Fundamentals of Joint Dislocations

Fundamentals of Joint Dislocations

Dislocations of the shoulder, elbow, hip, knee, ankle, and sternoclavicular joints are traumatic orthopedic emergencies due to the potential for neurovascular impairment and consequent disability if not treated immediately. The definitive treatment of dislocated joints consists in reducing the lesion to the correct anatomical position. Whether this occurs on site or in the hospital depends on the competence of the athletic trainer. An adequately trained athletic trainer can attempt joint reduction with the approval of the team doctor; Such approval must be in writing and must clearly refer to specific joints and types of dislocations. This is particularly indicated if the EMS arrival or hospital transport is prolonged. Early reduction after joint dislocation is less difficult than prolonged reduction. This is due to muscle spasms and pain protection, which will increase over time and make these efforts more difficult.7 Attempts at reduction should only be made after a thorough examination of the joint. In addition, neurovascular status must be monitored before, during and after each attempt. As a general rule, most emergency health service providers are not specifically trained or licensed to reduce joint dislocations. Significant resistance or greatly increased pain are reasons for aborting reduction attempts and may indicate an associated fracture. Unreduced dislocations must be splinted in the position found and the athlete immediately transferred to the hospital. If reduction is successful, distal neurovascular function should be rechecked, followed by careful application of ice and splinting the area into a functional position. The athlete should be seen by an orthopedic surgeon as soon as possible for further evaluation of joint function. In most cases, dislocations of the patella, shoulder, fingers, or toes should only be reduced in the field if necessary. Reductions in the elbow, hip or knee joints are considered difficult and should only be done by a specialist doctor. This difficulty is attributed to challenging reduction techniques, the high likelihood of concomitant fractures, and the severe complications of incompetent attempts. The athletic trainer who plays sports without the presence of a physician must obtain or develop written clinical standards and field protocols related to the management of joint dislocations. In any case, all dislocations, reduced or not in the field, must be evaluated.


to an orthopedic surgeon as soon as possible.

Dislocations of the Hand

Dislocations at the hand, especially of the digits, are common in sports activities. Mechanisms of injury may present as either significant or marginal trauma and usually consist of axial loading, compression, hyperextension, and valgus or varus forces on the respective joint. Although these injuries are painful and frequently grotesque, they seldom arise to the level of an emergency unless open. Proper treatment of joint dislocations to the hand is mandated because improper care may result in long-term disability

and poor anatomical function. This is especially true for dislocations of the thumb . As such, reduction attempts of thumb dislocations should be limited to a hospital setting. Reduction of common finger dislocations requires firm traction along the longitudinal axis of the joint and gentle movement so as to return the joint to normal anatomical alignment . If the reduction is successful, treatment consists of applying ice and splinting in a position of function such as buddy taping. If reduction is unsuccessful or is not attempted, then treatment is to splint in the position found and immediately transport to a hospital. Only rarely should EMS be used for transporting an

injured athlete with a dislocation to the hand.

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