakness are particularly prone to dislocation.

Dislocation: What is it?

“Luxation” is the medical term for a dislocation. The condyle – the bone that normally lies in the joint socket – springs out of it. The two joint components thus lose contact with each other.

This is especially easy with very flexible joints: Normally, attached muscles and ligaments stabilize a joint. However, if these structures are damaged or overstretched, for example, a careless, jerky movement or a fall is often enough – the condyle jumps out of the socket.

Such a dislocation is very painful. And the more often a bone leaps out of the joint socket, the easier it will happen again, as the surrounding structures “wear out”.

Which dislocations are there?

There are different types of dislocations – depending on which joint is dislocated, how the dislocation is made or how severe it is. Examples:

Shoulder joint dislocation

The shoulder joint is the most flexible joint in humans. It is most commonly affected by dislocation of all joints. How to do first aid for a joint dislocation of the shoulder, read in the article Shoulder Dislocation.

Elbow Dislocation

A dislocated elbow is the second most common form of joint dislocation, at about 20 percent. It is caused by a fall on the outstretched arm. Frequently, such elbow dislocation is accompanied by further injuries such as torn ligaments, broken bones or nerve injuries.

patellar dislocation

The kneecap (patella) can jump out of its slide bearing. Most often, this happens to adolescent women, such as in sports. Which first aid measures are recommended for such an injury and what the treatment by the doctor looks like, you will learn in the article Patellar Luxation.

Fingerluxation

When volleyball or basketball bounces violently against an outstretched finger during sport, a finger joint can easily slip out of its normal position. With such a dislocated finger you should definitely go to the doctor! Why this is so and how to properly provide first aid for such an injury, read in the article finger luxation.

Traumatic dislocation

This is what medics are talking about when a joint dislocates due to direct or indirect force (for example, in an accident or fall). The sudden strong impact of violence can shift the articular surfaces to diverge.

Habitual dislocation

The habitual dislocation is due to a congenital or acquired joint instability (eg due to very loose ligaments). It is then often already a minimum stress, and the affected joint is dislocated. A dislocation without any force is called also spontaneous dislocation.

Habitual dislocations are often less painful than traumatic, as the ligaments and muscles are already overstretched.

Pathological dislocation

It arises, for example, as a result of chronic joint damage or joint inflammation with capsule overstretching. Joint destruction as well as muscle paralysis can lead to pathological dislocation.

Congenital dislocation

Some children are already born with a dislocated joint or are prone to recurrent nodules from birth. The cause in both cases is a malformation (dysplasia) of the affected joint. For example, in cases of hip dysplasia, the femur repeatedly jumps out of the acetabular cup.

Luxationsfraktur

Sometimes, when one of the bones involved in the dislocation breaks down completely, or a small piece of bone breaks off. Then doctors speak of a dislocation fracture. This risk exists, for example, in falls with high force on the joint (traumatic dislocation).

subluxation

In a dislocation, the joint-forming bone ends are completely displaced. If, on the other hand, there is only a partial drifting of the articular surfaces, there is a subluxation. The most important information and the special case of Chassaignac palsy can be read in the article Subluxation.

Older people are more prone to dislocation than young people. With age, tendons, ligaments and bones wear out, making joints more unstable. In principle, young men also develop joints more often than women, as they often engage in risky sports.

Dislocation in children

Children before the age of 7 rarely suffer dislocation. Your bones are even more flexible and can evade better in case of violence. However, a special form of elbow dislocation, Chassaignac’s paralysis, occurs almost exclusively in children. This form of incomplete dislocation (subluxation) occurs when you pull a child’s arm jerkily. Read more about this in the subluxation article.

Dislocation: what to do?

• restraint: First, you should immobilize the dislocated joint with a wrap or bandage. In case of dislocations on the arm, you can also ask the affected person to hold the same. In addition, you can stabilize the arm by gently clamping a pad between the arm and trunk.
• CoolIn a dislocation the affected area swells quickly. In addition, severe pain occurs. Both – swelling and pain – can be relieved by cooling. You can, for example, ice cube or a cool pack hang up.

Dislocation: risks

A dislocation is usually very painful. When drifting apart of the bone ends namely vessels, nerves and muscles can be damaged. Because of the severe pain, the patient usually takes a restrain. For example, with a dislocated shoulder, he can instinctively press the affected arm against the trunk.

It is also typical for dislocation that the affected part of the body suddenly has little or no movement (for example, the finger in case of a finger dislocation or the arm in the case of a dislocation of the shoulder).

If nerves have been injured while being stretched out, sensations of distress may occur in the area of ​​supply. This can be, for example, a tingling sensation or a furry feeling in the fingers during a shoulder dislocation.

Luxation: When to the doctor?

A dislocation is always a medical emergency and is usually treated in the hospital. So if someone has a joint dislocated, a doctor’s visit is always advisable. As a first responder you should bring the patient immediately to a doctor or to the hospital or call the ambulance.

Dislocation: examinations at the doctor

The doctor first gives the patient painkillers, so that the subsequent physical examination is bearable. In this examination, the physician looks closely at the affected joint itself and its position. In addition, he examines how it is about the circulation, mobility and perception of the affected body part ordered. For example, if the hand appears pale or even bluish in a dislocated shoulder or elbow joint, a vessel is probably injured. If the patient is unable to properly move his or her fingers or if he feels a tingling in the appropriate places, it is likely that the nerves are injured.

In the next step, the dislocated joint is X-rayed. So the doctor can determine if it is really completely dislocated and if it also bones were injured. Occasionally, a dislocation is already visible in the ultrasound image (especially in children).

But there are also dislocations that only show up in computed tomography (CT) or MRI (magnetic resonance imaging, MRI). These more complex procedures also detect accompanying injuries to the soft tissue, such as ligament tears.

In rare cases, joint dislocation (arthroscopy) is necessary in a dislocation.

Dislocation: treatment by the doctor

In the case of a dislocation without accompanying injuries, the doctor can usually manually re-dissect the dislocated joint (reposition). That can be very painful. Therefore, the patient usually gets a strong analgesic or a short anesthetic before. This also has the advantage that then the muscle tension is reduced. This makes it easier to insert the bone back into the socket.

After reduction, the joint is usually retouched to control its correct position. After that, it is immobilized for a while with the help of special bandages or plaster splints.

In some cases of dislocation, manual restraint does not succeed or there are concomitant injuries (e.g., nerve injury or bone fracture). Then an operation is necessary. In younger, physically active people, a dislocation is often operated to reduce the risk of new dislocations. During the procedure, the doctor can namely tighten the overstretched capsule or ligaments and thus give the joint more stability again.

Prevent dislocation

A stable joint does not age so easily. A stable holding device around a joint can therefore reduce the risk of dislocation. Regular coordination exercises and strengthening exercises help those muscles that stabilize a joint. In sports, appropriate protective equipment can help to prevent traumatic dislocation (or other sports injuries).

If someone is more likely to dislocate (for example due to connective tissue weakness), it may be advisable to do without certain activities or sports.