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Joint Dislocation

Joint dislocation results from contact sports or trauma. Dislocation typically occurs at the shoulder, elbow, finger, ankle, etc. The diagnosis is confirmed by the history, physical exam, and radiographic imaging.


Presentation

Joint dislocations can be sustained during contact sports and physical activities [1] such as football, basketball, wrestling, gymnastics, skiing, etc. Dislocations also occur as a result of a direct blow to the joint during a traffic collision. Additionally, individuals with connective tissue disease tend to have ligamentous laxity and hence may be predisposed to joint dislocation. Individuals susceptible to falls are also prone to this type of injury.

Generally, the clinical presentation of dislocation is characterized by joint deformity, swelling, and discoloration. Moreover, the affected joint exhibits a restricted range of motion and pain with movement. Bruises and abrasions may also be apparent.

The most predominant joint dislocation is that of the glenohumeral, or shoulder joint [2] as a result of its high range of motion [3]. It is responsible for more than half of athletic-related dislocations in high school students [2].

The second most frequently dislocated joint is the elbow [4], in which nearby structures are typically disrupted as well [3].

Also prevalent are finger injuries since the digits are vulnerable to trauma [3]. They are often accompanied by hand and wrist injuries as well [5].

The ankle is a commonly involved site in sports injuries. Specifically, ankle dislocations are typically accompanied by fractures [6].

While rare in sports, hip dislocations are very serious due to complications such as avascular necrosis of the femoral head, which requires urgent medical care [7].

Also uncommon in sports are knee dislocations, which are associated with neurovascular injuries, especially that of the popliteal artery [4] and peroneal nerve [8].

Complications

Dislocated joints may encompass injuries of nearby nerves, blood vessels, ligaments, tendons, and muscles. Also, repaired dislocations may be prone to repeated injuries and the development of arthritis with aging.

Physical exam

The exam consists of numerous components. Initially, the clinician will note findings such as the symmetry, swelling, color, shape, and overall appearance of the affected joint in comparison to the normal one. Very importantly, the joint's range of motion and special maneuvers are also tested. Also crucial is the neurovascular evaluation, which includes a thorough neurologic exam and a check of the pulses. Note that the neurovascular assessment should be performed pre- and post-reduction [3] [9].

Single S2
  • Modelling was based on fixation with a single S1 screw (S1-1), single S2 screw (S2-1), two S1 screws (S1-2) and a combination of a single S1 and a single S2 screw (S1–S2).[ncbi.nlm.nih.gov]
Malocclusion
  • This could relate to the heavy tooth wear, frequent antemortem tooth loss and the related sequelae of severe malocclusion and overclosure evident in many surviving ancient Egyptian skulls.[ncbi.nlm.nih.gov]
Tooth Loss
  • This could relate to the heavy tooth wear, frequent antemortem tooth loss and the related sequelae of severe malocclusion and overclosure evident in many surviving ancient Egyptian skulls.[ncbi.nlm.nih.gov]
Fracture
  • Till now we know two fracture pattern in forearm fracture dislocation, Galeazzi fracture dislocation which is defined as fracture of radial shaft with distal radioulnar joint (DRUJ) dislocation and Monteggia fracture dislocation which is ulnar fracture[ncbi.nlm.nih.gov]
Right Shoulder Pain
  • He presented with right shoulder pain, right upper limb functional impairment and right sternoclavicular joint depression. Standard chest radiographs were normal. Chest CT scan showed posterior dislocation and allowed us to determine its variety.[ncbi.nlm.nih.gov]
Skeletal Dysplasia
  • As transport of vesicles from the golgi apparatus to the plasma membrane occurs through kinesin motor proteins along microtubule tracks, the function of EXOC6B is linked to KIF22 suggesting a common pathogenic mechanism in skeletal dysplasias with joint[ncbi.nlm.nih.gov]
Severe Joint Laxity
  • Abstract We report two brothers from a consanguineous couple with spondyloepimetaphyseal dysplasia (SEMD), multiple joint dislocations at birth, severe joint laxity, scoliosis, gracile metacarpals and metatarsals, delayed bone age and poorly ossified[ncbi.nlm.nih.gov]
Facial Pain
  • Shortly after TEE and DCCV, the patient complained of bilateral facial pain. An orthopantomogram revealed bilateral TMJ dislocation. A closed reduction was performed by maxillo-facial surgeons under intravenous anaesthesia.[ncbi.nlm.nih.gov]
Neglect
  • The first follow-up radiograph was obtained as late as 5 months following the operation and revealed a neglected dislocation and periarticular ossifications.[ncbi.nlm.nih.gov]
  • However, overall 87% with type III dislocation showed satisfactory outcome with conservative treatment of ‘Skilful neglect’. REFERENCES: 1. Allman FL Jr. Fractures and ligamentous injuries of the clavicle and its articulation.[shoulderdoc.co.uk]

Workup

The workup for joint dislocation consists of the patient's history, physical exam, and the appropriate imaging. Very importantly, the clinician should elicit a detailed account regarding the incident and mechanism of injury.

Shoulder dislocation is best diagnosed with radiography, particularly the anteroposterior (AP), axillary lateral, and scapular Y-views [1]. Other modalities such as ultrasonography may be required to rule out fractures [10].

To evaluate an elbow dislocation, AP and lateral radiographs are obtained prior to and after reduction to ensure the neurovascular status is sound and the reduction is successful. Ultrasonography [11] and computed tomography (CT) imaging are helpful in assessing other structures.

A digit dislocation is identified with pre and post-reduction radiographs with AP, true lateral, and oblique views [12].

An ankle dislocation is examined with AP, lateral and oblique radiographic views before and after reduction. Additionally, CT scanning is used for display of fractures and alignment.

In traumatic cases, the hips are evaluated with an AP radiograph and CT scanning of the pelvis and hips. Lateral views or CT imaging are warranted in cases with negative AP film but dislocation is still suspected [13].

Knee assessment is conducted with radiography prior to ligament stress tests and after reduction [14]. Also, duplex ultrasonography detects the presence vascular injury [15].

Delayed Bone Age
  • Abstract We report two brothers from a consanguineous couple with spondyloepimetaphyseal dysplasia (SEMD), multiple joint dislocations at birth, severe joint laxity, scoliosis, gracile metacarpals and metatarsals, delayed bone age and poorly ossified[ncbi.nlm.nih.gov]

Treatment

  • Early surgical treatment is recommended for patients with unsatisfactory reset. Delayed diagnosis and treatment often lead to chronic and persistent lower ulnar joint subluxation or dislocation, or even osteoarthritis.[ncbi.nlm.nih.gov]

Prognosis

  • Overall, the prognosis of trapeziometacarpal dislocation treated acutely is favorable and stable over time. However, the role of open surgery and ligament reconstruction remains controversial, especially in children.[ncbi.nlm.nih.gov]
  • […] superior displacement of the clavicle indicates an anterior dislocation 6 difficult to determine anterior or posterior dislocation CT joint space widening and asymmetry at the sternoclavicular joint associated injuries of the mediastinum Treatment and prognosis[radiopaedia.org]
  • Prognosis The outlook is excellent for returning the dislocated ball of the joint to the socket. However, in some people, the joint may continue to become dislocated. If this happens, you may need surgery. 4/16/13 2002- 2017 Aetna, Inc.[colgate.com]

Etiology

  • RESULTS: The most common etiologies in the SSF group were fall (n 3) and direct ear trauma (n 3), and for those in the ISD group, the most common etiology was traffic accident (n 6).[ncbi.nlm.nih.gov]
  • […] encounter A- initial encounter D- subsequent encounter S- sequela Sternoclavicular Dislocation ICD-9 839.61(dislocation of sernum; sternoclavicular joint: closed) 839.71(dislocation of sernum; sternoclavicular joint: open) Sternoclavicular Dislocation Etiology[eorif.com]
  • Metabolic etiologies are a rare but important cause[epilepsydiagnosis.org]
  • Developmental dysplasia of the hip: etiology, pathogenesis, and examination and physical findings in the newborn. Instr Course Lect. 2001 ;50: 535 – 540. Google Scholar Medline 22. Hefti, F, Muller, W.[doi.org]

Epidemiology

  • This study examines the epidemiological characteristics of patients presenting for emergency care of finger dislocations within the United States.[doi.org]
  • We present an up-to-date literature review on the epidemiology, clinical presentation, radiologic assessment, treatment options and prognostic factors of these uncommon injuries.[ncbi.nlm.nih.gov]
  • Lower limb injuries in New Zealand Defence Force personnel: descriptive epidemiology. Aust N Z J Public Health. 2008 ;32(2): 167 – 173. Google Scholar Crossref Medline ISI 8.[ajs.sagepub.com]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology, treatment, and diagnosis of PSCJD are discussed.[ncbi.nlm.nih.gov]
  • […] develop but usually resolves with therapy more commonly seen in volar dislocations swan neck deformity occurs secondary to a volar plate injury seen in dorsal dislocations extensor lag seen in volar dislocations PIP Fracture-Dislocations Introduction Pathophysiology[orthobullets.com]

Prevention

  • Eminectomy, whose validity has been demonstrated by several authors, acts on the bony obstacle, preventing condylar locking, but does not have a therapeutic effect on TMJ ligament and capsular laxity or masticatory muscle incoordination, which seem to[ncbi.nlm.nih.gov]
  • […] is always detached (usually from middle phalanx) in PIP dorsal dislocations; - distal avulsion of volar plate in dorsal PIP dislocations makes entrapment of plate w/in the joint unlikely (in contrast to MP joint in which complex dorsal dislocations prevent[wheelessonline.com]
  • Prevention You can take steps to prevent dislocation by: Being careful to avoid falls: Keep walkways free of things that can make you trip Use glasses or contacts so you can be aware of your surroundings Keep your home well lit Be aware of the side effects[intermountainhealthcare.org]

References

Article

  1. Sofu H, Gürsu S, Koçkara N, et al. Recurrent anterior shoulder instability: Review of the literature and current concepts. World J Clin Cases. 2014; 2(11):676-682.
  2. Benjamin HJ, Hang BT. Common acute upper extremity injuries in sports. Clin Pediatric Emerg Med. 2007;8(1):15-30.
  3. Skelley NW, McCormick JJ, Smith MV. In-game Management of Common Joint Dislocations. Sports Health. 2014;6(3):246-255.
  4. Hodge DK, Safran MR. Sideline management of common dislocations. Curr Sports Med Rep. 2002;1(3):149-155.
  5. Elfar JC, Yaseen Z, Stern PJ, Kiefhaber TR. Individual finger sensibility in carpal tunnel syndrome. J Hand Surg Am. 2010;35(11):1807-1812.
  6. Title CI, Katchis SD. Traumatic foot and ankle injuries in the athlete. Orthop Clin North Am. 2002;33(3):587-598.
  7. Smith MV, Sekiya JK. Hip instability. Sports Med Arthrosc. 2010;18(2):108-112.
  8. Niall DM, Nutton RW, Keating JF. Palsy of the common peroneal nerve after traumatic dislocation of the knee. J Bone Joint Surg Br. 2005;87(5):664-667.
  9. Cohen MS, Hastings H-II. Acute elbow dislocation: evaluation and management. J Am Acad Orthop Surg. 1998;6(1):15-23.
  10. Akyol C, Gungor F, Akyol AJ, et al. Point-of-care ultrasonography for the management of shoulder dislocation in ED. Am J Emerg Med. 2016; 34 (5):866-70.
  11. Lee KS, Rosas HG, Craig JG. Musculoskeletal ultrasound: elbow imaging and procedures. Semin Musculoskelet Radiol. 2010; 14(4):449-60.
  12. Gilbert TJ, Cohen M. Imaging of acute injuries to the wrist and hand. Radiol Clin North Am. 1997; 35(3):701-25.
  13. Wylie JD, Abtahi AM, Beckmann JT, Maak TG, Aoki SK. Arthroscopic and imaging findings after traumatic hip dislocation in patients younger than 25 years of age. J Hip Preserv Surg. 2015;2(3):303-9.
  14. Bouaicha S. The acute knee injury - practical considerations. Praxis (Bern 1994). 2014;10(8):439-44.
  15. Knudson MM, Lewis FR, Atkinson K, Neuhaus A. The role of duplex ultrasound arterial imaging in patients with penetrating extremity trauma. Arch Surg. 1993; 128(9):1033-7; discussion 1037-8.

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Last updated: 2019-06-28 11:45