Dislocation

Risk: The risk of dislocation depends on the joint involved as well as activities performed by the individual. Individuals who participate in contact sports such as football, rugby, hockey, or soccer are at higher risk of joint injuries resulting in dislocations and subluxations. Non-contact sports and activities with potential for high speed such as downhill skiing or rollerblading also can produce joint trauma resulting in dislocations, as can motor vehicle accidents. Males are at greater risk for dislocations than females, most likely because of their higher participation in contact sports. Risk for joint dislocations may be greater in individuals with chronic conditions associated with joint instability such as rheumatoid arthritis and connective tissue disorders associated with ligamentous laxity (e.g., Ehlers-Danlos syndrome, Marfan syndrome).

Incidence and Prevalence: Incidence and prevalence of dislocations varies for specific joints.

History: The individual usually reports a fall or serious trauma followed by excruciating pain in the affected area and difficulty moving the affected joint or limb. The individual may report a sensation of something slipping, tearing, or “popping.”

Physical exam: The joint may have an obvious change in shape (deformity) along with decreased range of motion. Gentle touching of the affected joint (palpation) may reveal tenderness. If the displaced bones have slipped back into their normal position without treatment (spontaneous reduction), no visual deformity may be observed, but abnormal motion may still be evident on physical examination. Limitation of joint movement, bruising (ecchymosis), and sometimes a change in the length of the extremity may be present. A complete nerve and vascular examination is essential to rule out associated injuries.

Tests: Dislocations can usually be confirmed with plain x-rays taken in at least 2 views. Even if the bones have returned to their normal position, x-ray may reveal bone chips in the joint space, swelling in the joint space, or a fracture. CT, MRI or arthroscopy may be indicated if damage to the joint capsule, ligaments, or cartilage is suspected. Procedures that evaluate muscle and nerve function (e.g., electromyography [EMG]; nerve conduction velocity [NCV]) may be necessary. Angiography can detect damage to blood vessels.

Rehabilitation can be used to support successful recovery from a joint dislocation. Therapy may help individuals return to their previous activity level through guided exercise which may help to prevent future dislocations (Kirkley). Rehabilitation will depend on the joint involved, how the dislocation is managed (operative, nonoperative), degree of soft tissue involvement, and the length of immobilization (Edmonds). An individual's age, occupation and sports interests may also determine how the dislocation will be managed. If the dislocation required surgical repair, then therapy may begin when specified by the treating physician.

The initial focus of therapy is to control pain and edema. This may be accomplished through use of modalities such as heat and cold treatments (Braddom). Gentle active range of motion may be started when advised by the treating physician.

When pain and edema are controlled, the focus of rehabilitation is regaining full active range of motion, strength and function. As a result of the soft tissue damage associated with some dislocations, and the disruption of the joint integrity, it is important to emphasize joint stabilization exercises and proprioceptive training. A home exercise program is given to the individual and progressed in conjunction with supervised therapy.