Joint Dislocation - Diagnosis, Treatment & Surgery

What is Joint Dislocation?

Joint dislocation, also termed luxation, is a medical condition wherein an abnormal separation occurs in the joint where two or more bones meet. This typically results from sudden trauma, like a fall or forceful impact, which pushes the bones out of their standard position leading to the misalignment of the joint. Such dislocations can happen anywhere but are most predominantly found in the shoulder (shoulder joint dislocation), elbow (elbow joint dislocation), wrist and hip joints (hip joint dislocation).

In India, thousands of cases of joint dislocations are reported annually, primarily from sports-related injuries or accidents. It affects both adults and teenagers with a significant number of cases reported amongst those engaged in high-impact sports or having previous injuries. According to an article on NCBI, shoulder dislocations are the most commonly encountered in Indian emergency departments.

What causes Joint Dislocation?

Joint dislocations can occur due to various factors:

• Sudden trauma: An abrupt forceful impact or fall is the most common cause of joint dislocation.
• Sports: Participation in high-impact sports such as football, basketball or skiing increases the risk of conditions like acromioclavicular joint dislocation.
• Genetic factors: Certain individuals may be genetically predisposed to joint dislocations due to a family history of such occurrences.
• Muscle imbalances: Weak or tight muscles around the joint can lead to instability, raising the likelihood of dislocation.
• Previous injuries: Those with a history of injuries to the joint or surrounding muscles are more prone to dislocations.
• Joint instability: Conditions like ligamentous laxity (loose joints) can enhance the risk of dislocations, such as AC joint dislocation.
• Age: Teenagers and young adults are more commonly affected, although joint dislocation can occur at any age.

Types of Joint Dislocation

Various types of joint dislocations can occur due to different reasons. Here we will explore these types:

• Complete Dislocation: This is a condition where the bones in the joint are entirely separated from each other, resulting in a complete loss of contact.
• Incomplete Dislocation: In this type, the bones are partially separated but maintain some level of contact between them.
• Subluxation: It is a minor or partial dislocation where the bones are still relatively close to each other within the joint.
• Recurrence: This refers to joints that dislocate repeatedly, generally owing to underlying instability or muscle imbalances.

Symptoms of Joint Dislocation

In the event of a joint dislocation, you might experience the following symptoms:

• Severe pain: The most common symptom is intense pain, especially when trying to move or put weight on the affected joint.
• Swelling and bruising: The dislocated area may swell up and show signs of bruising due to internal bleeding and inflammation.
• Limited mobility: The joint may become stiff, restricting movement because of pain and swelling.
• Deformity: A visible change in the shape or arrangement of the joint can suggest a dislocation.
• Numbness or tingling: These sensations could signify nerve compression or irritation.

Diagnosis and Evaluation of Joint Dislocations

To diagnose a joint dislocation, doctors follow an established method:

• Patient history: Firstly, understanding the patient’s history is vital. Information regarding how the injury happened and any prior injuries to that joint helps ascertain the severity and possible complications.
• Physical examination: This involves checking for signs of dislocation in the joint, such as deformity, swelling, bruising, and limited mobility. The neurovascular exam ensures there is no nerve or vascular damage.
• Imaging studies: Imaging studies such as X-rays or Ultrasound scans, help in confirming diagnoses. They also help in identifying additional injuries, such as fractures. Cross-Sectional Imaging (like CT or MRI scans) are used for more detailed inspection of the joint-supporting structures and to assess ligamentous and other soft tissue injuries.

Treatment of Joint Dislocation

When treating joint dislocations, doctors follow a structured approach:

• Initial care involves Rest, Ice, Compression, and Elevation (RICE) to reduce pain and swelling. The joint is then immobilised using a splint, sling, or cast to prevent further damage and facilitate healing.
• Reduction is the process of repositioning the joint back into its normal alignment. This can be done manually or surgically, often involving anaesthesia or sedatives for comfort.
• Immobilisation devices are used post-reduction to keep the joint stable while it heals. Mild pain relievers or muscle relaxants may be prescribed.
• Rehabilitation involves exercises to strengthen the joint and improve stability. A structured rehabilitation programme helps restore the joint’s strength, range of motion, and function.
• Surgery may be required if there are additional complications like damage to nerves or blood vessels. If the dislocation is recurrent, surgery may be recommended to improve joint stability and prevent future dislocations.
• Regular Follow-Up appointments allow the doctor to monitor healing progress and adjust treatment if needed. Prevention methods such as protective gear, maintaining a healthy weight, and strengthening exercises can also help avoid future dislocations. With these steps, recovery from a joint dislocation can be effectively managed.

When is Joint Dislocation considered serious?

Joint dislocations can become serious under certain circumstances. A dislocation, such as an ac joint dislocation or shoulder joint dislocation, is deemed critical when accompanied by complications like:

• Fractures: When the injury causing the dislocation also results in a fracture.
• Blood vessel damage: This can occur when a dislocated hip or knee disrupts blood flow to the leg, causing tissues to die (necrosis).
• Nerve damage: Severe joint dislocations can result in long-lasting nerve damage within the affected limb.
• Skin tears: If the skin is torn during the dislocation, it increases risk of serious complications.
• Infections: These may arise when the skin is torn or if the joint is not properly immobilised and treated.
• Long-lasting joint problems: Dislocations can weaken or tear the ligaments and tendons stabilising the joint.

Prevention of Joint Dislocation

While it’s not always possible to prevent joint dislocations like acromioclavicular joint dislocation, there are strategies one can adopt to minimise risks. Regular exercise helps to strengthen muscles and improves balance and coordination, reducing the likelihood of injuries such as elbow joint dislocation.

Ensuring correct techniques and using appropriate equipment during sports can also lower risk levels. If you are at a higher risk due to earlier episodes of dislocations like hip joint dislocation, consulting an orthopaedic specialist for personalised prevention strategies can be beneficial.

Myths & Facts about Joint Dislocation

There are several misconceptions about joint dislocations. Some prevalent myths along with corresponding facts include:

• Myth 1: Dislocated and separated shoulders are the same.
  Fact: They are different conditions; a separated shoulder involves torn ligaments.
• Myth 2: You can pop your shoulder back into place yourself.
  Fact: It is dangerous to attempt this; professional medical assistance is necessary.
• Myth 3: A shoulder that has been dislocated won’t dislocate again.
  Fact: Recurrence is high, often necessitating surgery.
• Myth 4: The main symptom of a dislocated shoulder is a floppy arm.
  Fact: Acute pain is the primary symptom.
• Myth 5: Most people dislocate their shoulders in their lifetime.
  Fact: While common, not everyone will experience a dislocation.

When to Consult a Doctor for Joint Dislocation?

If you suspect a joint dislocation, it is crucial to seek immediate medical attention to minimise the risk of serious complications and ensure effective treatment. You should consult an orthopaedic surgeon, particularly if you experience severe pain, inability to move the joint, visible deformity, swelling, or discoloration. Timely consultation can also prevent recurring dislocations.

Questions to Ask your Doctor about Joint Dislocation

When visiting your doctor concerning joint dislocation, consider asking the following questions:

• Which type of dislocation do I have?
• What treatments will I need?
• How long will recovery take?
• How long will I need to wear a splint or sling?
• Will surgery be necessary?
• When can I return to regular activities or sports?
• What is the risk of the dislocation happening again?
• How can I prevent future dislocations?
• What are potential complications?
• When should I call the doctor after treatment?