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    Dislocation

    Joint dislocation

    A dislocation is a separation of two bones where they meet at a joint. Joints are areas where two bones come together.

    A dislocated bone is no longer in its normal position.

    Considerations

    It may be hard to tell a dislocated bone from a broken bone. Both are an emergency. You will need the same first aid treatment.

    Most dislocations can be treated ina doctor's office or emergency room. You may be given medicine to make you sleepy and to numb the area.Sometimes, general anesthesia in the operating room is needed.

    When treated early, most dislocationswill not result in permanent injury.

    • Injuries to the surrounding tissues generally take 3 - 6 weeks to heal. Sometimes, surgery to repair a torn ligament is needed.
    • Injuries to nerves and blood vessels may result in more long-term or permanent problems.

    Once a joint has been dislocated, it is more likely to happen again. Follow-up with an orthopedic surgeon is recommended after a dislocation.

    Causes

    Dislocations are usually caused by a sudden impact to the joint. This usually occurs following a blow, fall, or other trauma.

    Symptoms

    A dislocated joint may be:

    • Accompanied by numbness or tingling at the joint or beyond it
    • Intensely painful, especially if you try to use the joint or bear weight on it
    • Limited in movement
    • Swollen or bruised
    • Visibly out of place, discolored, or misshapen

    Nursemaid's elbow is a partial dislocation common in toddlers. The main symptom is refusal to use the arm. Nursemaid's elbow can be easily treated in a doctor's office.

    First Aid

    1. Call 911 before you begin treating someone who may have a dislocation, especially if the accident causing the injury may be life-threatening.
    2. If there has been a serious injury, check the person's airway, breathing, and circulation. If necessary, begin rescue breathing, CPR, or bleeding control.
    3. Do not move the person if you think that the head, back, or leg has been injured. Keep the person still. Provide reassurance.
    4. If the skin is broken, take steps to prevent infection. Do not blow on the wound. Rinse the area gently to remove obvious dirt, but do not scrub or probe. Cover the area with sterile dressings before immobilizing the injury.
    5. Splint or sling the injury in the position in which you found it. Do not move the joint. Be sure to immobilize the area above and below the injured joint.
    6. Check the person's blood circulation around the injury by pressing firmly on the skin in the affected area. It should blanch white, then regain color within a couple of seconds. Avoid this step if the skin has been broken, to reduce the risk of infection.
    7. Apply ice packs to ease pain and swelling.
    8. Take steps to prevent shock. Unless there is a head, leg, or back injury, lay the victim flat, elevate the feet about 12 inches, and cover the person with a coat or blanket.

    DO NOT

    • Do NOT move the person unless the injury has been completely immobilized.
    • Do NOT move a person with an injured hip, pelvis, or upper leg unless it is absolutely necessary. If you are the only rescuer and the person must be moved, drag him or her by the clothing.
    • Do NOT attempt to straighten a misshapen bone or joint or to change its position.
    • Do NOT test a misshapen bone or joint for loss of function.
    • Do NOT give the person anything by mouth.

    When to Contact a Medical Professional

    Call 911 if the person has:

    • A bone projecting through the skin
    • A known or suspected dislocation or broken bone
    • An area below the injured joint that is pale, cold, clammy, or blue
    • Severe bleeding
    • Signs of infection, such as warmth or redness at the injured site, pus, or a fever

    Prevention

    Preventing injuries in children:

    • Create a safe environment around your home.
    • Pay careful attention to preventing falls by gating stairways and keeping windows closed and locked.
    • Supervise children carefully. There is no substitute for close supervision no matter how safe the environment or situation appears to be.
    • Teach children how to be safe and look out for themselves.

    Preventing dislocations in adults:

    • Avoid falls by not standing on chairs, countertops, or other unstable objects.
    • Eliminate throw rugs, especially for the elderly.
    • Wear protective gear when participating in contact sports.

    For all age groups:

    • Keep a first aid kit handy.
    • Remove electrical cords from floor surfaces.
    • Use handrails on staircases.
    • Use nonskid mats on the bottom of the bathtubs and avoid bath oils.

    References

    Browner BD, Jupiter JB, Levine Am, Trafton PG, Krettek C., eds. Skeletal Trauma. 4th ed. Philadelphia, Pa: Saunders Elsevier;2008.

    Chapman MW. Fracture healing and closed treatment of fractures and dislocations. In: Chapman MW, Szabo RM, Marder RA, Vince KG, Mann RA, Lane JM, et al, eds. Chapman's Orthopaedic Surgery. 3rd ed. Philadelphia, Pa: Lippincott, Williams & Wilkins: 2000:chap 10.

    Foley KA. Knee dislocation. In: Rosen P, Barkin RM, Hayden SR, Schaider JJ, Wolfe R, eds. Rosen and Barkin's 5-Minute Emergency Medicine Consult. 3rd ed. Philadelphia, Pa: Lippincott, Williams & Wilkins; 2007.

    Brabson TA, Greenfield BS. Prehospital Immobilization.In:Roberts JR, Hedges JR, eds. Roberts: Clinical Procedures in Emergency Medicine.5th ed. Philadelphia, Pa: Saunders Elsevier; 2009: chap 46.

    Ufberg JW, McNamara RM. Management of Common Dislocations.In:Roberts JR, Hedges JR, eds. Roberts: Clinical Procedures in Emergency Medicine.5th ed. Philadelphia, Pa: Saunders Elsevier; 2009: chap 49.

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    • Radial head injury

      illustration

    • Dislocation of the hip

      illustration

    • Shoulder joint

      illustration

      • Radial head injury

        illustration

      • Dislocation of the hip

        illustration

      • Shoulder joint

        illustration

      Self Care

      Tests for Dislocation

        Review Date: 4/12/2012

        Reviewed By: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

        The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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