Dislocation Causes and Treatment
A dislocation occurs when the surfaces of a joint that normally slide across each other are totally displaced, one from the other. If there is partial separation of the joint surfaces, the condition is called subluxation.
A dislocation can be a birth defect (e.g. congenital dislocation of the hips), due to a severe injury (almost any joint in the body), spontaneous for no apparent reason but caused by disease in a joint (e.g. the dislocation of a toe joint severely affected by arthritis), or recurrent, when after previous dislocation the joint dislocates very easily in the future (e.g. shoulder). A dislocation caused by injury may also be associated with a fracture, and anyone treating a dislocation must be aware of this possibility.
Inevitably, cartilages and ligaments, and possibly muscles and tendons around a dislocated joint will also be stretched, strained or torn by the dislocation. A dislocated joint will be painful, swollen and difficult or impossible to move. The skin over the dislocated joint will have different contours to the same joint on the other side of the body. An X-ray is the only definitive way to make the diagnosis.
A dislocation can be associated with complications, such as pinching a nerve or blood vessel, which may cause severe pain beyond the dislocation, and a poor blood supply that can result in tissue death and gangrene. Other complications involve the joint itself, and repeated dislocations can damage the smooth surfaces of the joint and lead to persistent pain after the dislocation has been reduced and to the premature development of arthritis.
A dislocation is treated by replacing the bones of the joint back into their correct position. Immediately after the injury, this can sometimes be done quite easily, even with major joints, as the damaged muscles around the joint will not yet have gone into a spasm. This spasm can later make the reduction of dislocations very difficult without an anesthetic to relax the muscles.
Those giving first aid may attempt the reduction of a dislocation, but if not readily successful should not persist, as there may be a fracture or other complication present. In severe cases, a joint may need to be replaced in its correct position by an open operation. The hip is a common example of this. Severely damaged ligaments and cartilages around a joint may also need to be surgically repaired.
After the joint has been correctly replaced, little or no rest is required. A major joint may require one or two days of limited use, but prolonged rest of the joint can lead to the formation of scar tissue and a permanent limitation of movement. Movement of the joint through its maximum possible range, without putting it under any stress (e.g. avoid weights), is the best way of bringing a joint back to full recovery as quickly as possible. The exception to this rule is the situation when a fracture is also present. The fracture will require immobilization to allow healing. Physiotherapy will then be required at a later date to fully mobilize the joint once the fracture has healed.
Joints that dislocate repeatedly (e.g. the shoulder) may require an operation to tighten the ligaments and muscles around the joint to prevent further dislocations.
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