Joint Reduction: Understanding Dislocations, Subluxations, and the Treatment Process

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

When a joint is put back into its proper anatomical position after being dislocated or partially dislocated (subluxed), the medical term for this procedure is reduction.

The Core Terminology: Reduction

In the field of orthopedics and emergency medicine, the specific term used to describe the act of realigning a dislocated or subluxed joint is reduction. This term refers to the process of restoring the anatomical relationship between the bones that form a joint. It is a critical medical procedure aimed at alleviating pain, restoring function, and preventing long-term complications associated with joint displacement.

While terms like "setting a bone" might be used colloquially, "reduction" is the precise medical descriptor. It's important to distinguish joint reduction from other manual therapies, such as chiropractic adjustments or osteopathic manipulations, which typically address spinal or peripheral joint dysfunctions or subluxations (partial misalignments) rather than complete dislocations.

Understanding Joint Dislocation and Subluxation

Before a joint can be reduced, it must first be displaced. Understanding the nature of this displacement is crucial:

• Dislocation (Luxation): This occurs when the bones that form a joint are completely separated from their normal articulation. The joint surfaces are no longer in contact. Dislocation is a severe injury often accompanied by intense pain, visible deformity, swelling, and a complete loss of function in the affected limb or digit. Common joints prone to dislocation include the shoulder, fingers, kneecap (patella), and elbow.
• Subluxation: This is a partial dislocation, where the joint surfaces are still in contact but are no longer in their proper alignment. While less severe than a full dislocation, a subluxation can still cause pain, instability, and impaired function. It can sometimes spontaneously reduce itself, but often requires medical intervention.

Causes of Joint Displacement: Most dislocations and subluxations are caused by trauma, such as a fall, a direct blow, or a sudden twisting motion during sports activities. In some individuals, underlying joint laxity or previous injuries can make them more susceptible to recurrent dislocations.

The Process of Joint Reduction

Joint reduction is a skilled medical procedure that involves carefully maneuvering the dislocated bones back into their correct position within the joint capsule. The specific technique used varies depending on the joint involved and the type of displacement. Common principles include:

• Traction and Counter-Traction: Applying a steady pull on the limb while stabilizing the adjacent body part.
• Specific Maneuvers: Using precise rotational or translational movements designed to guide the bone head back into the joint socket.
• Pain Management: Due to the severe pain associated with dislocations, reduction often requires pain medication, muscle relaxants, or even conscious sedation (procedural sedation) to relax the muscles surrounding the joint and minimize patient discomfort during the procedure.

A successful reduction is typically confirmed by a palpable "clunk" as the joint realigns, immediate pain relief, and restoration of the joint's normal contour and range of motion. Imaging studies, such as X-rays, are often performed before and after reduction to confirm the diagnosis, rule out associated fractures, and verify successful realignment.

Who Performs a Joint Reduction?

Joint reduction is a medical procedure that must be performed by a qualified healthcare professional. This typically includes:

• Emergency Physicians: Often the first point of contact in an emergency setting.
• Orthopedic Surgeons: Specialists in musculoskeletal injuries, particularly for complex dislocations or those requiring surgical intervention.
• Physician Assistants and Nurse Practitioners: In some settings, under the supervision of a physician, they may perform reductions.
• Paramedics/Advanced Emergency Medical Technicians: In certain urgent field situations, protocols may allow for reduction of specific joints (e.g., shoulder) if transport to a medical facility is significantly delayed and the patient meets strict criteria.

Why Self-Reduction is Not Recommended

Attempting to reduce a dislocated joint yourself or having an untrained individual do so carries significant risks and is strongly discouraged:

• Misdiagnosis: The injury might not be a simple dislocation. A fracture (a broken bone) can present with similar symptoms, and attempting to reduce a fractured joint can cause severe, irreversible damage.
• Further Injury: Improper technique can lead to:
  • Nerve Damage: Stretching or severing nerves around the joint.
  • Vascular Damage: Tearing blood vessels, potentially leading to limb ischemia (lack of blood flow).
  • Soft Tissue Damage: Tearing ligaments, tendons, or the joint capsule, worsening instability and increasing the risk of future dislocations.
  • Chondral Damage: Injury to the articular cartilage, which can lead to early-onset arthritis.
• Increased Pain and Muscle Spasm: Without proper analgesia and muscle relaxation, self-reduction is excruciatingly painful and often unsuccessful due to muscle guarding.
• Incomplete Reduction: The joint may appear reduced but remain partially misaligned, leading to chronic pain and dysfunction.

Always seek immediate medical attention for a suspected joint dislocation.

After a Joint Reduction: Recovery and Prevention

Once a joint has been successfully reduced, the focus shifts to recovery and prevention of recurrence:

• Immobilization: The joint is typically immobilized (e.g., with a sling, brace, or cast) for a period to allow the stretched or torn ligaments and joint capsule to heal. The duration depends on the joint, severity of the injury, and individual factors.
• Pain Management: Analgesics are prescribed to manage post-reduction pain and discomfort.
• Rehabilitation (Physical Therapy): This is a crucial component of recovery. A physical therapist will guide the patient through exercises designed to:
  • Restore full range of motion.
  • Strengthen the muscles surrounding the joint to improve stability.
  • Enhance proprioception (the body's sense of joint position) to prevent future injuries.
• Prevention of Recurrence: Strategies include continued strengthening, avoiding high-risk movements or activities, and in some cases, surgical intervention (e.g., for recurrent shoulder dislocations) to repair damaged ligaments or reshape bony structures.

When to Seek Medical Attention

If you suspect a joint dislocation or experience any of the following, seek immediate medical attention:

• Severe pain in a joint after an injury.
• Visible deformity or "out-of-place" appearance of a joint.
• Inability to move the affected limb or digit.
• Swelling, bruising, or numbness/tingling around the joint.
• Any "pop" or "snap" heard or felt during an injury, followed by significant pain or dysfunction.

Conclusion

The medical term for putting a joint back in place is reduction. This procedure is a critical intervention for joint dislocations and subluxations, requiring the expertise of trained medical professionals. While the immediate goal is to alleviate pain and restore joint alignment, the long-term success hinges on proper post-reduction care, including immobilization and a comprehensive rehabilitation program. Attempting self-reduction is dangerous and can lead to severe, irreversible complications, underscoring the importance of seeking professional medical care for any suspected joint displacement.