Dislocation: Treatment, Rehabilitation, and Prevention

What is the Treatment for a Dislocation?

The treatment for a dislocation primarily involves immediate medical attention to manually or surgically realign the displaced bones in the joint (reduction), followed by a structured rehabilitation program to restore stability, strength, and function.

Understanding a Dislocation

A dislocation occurs when the bones that form a joint are forced out of alignment, resulting in a complete separation of the joint surfaces. This traumatic injury can affect any joint in the body, but it is most common in highly mobile joints such as the shoulder, fingers, kneecap (patella), and less frequently, the elbow, hip, or jaw.

Common Causes:

• Traumatic impact: Falls, sports injuries (e.g., direct blow, hyperextension, twisting forces).
• Motor vehicle accidents.
• Extreme stretching or twisting.

Key Symptoms:

• Severe pain: Often excruciating and immediate.
• Visible deformity: The joint may look visibly out of place, misshapen, or swollen.
• Swelling and bruising: Rapid onset around the affected joint.
• Inability to move the joint: Or severe pain upon attempting movement.
• Numbness or tingling: If nerves are compressed or damaged.

Immediate First Aid (Pre-Medical Intervention)

A suspected dislocation is a medical emergency that requires prompt professional attention. While awaiting medical help, focus on stabilizing the injury and managing pain.

• Do NOT attempt to relocate the joint yourself. This can cause further damage to nerves, blood vessels, ligaments, or the joint surfaces.
• Immobilize the joint: Use a splint, sling, or padded bandage to keep the joint in its current position and prevent further movement. If no immediate splinting materials are available, try to keep the limb as still as possible.
• Apply ice: Place an ice pack wrapped in a cloth on the injured area for 15-20 minutes at a time to help reduce pain and swelling.
• Elevate the limb: If possible, elevate the injured limb above the level of the heart to help minimize swelling.
• Seek immediate medical attention: Call emergency services or transport the individual to the nearest emergency room or urgent care clinic.

Medical Treatment: Reduction

Once at a medical facility, the primary goal of treatment is reduction, which is the process of putting the bones back into their correct anatomical position.

• Diagnosis: A healthcare professional will typically perform a physical examination and order X-rays to confirm the dislocation, identify its direction, and rule out any associated fractures or other injuries.
• Closed Reduction: This is the most common method and involves a physician manually manipulating the bones back into place without making an incision.
  • Anesthesia/Sedation: To minimize pain and muscle spasm during the procedure, the patient will typically receive pain medication, muscle relaxants, or conscious sedation (e.g., intravenous medications). In some cases, local anesthetic is injected directly into the joint.
  • Technique: The specific manipulation technique varies depending on the joint involved (e.g., specific traction and rotation maneuvers for a shoulder dislocation).
• Open Reduction (Surgical): In certain circumstances, surgery may be required to realign the joint. This is typically necessary if:
  • Closed reduction is unsuccessful.
  • There are associated injuries, such as a severe fracture, significant ligamentous damage, or trapped soft tissues that prevent manual reduction.
  • The dislocation is recurrent or chronic.
  • Surgery may be performed using minimally invasive arthroscopic techniques or traditional open surgery, depending on the complexity of the injury.

Post-Reduction Management

After the joint has been successfully reduced, the focus shifts to protecting the joint and managing pain while initial healing occurs.

• Immobilization: The joint will be immobilized using a sling, brace, cast, or tape for a specific period. This prevents re-dislocation and allows injured ligaments, tendons, and joint capsules to heal. The duration of immobilization varies significantly based on the joint and the severity of the injury (e.g., a few days for a finger, several weeks for a shoulder).
• Pain Management: Over-the-counter pain relievers (e.g., NSAIDs like ibuprofen) or prescription pain medication may be prescribed to manage discomfort.
• Continued RICE Protocol: Rest, Ice, Compression, and Elevation continue to be beneficial in reducing swelling and pain during the initial healing phase.
• Monitoring for Complications: Healthcare providers will monitor for potential complications such as nerve damage (e.g., persistent numbness, weakness), blood vessel damage (e.g., coldness, pallor, diminished pulse in the limb), or joint stiffness.

Rehabilitation: Restoring Function and Stability

Rehabilitation is a critical phase of dislocation treatment, aimed at restoring full range of motion, strength, proprioception (joint position sense), and stability to the affected joint. This process is often guided by a physical therapist or athletic trainer.

• Importance of Physical Therapy: A structured rehabilitation program is essential to prevent stiffness, muscle atrophy, and recurrent dislocations. It helps the joint regain its normal function and reduces the risk of long-term complications.
• Phased Approach: Rehabilitation typically progresses through several phases:
  • Phase 1: Protection and Pain Control: While the joint is immobilized, gentle isometric exercises (muscle contractions without joint movement) may be introduced to maintain muscle tone. Focus remains on pain and swelling control.
  • Phase 2: Restoring Range of Motion (ROM): Once adequate healing has occurred, the therapist will guide exercises to gradually restore the full, pain-free range of motion. This may involve passive range of motion (therapist moves the joint) and active range of motion (patient moves the joint).
  • Phase 3: Strengthening: Progressive resistance exercises are introduced to strengthen the muscles surrounding the joint. This is crucial for providing dynamic stability and support to the joint, reducing the risk of re-dislocation. Exercises may involve resistance bands, light weights, and bodyweight movements.
  • Phase 4: Proprioception and Neuromuscular Control: Exercises focusing on balance, coordination, and the body's awareness of joint position are incorporated. This is particularly important for joints like the shoulder and ankle. Examples include balance board exercises or single-leg stands.
  • Phase 5: Return to Activity: Gradually, sport-specific drills or functional movements relevant to the individual's daily activities or athletic pursuits are introduced. The return to full activity is typically gradual and guided by the physical therapist, ensuring the joint is strong and stable enough to withstand demands.
• Adherence: Patient adherence to the prescribed exercise program is paramount for a successful recovery and to minimize the risk of re-injury.

Preventing Recurrence

While not always preventable, several strategies can help reduce the risk of future dislocations, especially after an initial injury.

• Consistent Strengthening and Stability Exercises: Continue with the prescribed exercises even after formal physical therapy ends to maintain muscle strength and joint stability.
• Proper Technique: Learn and practice correct form for exercises, sports, and daily activities to avoid movements that place undue stress on the joint.
• Protective Gear: Wear appropriate protective gear, such as braces or supportive taping, during activities that place the joint at risk, if recommended by a healthcare professional.
• Awareness of Risk Factors: Individuals with generalized ligamentous laxity (hypermobility) or a history of previous dislocations may be at higher risk and should take extra precautions.

When to Seek Emergency Care

Any suspected dislocation warrants immediate medical attention. Do not delay seeking care, especially if you observe:

• Severe pain and visible deformity.
• Numbness, tingling, or weakness in the limb.
• The limb appears pale, cold, or has an absent pulse.
• There is an open wound near the dislocated joint.

Prompt and appropriate treatment is key to ensuring proper healing and minimizing long-term complications following a dislocation.