Joint Dislocation: Understanding Reduction, Risks, and Recovery

What is it called when you put a dislocation back in place?

The medical term for putting a dislocated joint back into its proper anatomical position is reduction. This procedure aims to restore the joint's normal alignment and function, alleviating pain and preventing further damage.

Understanding Joint Dislocation

A joint dislocation occurs when the bones that form a joint are forced out of alignment, resulting in a complete separation of the articular surfaces. This traumatic injury often involves damage to the ligaments, joint capsule, and surrounding soft tissues that normally stabilize the joint.

Common characteristics of a dislocation include:

• Severe pain: Often intense and immediate at the time of injury.
• Visible deformity: The joint may appear obviously out of place, swollen, or misshapen.
• Swelling and bruising: Due to soft tissue damage and internal bleeding.
• Inability to move the joint: Active or passive movement is often severely restricted or impossible.
• Numbness or tingling: If nerves are compressed or stretched.

While any joint can dislocate, some of the most commonly affected include the shoulder, fingers, kneecap (patella), elbow, and hip. The mechanism usually involves a sudden, forceful impact or an extreme range of motion that exceeds the joint's physiological limits.

The Term: "Reduction"

In orthopedics and emergency medicine, the specific term for the action of returning a dislocated bone to its correct anatomical position within the joint is reduction. The word "reduction" comes from the Latin "reducere," meaning "to lead back." In this context, it signifies the process of leading the displaced bone back into its natural socket or alignment.

While less formal terms like "setting the joint" or "popping it back in place" are sometimes used colloquially, reduction is the precise medical terminology. The goal of reduction is to restore the integrity of the joint, reduce pain, and initiate the healing process.

Why "Reduction" is a Medical Procedure (Not Self-Treatment)

Attempting to reduce a dislocation without proper medical training is extremely dangerous and can lead to severe, irreversible complications. Reduction is a skilled medical procedure that must be performed by a trained healthcare professional, such as a physician, orthopedic surgeon, or trained paramedic.

Risks of improper or self-reduction include:

• Further joint damage: Causing additional fractures to the bone ends or articular cartilage.
• Nerve damage: Compressing, stretching, or tearing nerves, leading to permanent numbness, tingling, or weakness.
• Vascular damage: Injuring blood vessels, potentially leading to compartment syndrome, loss of blood supply to the limb, or even amputation in severe cases.
• Increased soft tissue injury: Tearing ligaments, tendons, or the joint capsule further, leading to chronic instability.
• Increased pain and swelling: Exacerbating the initial injury.
• Incomplete reduction: The joint may appear to be in place but is not fully aligned, leading to ongoing pain and dysfunction.

Before reduction, medical professionals typically perform imaging studies, most commonly X-rays, to confirm the diagnosis of dislocation, identify the direction of displacement, and, crucially, rule out any associated fractures. An attempt at reduction with an undiagnosed fracture could cause significant harm. After reduction, another X-ray is often performed to confirm successful realignment.

Methods of Reduction

The method of reduction chosen depends on the specific joint involved, the direction of the dislocation, and the patient's condition. Most dislocations are managed through closed reduction, which involves manual manipulation of the joint without surgical incision.

Common approaches to closed reduction include:

• Traction-Countertraction: Applying opposing forces to gently pull the bones apart and then guide them back into place.
• Specific Maneuvers: Utilizing particular movements or positions that leverage biomechanical principles to guide the dislocated bone back. Examples include various techniques for shoulder dislocations (e.g., external rotation, Stimson's maneuver) or specific methods for finger dislocations.
• Pain Management and Sedation: Due to the severe pain associated with dislocations and the need for muscle relaxation, patients often receive pain medication, muscle relaxants, procedural sedation, or even general anesthesia before the reduction attempt.

In some cases, if closed reduction is unsuccessful, or if there are associated complex fractures, significant soft tissue interposition, or recurrent dislocations, open reduction may be necessary. This involves surgical intervention to directly visualize the joint and manually realign the bones.

Post-Reduction Care and Rehabilitation

Following successful reduction, immediate care focuses on stabilizing the joint and managing pain to promote healing and prevent re-dislocation.

Key components of post-reduction care include:

• Immobilization: The joint is typically immobilized using a sling, brace, cast, or tape for a period determined by the joint, the severity of the initial injury, and the individual's healing progress. This allows damaged ligaments and soft tissues to heal.
• Pain Management: Analgesics and anti-inflammatory medications are prescribed to manage pain and swelling.
• Rehabilitation (Physical Therapy): This is a critical component to restore full function and prevent future dislocations. A structured rehabilitation program typically progresses through phases:
  • Initial Phase: Focus on pain and swelling control, gentle range of motion exercises as tolerated, and protecting the healing tissues.
  • Strengthening Phase: Gradually introducing exercises to strengthen the muscles surrounding the joint. For example, after a shoulder dislocation, strengthening the rotator cuff muscles is crucial.
  • Proprioception and Neuromuscular Control: Exercises to re-educate the joint's sense of position and movement, improving stability and coordination.
  • Return to Activity: Gradually progressing to sport-specific or activity-specific drills, ensuring the joint can withstand the demands of normal life and desired activities.
• Prevention of Recurrence: Adherence to the rehabilitation program, avoiding high-risk movements, and sometimes considering prophylactic bracing are important to reduce the risk of future dislocations, especially for those who experience recurrent instability.

When to Seek Immediate Medical Attention

If you suspect a dislocation, it is imperative to seek immediate medical attention. Do not attempt to reduce the dislocation yourself or allow an untrained person to do so.

Call emergency services or go to the nearest emergency room if you experience:

• A visible deformity of a joint.
• Severe pain at a joint after an injury.
• Inability to move a joint.
• Numbness, tingling, or weakness in the limb below the injured joint.
• Coolness or paleness of the skin below the injured joint, which could indicate compromised blood flow.

Prompt and professional medical intervention ensures the safest and most effective reduction, minimizing complications and optimizing the path to recovery.