Dislocation: Causes, Symptoms, Treatment, Recovery, Prognosis

Dislocation is a common condition which can occur in anyone. Dislocation occurs when the bone slips out of the joint. Citing an example, the bone of the arm fits into the joint of the shoulder. When this bone slips out of the joint of the shoulder then a dislocation occurs and it is termed as a shoulder dislocation.¹ It is not uncommon to have dislocations but it becomes a cause of concerns when this starts to happen very frequently suggesting that the bone is quite unstable. The areas of the body where dislocation is most likely to occur are the knee, hip, ankle, and shoulder. Dislocation is condition which requires immediate treatment as the bone gets out of its normal position which may result in significant damage to the surrounding ligaments and tendons and even nerves. Depending on the site of dislocation, the physician may choose the mode of treatment which usually consists of immobilization, rest, and in some cases even surgery.

Dislocations normally occur due to a sudden and forceful impact on the bone such as a fall or being hit by an object. Motor vehicle accidents may also result in Dislocations. It should be noted here that once if a joint dislocates it is more likely that it will dislocate again in the future.

There is no particular risk factor for Dislocations but it is seen more in elderly population who are at risk for frequent falling. People who are victims of domestic violence can also be at risk for Dislocations after being hit or thrown awkwardly. Other than that there are no particular risk factors for Dislocation. Dislocations are also seen in children when they are playing and fall unexpectedly. People involved in heavy manual labor are at risk for dislocations due to the high demand job that they do of heavy lifting and moving.

Dislocation can be easily recognized. The classic presenting feature of a Dislocation is that the affected area will become swollen and will look bruised and discolored. There will also be reduced range of motion of the joint. There may also be a visible deformity around the area of the joint. Some of the other symptoms that are experienced after a Dislocation are:

• Reduced range of motion ²
• Painful motion of the affected joint
• Numbness around the injured site
• Tingling feeling around the injured site.

The situation here becomes quite complicated because it is difficult to tell whether a bone is dislocated or is it fractured. Immediately after the injury, when you notice the above mentioned symptoms you need to proceed to the nearest emergency room for an evaluation. The treating physician will first inspect the area in question. The physician will try to move the joint to see if there is increasing pain. The physician will also palpate the area to look for signs of tenderness. If the physician suspects a fracture or dislocation then radiological studies will be ordered of the affected area in the form of an x-ray which will clearly delineate whether it is a fracture or dislocation.

The treatment for Dislocation depends on the joint that has been dislocated and the severity of the dislocation. The treatment will begin with following the RICE protocol and allowing the bone to get back into position naturally which tends to happen in many cases. In case if the bone does not go back to its position naturally then the following treatment modalities may be adopted for treatment of Dislocation:

Manipulation under Anesthesia: This is a minimally invasive procedure in which the physician will try to physically put the bone back into its position under local anesthesia.

Immobilization: Once the joint has been placed back into position by the above procedure the area will be immobilized for a period of time to allow the bone to settle down so that it does not dislocate again. The time the area needs to be immobilized will depend on the area and severity of Dislocation.

During treatment, pain medications and NSAIDs in the form of Tylenol or ibuprofen will be given to control pain and calm down the swelling.

Surgery: This is a mode treatment done for dislocation when there is damage to the nerves and ligaments due to the dislocation or if manipulation under anesthesia fails to put the bone back into the joint. Surgery is also recommended for those individuals who have frequent dislocations. The surgery will be done to reconstruct the joints and repair any damage done to the adjoining structures to prevent frequent dislocations. In some rare cases, joint replacement surgery may need to be done.

Rehabilitation: Once the dislocated bone is fitted appropriately back into its normal position, the next step towards treatment is rehabilitation. This is because long period of immobilization causes stiffness of the muscles and hence strengthening is required to get the muscle back in shape so that the joint function properly and in normal fashion after a dislocation.

The recovery time for dislocation depends on the bone dislocated and the severity of it. In majority of cases, it takes about a couple of weeks for an individual to recover from dislocation but in some cases such as the dislocated hip joints it may take around four to six months before full recovery can be made after a Dislocation. Recovery time following dislocation will also be more in case if there is damage to the nerves or vessels in which case surgery may be required to fix those and thus prolonging the healing time.

Some measures that an individual can adopt to prevent Dislocation are:

• Use handrails when maneuvering stairs
• Use nonskid mats in wet areas such as bathrooms.
• Do not have electrical or telephone cords on the floor of the house which may put you at risk for tripping and falling causing Dislocation.

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