What does a dislocated knuckle look like: The request could not be satisfied
What to do plus symptoms, causes, and treatment
A dislocated finger occurs when a finger bone slips out of its joint. Sports injuries, falls, and accidents can cause a finger or thumb to dislocate.
Dislocating a finger or thumb can be extremely painful and distressing. Although dislocation is not a life-threatening emergency, it is still important to seek prompt medical attention.
This article describes what to do when a person dislocates their finger or thumb. It also discusses the symptoms, causes, treatment, and recovery for a dislocated finger.
Share on PinterestA person should not try to relocate a dislocated finger themselves.
Image credit: Mdumont01, 2013
People who suspect they have dislocated their finger should seek immediate medical attention. While waiting for help or heading to a clinic, it is important not to move the damaged finger or thumb. Applying ice to the finger may help to reduce pain and swelling.
Do not attempt to move the finger bone back into its joint; a qualified healthcare professional must do this. Trying to relocate the finger bone without proper training can make the injury worse and cause additional pain and swelling.
People who attempt to move their own finger bone back into place also risk permanently damaging the surrounding structures, such as:
- blood vessels
- joint articular cartilage
A dislocated finger may appear swollen or crooked and is typically very painful.
Other signs that indicate a dislocated finger include:
- numbness or tingling
- bruising or discoloration of the skin
- difficulty moving the injured finger
Fingers contain three joints, and thumbs contain two. A joint is where the ends of two bones meet. Ligaments are short bands of fibrous material that hold the bones together and help support the joint.
Dislocations can occur when a significant force causes the ligaments to give way, causing the bone to slip out of the joint.
Sports injuries are a common cause of dislocated fingers. According to a 2015 review, around half of all sports-related hand injuries affect the fingers. Sports with the highest rates of hand injuries include football, gymnastics, basketball, lacrosse, and wrestling.
Other possible causes of a dislocated finger can include:
- overextending the finger
- blunt force impact to the tip of the finger, or jamming
- falling on an outstretched arm
People with health conditions that can weaken joints and ligaments may be at greater risk of dislocations.
A healthcare professional will examine the affected finger and ask the person about how and when the injury occurred. They may then order an imaging test to confirm a dislocation or evaluate the extent of damage to the finger.
Imaging tests for dislocated fingers include:
- X-ray. X-rays use electromagnetic radiation to create images of the body’s internal structures. Doctors use X-ray images to confirm dislocations and to check for fractures or breaks.
- MRI scan. An MRI scan uses strong magnetic fields and radio waves to create detailed images of the tissues inside the body. A doctor may recommend an MRI scan if they suspect significant tissue damage near the dislocated joint.
Treatment options vary depending on the location and severity of the dislocation.
The first step in treating a dislocated finger or thumb typically involves carefully manipulating the bone back into the joint. The procedure is known as reduction.
Before performing a reduction, the healthcare professional may use a local anesthetic to numb the affected area of the person’s hand.
After the healthcare professional has completed the reduction procedure, they may order an X-ray test to check the alignment of the bone inside the joint.
After reduction, a person will normally need to wear a splint to protect and immobilize the injured finger while it heals. A splint contains a rigid strip of metal that supports a broken or dislocated bone. Immobilization stops a person moving their finger and prevents them dislocating or injuring it again.
A healthcare professional may also recommend “buddy taping” the splinted finger to an adjacent finger. Buddy taping provides support for the injured finger while allowing a greater range of motion.
A person with a dislocated finger may need to wear the splint for several weeks. However, wearing a splint for too long may cause permanent stiffness and reduced mobility of the finger.
Depending on the type or severity of the injury, some people with a dislocated finger may also have a bone fracture. A fracture occurs when a significant amount of force impacts a bone causing it to splinter or break into two or more separate pieces.
Finger fractures also require reducing and splinting. Some people with finger fractures may require K-wire fixation. K-wires are thin metal rods that surgeons implant to help stabilize bone fragments.
Dislocated fingers that involve torn ligaments, fractures, or broken bones may require a surgical procedure known as open reduction.
Like other treatments for dislocated finger, surgical procedures aim to reduce, stabilize and restore mobility to the finger without damaging surrounding structures.
According to a 2017 review, dislocated fingers typically heal within 4 to 6 weeks. Factors that affect recovery time can include:
- the severity and location of the dislocation
- damage to ligaments and tendons
- bone fractures
- requiring surgery
Following reduction and splinting, some people may also require physical or occupational therapy. A physical or occupational therapist will show a person how to do exercises that strengthen the finger and improve the range of motion.
Some things people can do at home while their finger heals include:
- keeping their splint clean and dry
- keeping their finger elevated above the level of their heart to reduce swelling
- resting their finger and avoiding moving it during the healing process
- applying cold compresses or ice packs to reduce pain and inflammation
- taking over-the-counter medications, such as ibuprofen or acetaminophen, to help reduce pain and swelling
- regularly performing any finger exercises that a therapist recommends
Following recovery, a dislocated finger may be more prone to injury in the future. A person can reduce the risk of dislocating the finger again by:
- performing hand and finger exercises to strengthen muscles, tendons, and ligaments
- wearing a splint or buddy tape during sports activities
- avoiding wearing rings while playing sports
While painful and distressing, a dislocated finger is not a life-threatening emergency. However, it is important to seek prompt medical attention.
A person should not attempt to relocate the dislocated finger themselves. Manipulating the injured finger can cause additional damage to the joint or the surrounding structures.
Following medical treatment, dislocated fingers usually take a few weeks to heal. Bone fractures and damage to the surrounding tissues can significantly increase recovery time.
Dislocated Finger – Hand – Conditions – Musculoskeletal – What We Treat
What is the dislocation of a finger?
A dislocation of a finger is when the two bones which make up the knuckle joint displace or ‘pop out’ of their normal alignment. A physiotherapy programme is important following a dislocated finger.
Above: Therapist soft tissue massage of the metacarpals and connective tissues in the hand
How does the dislocation of a finger happen?
A knuckle joint is caused to dislocate when it is bent in the wrong direction with force. This can occur when a ball hits a finger or when a finger gets caught in a fellow competitor’s clothing, a net or the ground.
What are the symptoms of a dislocated finger?
Immediate and intense pain is felt in the knuckle when it is dislocated. An obvious bump or deformity at the knuckle can often be seen due to the displacement of the bones which join to make the joint. The knuckle may also become swollen. Other symptoms can include::
What should I do if I have dislocated finger?
If you have or suspect you have dislocated a finger, you should cease participating and go directly to your nearest accident and emergency department to have the joint examined. To reduce your pain and control any swelling, you should apply a bag of frozen peas or crushed ice wrapped in a moist towel or cloth around the injured knuckle for up to 20 minutes at a time.
At the accident and emergency department an X-ray will be taken of your hand to determine whether any of the bones are damaged. From this, they can provide you with an exact diagnosis and determine an appropriate treatment plan. If your knuckle is still ‘out of joint’ relocating or ‘reducing’ the bones back into their normal position is the initial treatment. This may sometimes require surgery.
Physiotherapy treatment following a dislocated finger.
Once your finger has been relocated physiotherapy treatment can start immediately. Treatment may involve wearing a splint, electrotherapy to decrease pain, swelling and promote healing. Your physiotherapist will also provide you with a graduated programme of stretching and strengthening exercises to improve joint movement and strength. When you do return to normal activity or participation in sports your physiotherapist will advise you on protective measures such as taping techniques, splints and supports to protect the knuckle joint.
Other treatments may include:
What shouldn’t I do if I have dislocated my finger?
If you have a dislocated finger, you shouldn’t try to relocate the bones or ‘reduce’ the dislocation. This can lead to further damage and delay recovery. In addition, you should avoid activities which can increase the blood flow to the injured area. These include hot showers, heat rubs, massage and the consumption of alcohol. These may increase bleeding and swelling around the dislocated joint, potentially prolonging your recovery.
Could there be any long-term effects from the dislocation of a finger?
Dislocated fingers generally heal without complication in a matter of months. However, to enable this to occur, surgery is often required to relocate the bones back to their normal position. Following surgery, recovery may be prolonged if you damaged structures surrounding the joint when you dislocated your finger. These include the ligaments supporting the knuckle joint, the bones making up the joint and the cartilage lining the surfaces of the joint. Similarly, recovery may be prolonged if the dislocated finger is not appropriately treated. This may result in a stiff, swollen and painful finger.
To arrange a physiotherapy assessment call Physio.co.uk on 0330 088 7800 or book online.
Causes, Symptoms and Treatment Options
Medically reviewed by Drugs.com. Last updated on Jan 22, 2021.
What is a Finger Dislocation?
A finger dislocation is a joint injury in which the finger bones move apart or sideways so the ends of the bones are no longer aligned normally. Finger dislocations usually happen when the finger is bent backward beyond its normal limit of motion.
The bones that make up the joints of the fingers are known by the medical terms phalanges and metacarpal bones. Any of these joints can be dislocated in an injury:
- Distal interphalangeal joints are in the finger joints closest to the fingernails. Most dislocations in these joints are caused by trauma, and there is often an open wound in the location of the dislocation.
- Proximal interphalangeal joints are the middle joints of the fingers. A dislocation in one of these joints is also known as a jammed finger or coach’s finger. It is the most frequent hand injury in athletes, and it is especially common among those who play ball-handling sports, such as football, basketball and water polo. In most cases, the dislocation happens because the fingers are bent backward when an athlete tries to catch a ball or block a shot. Proximal interphalangeal joint dislocations also can happen when an athlete’s fingers are twisted or bent by an opponent, especially when two athletes wrestle or grab for control of a ball.
- Metacarpophalangeal joints are in the knuckles, located where the fingers meet the rest of the hand. These joints connect the metacarpal bones in the palm with the first row of phalanges in the finger. Because these joints are very stable, metacarpophalangeal joint dislocations are less common than the other two types. When metacarpophalangeal dislocations do occur, they are usually dislocations of either the index finger or little finger (pinky).
A dislocated finger is crooked, painful and swollen, and its surface skin may be cut, scraped or bruised. If a dislocated finger has been straightened on the playing field, it may feel abnormally loose, weak or unstable afterward.
Your doctor will suspect that your finger is dislocated if it appears deformed. In some cases, your doctor may order an X-ray of the finger to look for a fracture. When a finger bone is pulled away from connected tendons, it is common for a fragment of bone to separate from the main bone and stay with the tendon, a condition known as an avulsion fracture.
You can return to your sport once your dislocated finger has been realigned, your doctor has confirmed that the injured joint is stable and no bone is fractured, and your finger tenderness and swelling have improved. For a few weeks, you will need to wear a padded finger splint or buddy tape, which is used to strap the injured finger to an uninjured finger nearby for support.
If you need surgery to repair your dislocated finger, it usually takes at least four to six weeks before you can return to your sport.
After your dislocated finger has been treated, you often can prevent it from being injured again by using a protective splint, taping it to another finger or, in some cases, using a cast.
A dislocated finger can be corrected with or without injecting local anesthesia. To correct the dislocation, the doctor will press against the displaced bone to dislodge the bone if it is caught against the side of the joint. As the end of the bone is freed, the doctor can pull outward to restore the bone to its correct position. This is called closed reduction. Once your finger joint is back in its normal position, you will wear a splint or tape the finger to another finger for three to six weeks, depending on the specific type of your dislocation.
If your doctor cannot straighten your finger using closed reduction or if your injured joint is not stable after closed reduction, your dislocated finger may need to be repaired surgically. Surgery is also used to treat finger dislocations that are complicated by large fractures or fractures that involves the joint.
When To Call a Professional
Call your doctor immediately if you injure your finger and your finger is crooked, deformed, painful or swollen. If you are an athlete and someone straightens your injured finger on the playing field, check with your doctor to make sure that the injured joint is stable and not fractured. A dislocated joint that has an open wound should not be moved. It should be carefully splinted and evaluated immediately by a physician.
The long-term outlook is usually good, although it may take four to six months for your finger pain to disappear. In some cases, there is also a small amount of permanent swelling around the injured joint, especially an injured proximal interphalangeal joint. In athletes, a finger that has been dislocated often is injured again.
National Institute of Arthritis and Musculoskeletal and Skin Diseases
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National Athletic Trainers’ Association
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Sprained Knuckle Taping | Physical Sports First Aid Blog
If you’ve sprained one or more of your major knuckles, you’ll need to limit the movement of the fingers while the ligaments in the joint heal. Here’s a straightforward taping technique that will help.
The major knuckles are the joints where the fingers join the hand and are medically known as the metacarpophalangeal joints (or MCP Joints.) The joint has several attached ligaments that are involved in moving the fingers, and these ligaments can be damaged when there is trauma to the hand. (For instance, a heavy impact or falling onto the hand.) Typical symptoms of a knuckle sprain are pain, swelling and discolouration in the area of the knuckle.
This taping technique aims to limit the movement of the affected finger and to support it while the knuckle heals.
Step 1: Circle the hand once with the zinc oxide tape. The tape should run all the way around the hand, just above knuckles, as pictured. It does not need to be tight – just lay it onto the skin. This is the anchor for the rest of the tape job
Step 2: Start a strip of tape on the anchor at the thumb side of the affected knuckle. Bring the tape up to diagonally cross the knuckle onto the first joint of the finger. From there, loop the tape around the base of the finger, to come up on the other side of the finger. Finally, bring the tape back down across the knuckle. The tape should cross itself on the knuckle. Finish the strip of tape on the anchor.
Step 3: Lay another strip of tape on top of the strip from step 2. Follow the same path up and across the knuckle, around the base of the finger and back down across the knuckle. Basically, you’re looping the finger with tape to hold it so it can’t bend at the main knuckle. If more than one knuckle is injured, then add these tape loops to all of the affected fingers.
Step 4: Finish by laying another circle of tape all the way around the hand directly on top of the anchor from step 1
A thumb dislocation occurs when the tissues, or ligaments, that hold the joint together are torn. The bones then move, or are dislocated, out of their normal position. This causes pain, swelling, and bruising. Sometimes there is also a small fracture. You may need surgery to keep the joint in place while it heals. This may be the case if your injury is severe and the joint is not stable.
Once the joint is back in place again, it will take about 6 to 8 weeks or more for the ligaments to heal. During this time, your thumb should be protected from re-injury. This may be done with a cast or splint.
Finger splints prevent motion at the joint. They should generally not be left in place longer than 3 weeks to avoid stiffness and loss of joint function.
Hand exercises may be prescribed at your follow-up visit. These can help speed healing and maintain function. In most cases you will regain full function of your thumb. But it may take 12 to 18 months before all mild pain and swelling goes away and full function returns.
Keep your arm elevated to reduce pain and swelling. When sitting or lying down, raise your arm above the level of your heart. You can do this by placing your arm on a pillow that rests on your chest. Or you can place your arm on a pillow at your side. This is most important during the first 48 hours after injury.
Apply an ice pack over the injured area for no more than 20 minutes. Do this every 3 to 6 hours for the first 24 to 48 hours. To make an ice pack, put ice cubes in a sealed, zip-lock plastic bag, then wrap in a thin, clean towel or cloth. Don’t put ice or an ice pack directly on your skin. As the ice melts, be careful that the tape, gauze, cast, or splint doesn’t get wet. After that, keep using ice packs as needed to ease pain and swelling.
Keep the splint or cast dry at all times. Bathe with your splint or cast out of the water, protected with 2 large plastic bags. Place 1 bag around the other. Tape each bag with tape at the top end or use rubber bands. Water can still leak in even when your hand is covered. So it’s best to keep any tape, splint, or cast away from water. If a fiberglass cast or splint gets wet, you can dry it with a hair-dryer on a cool setting. A vacuum cleaner with a hose attachment can also be used to pull air through the cast for speed drying.
You may use over-the-counter pain medicine to control pain, unless another pain medicine was prescribed. Talk with your healthcare provider before taking these medicines if you have chronic liver or kidney disease, or if you have ever had a stomach ulcer or gastrointestinal bleeding.
Don’t play sports or do any physical exercise until your healthcare provider says that you can.
Follow up with your healthcare provider in the next 2 to 3 weeks, or as advised. It is important that you see the referral doctor. He or she can determine how long to leave any splint or cast in place and when to begin hand exercises.
If X-rays were taken, you will be told of any new findings that may affect your care.
When to seek medical advice
Call your healthcare provider right away if any of the following occur:
The injured thumb has increased pain or swelling
The injured thumb is red, warm, or has drainage
The injured thumb becomes cold, blue, numb, or tingly
The plaster cast or splint becomes wet or soft
The cast or splint has a bad smell
The splint or cast is too tight or too loose
Dislocations – Melbourne Hand Surgery
What is a dislocation?
A dislocation is an injury where the two bones that meet at a joint become separated, so that they no longer sit together. In many instances the injury occurs during sport and it is not uncommon for the dislocation to be reduced (relocated) by an athlete, trainer or coach.
How are dislocations assessed?
Finger joints are commonly reduced in a hospital emergency department with local anaesthetic used to numb the finger. Occasionally the joint can’t be reduced in the emergency department and an operation is required. It is good practice to have an X-ray before and after a joint is relocated, so that any fracture can be identified.
After the joint is relocated it is important to check the stability of the collateral ligaments, to see if the finger bends to the side in an abnormal manner. If the collateral ligaments have also been injured this will need to be taken into consideration when planning treatment and rehabilitation.
Sometimes when a joint dislocates the skin overlying it tears open. If this occurs it is necessary to have antibiotic treatment and an operation to wash out the joint, because bacteria from the skin or environment can infect the joint and cause major problems.
My x-ray shows a fracture
Minor fractures often occur with finger dislocations. These small fractures (termed “avulsion fractures“) can occur if a stretched ligament pulls off a fragment of bone where it inserts (this is especially common with a volar plate injury). Most of these minor fractures do not require surgery.
Sometimes hand injuries that cause a dislocation will also create a more significant fracture at the same location. These injuries commonly require surgery to maintain the bones in the proper position while they heal and to restore hand function.
How are dislocations treated?
Treatment for dislocations often includes treatment of swelling, specific exercises, splinting and buddy-strapping.
What are the possible complications?
The main complications from joint dislocation are instability (where the joint is too mobile), stiffness (where the joint is not mobile enough) and rarely post traumatic arthritis. Patients are often surprised that their joint is still swollen 2-3 weeks later, but this is actually not surprising because it is a significant injury that usually involves significant bleeding into the joint and bruising of ligaments and soft tissues. Hand therapy plays a crucial role in reducing swelling and achieving a normal range of joint movement.
Photo Credit: Twitter Account @tomsteinfort
Boxer’s Knuckle | SpringerLink
- Caroline van der Zee
- Frederik J. T. van Oosterom
- Bas A. C. M. Pijnenburg
Reference work entry
Traumatic injuries of the metacarpophalangeal (MP) joints are common among professional boxers. A boxer’s knuckle is a severe injury of the joint capsule frequently accompanied by an injury of the extensor apparatus. This injury can lead to a career-threatening situation for the athlete if not diagnosed and treated in a correct manner. The mechanism of injury is (repetitive) blunt trauma with forceful flexion of the MP joints resulting in stretching or dislocation of the extensor mechanism. The knuckle of the middle finger is most prone to damage since it protrudes in a clenched fist. Typical symptoms are MP joint swelling, pain, decreased joint extension, central tendon dislocation or subluxation, and a palpable defect at the site of the rupture. Surgical repair with centralization of the extensor tendon and sagittal band repair with or without capsular repair are the treatment of choice. Postoperative splinting is advised with the MP joint in 60–90° of flexion for a duration of 4–6 weeks. Returning to the professional sport can be accomplished after 3–4 months. This chapter describes the anatomy, incidence, diagnostic, and treatment strategy for this disabling injury in boxers.
Joint Capsule Extensor Tendon Extensor Mechanism Extensor Digitorum Communis Metacarpal Head
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© Springer-Verlag Berlin Heidelberg 2015
Authors and Affiliations
- Caroline van der ZeeEmail author
- Frederik J. T. van Oosterom
- Bas A. C. M. Pijnenburg
- 1.Department of Plastic, Reconstructive & Hand SurgeryOnze Lieve Vrouwe GasthuisAmsterdamThe Netherlands
- 3.Department of Orthopaedic SurgeryZiekenhuis AmstellandAmstelveenThe Netherlands
90,000 Shoulder dislocation: how to recognize and treat
The shoulder joint is one of the most mobile joints in the human body. The mobility of the joint allows you to raise your arms and get them behind your head.
In case of damage to the shoulder joint, the person can no longer move the limb. Poorly healed trauma leads to repeated dislocations. Damage occurs with any careless movement, for example, when you put your hand behind your head in a dream. This article will show you how to recognize a dislocated shoulder joint and how to heal the injury.
Anatomy of the shoulder joint
The shoulder joint consists of two bones: the humerus and the scapular. The head, that is, the upper part of the humerus, is in contact with the glenoid cavity of the scapula. The head is held in the joint thanks to the roller, the articular lip.
The joint is surrounded by a capsule consisting of connective tissue, that is, ligaments. They fix the upper part of the humerus in the correct position relative to the cavity of the scapula. Muscles and tendons also surround the shoulder joint.
The joint performs a large number of movements, that is, it is subjected to constant stress. The impact of an external force, for example, a fall, can cause displacement – the upper part of the humerus will change position relative to the cavity of the scapula.
What are the types of shoulder dislocations?
Depending on the direction of displacement of the head of the humerus, there are several types of dislocations.
- A dislocation is considered anterior if the head is displaced forward.The displacement may be accompanied by damage to the articular lip, separation. This type of injury is called a Bankart injury. Another unpleasant complication is the rupture of the joint capsule. Anterior dislocations occur during sports, with repetition of amplitude shoulder movements, throws, falling on a straight arm or shoulder laid back.
- When the head of the shoulder bone is displaced backward, one speaks of posterior dislocation. Such injuries occur much less frequently than anterior dislocations.A dislocation can occur from a blow to the shoulder, and the articular lip can come off.
- Inferior dislocation occurs when the head of the humerus is displaced downward. Injury can occur while exercising
- on the horizontal bar. This is the least common type of shoulder injury. It is very simple to diagnose inferior dislocation – a person cannot lower his arm.
If the dislocation of the shoulder joint occurs for the first time, the dislocation is called primary . Trauma is usually the cause of the primary dislocation.
When the humerus begins to “walk” in the shoulder joint, they talk about habitual dislocation. The condition becomes chronic. Most patients with habitual shoulder dislocation have at one time injured the shoulder joint. The injury was accompanied by the detachment of the articular lip, the cartilage that fixes the head of the humerus.
How to recognize a dislocated shoulder?
Primary dislocation will certainly make itself felt with a sharp pain in the shoulder area.Painful sensations arise when the ligaments are torn and the articular lip is torn off. The hand can no longer move normally, edema develops.
Deformation may be observed – the head of the humerus, which is not in place, will be felt under the skin. The shoulder, forearm, and even the hand can become numb and tingling.
If the injury is left untreated, dislocations will recur regularly. In this case, a large load is not required, one awkward movement will be enough. In this case, the patient will experience less pain than with the primary injury.The patient may even be able to correct the dislocation, however, with the load, the damage will happen again. Habitual dislocations cannot be cured on their own, an operation is necessary.
Diagnosis of shoulder dislocation
First, the doctor examines the patient and finds out the circumstances that led to the injury. Then, the patient is taken x-rays in several projections. This should be enough to determine if the head of the shoulder bone is positioned correctly.
X-rays also show whether the bones are damaged.A dislocated shoulder can be accompanied by bone fracture. In this case, it is not just a dislocation, but fracture dislocation .
If the radiography does not provide enough information about the damage, CT and MRI can be prescribed. Examinations help to obtain data on the condition of tissues, ligaments, bones and muscles
At the Caucasus Medical Center in Tbilisi, patients are offered diagnostic and treatment services for various injuries. Thousands of patients visit the hospital every year, not only from Georgia, but also from other countries.
The center is equipped with modern equipment that allows you to quickly obtain diagnostic results. The hospital employs experienced doctors who can accurately diagnose and begin treatment. You won’t have to wait long – the diagnostics are carried out within one day. The clinic takes over the treatment of chronic and occupational injuries, the athletes undergo rehabilitation.
Treatment of shoulder dislocation in the Caucasian Medical Center
After the diagnosis is made, the doctor proceeds to reposition the dislocation.Reduction of dislocation can occur in several ways: open and closed.
- Closed method – non-surgical. An anesthetic drug is injected into the patient’s joint, after which the traumatologist sets the head of the bone, puts it in place. If more than 24 hours have passed since the injury, it will be more difficult for the doctor to correct the dislocation, since the muscles have already contracted. Then the reduction will take place under anesthesia with the use of muscle relaxants.
- Open method involves surgical intervention.Surgery is a surefire way to heal frequently recurring dislocations. During the operation, the doctor opens and sets the patient’s joint. There are many different operations, the type of surgery depends on the individual case.
Traumatologists of the Caucasian Medical Center will select the necessary treatment and perform the operation within 24 hours. All hospital doctors are highly qualified specialists. Many of them have experience of working in Western clinics.
Caucasian Medical Center cooperates with well-known hospitals. This gives patients additional benefits – they can consult a renowned specialist. In addition, the hospital carries out unique operations in cooperation with the Ministry of Health of Georgia.
Recovery after surgery
Within 1 – 1.5 months after surgery, the limb must be immobilized, so wearing a fixation bandage is mandatory. When the function of the shoulder joint is restored, the patient is prescribed remedial gymnastics to strengthen the muscles.Physiotherapy treatments can also help to restore shoulder function faster. After surgery and removal of the fixation bandage, an x-ray should be taken to ensure that the head of the humerus is in the correct location.
Patients of the Caucasian Medical Center are supported at all stages of treatment. After the operation, an X-ray is taken, and if everything is in order, the patient is sent home. The doctor gives recommendations for further rehabilitation actions. You can also get a doctor’s consultation after discharge, both in person and online.
You can make an appointment with the Caucasian Medical Center on the website by filling out an application. They will tell you about the necessary documents and make an appointment. After confirming the appointment and paying for the services, the medical concierge will help you find a hotel and an interpreter. The hospital staff will arrange a transfer – you will be met at the airport. The center cooperates with insurance companies around the world, which means that you can reimburse the costs of treatment. Reviews of treatment in the clinic are available on the website of the medical center.
Dislocation: description of the disease, causes, symptoms, cost of treatment in Moscow
When the articulation of the articular surface of the bone is disrupted, this is called a dislocation. Such a violation is a consequence of a destructive process in the joint (arthrosis, arthritis) or injury. If an injury occurs, the end of the bone will be forcibly displaced from its normal position due to the effect of mechanical force. Trauma can occur even in prenatal development, resulting in a dislocation.
With a dislocation, the integrity and functioning of the joint is impaired. In a more difficult case, the joint capsule may rupture and damage to the ligaments, arteries, and nerve nodes. This situation requires the intervention of a qualified specialist who is able to provide first aid and prescribe appropriate treatment measures.
In most cases, you can get dislocated by hitting or falling. The zone of increased likelihood includes people who are involved in a contact sport (football players, hockey players, volleyball players, etc.)etc.). And also those who often ski, skate. There is a temporary deformation and immobilization of the dislocated joint. A characteristic sign of dislocation is the appearance of severe pain and swelling. In this case, the dislocation should be repositioned so that the displaced joint returns to its usual position.
What are the types of
Considering the degree of displacement, origin, size of the joint, dislocations can be classified. In terms of the degree of displacement, dislocations are complete, when the ends of the joints completely diverge, and incomplete, in which there is a partial contact of the surfaces of the joints. A dislocated joint is one that is farther from the body. An exception is the vertebra, collarbone, shoulder.
Given the origin, dislocation can be congenital and acquired. Congenital is one that arose due to disorders in the development of a child who was in the womb. The most common pathology includes dysplasia, dislocation of the hip joint. Acquired dislocation is the consequences of injury or disease (arthritis, arthrosis, osteomyelitis, poliomyelitis, etc.)etc.).
In addition, dislocation is open and closed. With a closed dislocation, the skin and tissues above the joint are not torn. During an open dislocation, a wound is formed. If we talk about complicated dislocation, then muscles, blood vessels, bones, tendons, and nerves are damaged. Habitual dislocation means its reoccurrence under the slight influence of external factors. This happens if a person has received poor-quality treatment. The occurrence of pathological dislocation (in most cases, affects the hip and shoulder joints) is associated with the destruction of the articular surface. Paralytic dislocation is characterized by paralysis or paresis of the muscles surrounding the joint.
What is ankle dislocation
If the ankle is displaced due to a ruptured ligament, it is called an ankle dislocation. There are times when the displacement of the joint and the rupture of the ligaments did not occur completely. This is called subluxation. This type of dislocation is not common. The risk zone includes elderly people who have fragile bones.In addition, athletes or women who like high heels are more likely to get this kind of dislocation.
Medical practice identifies some types of ankle dislocation:
Incomplete or partial rupture of the ligaments. In most cases, the anterior peroneal muscle is injured. The deltoid, calcaneofibular and tibiofibular may also suffer.
The ankle muscles were severely torn.This dislocation is characterized by the absence of immobility of the limb, however, the formation of swelling is observed. If you feel the damaged area, the person will experience pain. Usually, blood will accumulate in the damaged area.
Ligaments were completely torn. In this state, a person develops severe swelling and pain. He simply cannot step on his foot. In addition, it can be seen that blood has accumulated inside.
If we talk about the reasons for the dislocation of the ankle, this can include making an inaccurate landing on the foot or an incautious turn.Also, dislocation can happen when falling or hitting. It is necessary to highlight some factors that contribute to the appearance of such injury:
1. the presence of a high arch of the foot.
2. the presence of weak ligaments.
3. if the peroneal muscles are underdeveloped.
4. slight sprain.
5. neuromuscular disorders.
6. impaired walking. If the foot is incorrectly positioned, muscles will weaken over time, resulting in an increased risk of dislocation of the joint.
In addition, there are certain diseases that cause weak ligaments, which increases the load on the legs. This happens with: obesity, cancer, tuberculosis, osteomyelitis, arthrosis, muscle paresis, congenital pathology.
What is a dislocated ankle
A fairly common injury to the lower limb is an ankle dislocation. The likelihood is higher for retirees, athletes and women who prefer high heels.In most cases, such a problem occurs in people in winter, during icy conditions. A characteristic sign of a dislocated ankle is damage to the ligaments and the expulsion of the bone from the joint.
Symptoms are as follows:
the appearance of painful sensations that are localized in the ankle. The pain is constant. Its strengthening occurs with additional loads.
Puffiness appears.It can be seen as soon as the injury was received.
A hematoma or subcutaneous hemorrhage appears.
The articular form is impaired.
The presence of a characteristic click that a person hears when receiving a dislocation.
The mobility of the foot is impaired.
The local temperature rises.
What is Shoulder Dislocation
The shoulder joints are subjected to multiple and varied movements. He is vulnerable to injury. In the presence of a dislocation of the shoulder joint, a person will experience severe and sharp pain, articular functioning will be disrupted. In addition, the shoulder hardens or deforms, it is pulled to the side. As a result, the asymmetry of the shoulder joints appears. During palpation, the localization of the head of the shoulder joint in an unusual area is determined.Also, the joint will be motionless.
Another symptom is a weak pulse in the radial artery. This is due to the compression of the vascular trunk by the head of the shoulder bone. It is often found that due to the presence of such a dislocation, the sensitivity and motor function of the hand are impaired. In addition, there are other characteristic symptoms:
1. Swelling, painful attack in the appropriate place.
2. there is a noticeable decrease in mobility.
3.The shape of the shoulder joint becomes less smooth.
4. numbness of the upper limb.
5. the presence of bruises, which determine the affected area.
6. the disappearance of sensitivity in the forearm and other components of the hand.
If we talk about the causes of shoulder dislocations, the following can be distinguished:
with an excess of movements that are directed to this part of the body.This is called joint hypermobility.
The presence of an overly tilted glenoid cavity. This is the main cause of posterior or anterior shoulder dislocations.
Hypoplasia of the socket of the joint.
Accelerated movements of the same type, resulting in repeated stretching of the ligaments and the joint capsule.This includes athletes (swimmers, handball players, etc.).
What is a dislocated leg
With a dislocated leg, very strong painful sensations appear in the affected area. They appear not only when an injury is received, but also when a person tries to move a leg. On the damaged area, the articular shape changes, swelling appears, as well as the area where there are multiple bruises and swelling. This will then become a hematoma.If you do not consult a specialist for treatment, numbness and paralysis will join.
When trying to change the position of the injured limb, a person will experience severe pain. The victim is shown absolute rest, therefore, after first aid has been provided, he must be provided before the arrival of a team of specialists. It should be taken into account that if the nerve endings are squeezed, the injured limb may lose its sensitivity.
There are some complications of this type of dislocation:
Tendon ligament muscles are torn.
Nerves and blood vessels are damaged.
Increased likelihood of re-dislocation of the leg.
Arthritis is formed in the place where the joint is dislocated. The presence of such a complication is observed after many years.
During diagnostic measures, the doctor determines what type of dislocation occurred in a person.Dislocation is a complete displacement of the joint capsules and the absence of points where they touch. Defective dislocation, subluxation is characterized by partial joint contact. It should be remembered that with such an injury, the articular capsule always ruptures. In some cases, the tendon may rupture.
What is dislocated fingers
With a sudden and strong contraction of the muscles, dislocation of the fingers appears. With such an injury, the articular surfaces of the bone are displaced. This is painful.This is explained by the presence of a large number of nerve endings in the hands. Basically, a dislocation of the thumb occurs, since it is removed from the rest, and excessively unbend. The bones are displaced to the back of the hand, as a result of which the position of the articular head changes.
If we talk about the reasons, it can be any careless movement. With a strong external influence, the ability of the ligaments and muscles to keep the articular bone in a normal position is lost.Also, people who are professionally involved in sports (volleyball and basketball players) can get such a dislocation. It is often found that a person likes to crunch his joints. This also applies to the causes of the dislocation. If the foot hits something hard, it can injure the toes. For example, an unsuccessful landing on the foot or a sharp turn may become a provoking factor.
How to recognize a dislocation
Symptoms depend on what type of dislocation the person has. For example, with congenital dislocation of the hip joint, a person’s gait is disturbed, the asymmetry of the gluteal folds, over time one leg will be shorter compared to the other, resulting in lameness. With bilateral hip dislocation, a duck gait appears.
With congenital dislocation of the knee joint, a person notes the appearance of a severe pain syndrome of gait disturbance. In addition, the joint becomes inflamed and immobilized. Traumatic dislocation is characterized by the appearance of swelling, stiffness and pain in the joint.
There are also common signs of dislocation:
The appearance of redness in the place where the joint is damaged.
The appearance of a severe pain syndrome, the intensification of which occurs during any movement of the affected limb.
Visual definition of articular deformity. A dislocation provokes a change in both the size and shape of the joint.
The appearance of severe swelling in the place where the dislocation occurred.
If the nerves are damaged, the person will no longer feel the affected limb.
The motor function is impaired.
The body temperature rises (changes in heat and chills occur).
Why does dislocation appear
Dislocation is caused by indirect trauma when the injured area is distant from the affected joint.In addition, the appearance of traumatic dislocation is associated with sudden movements that exceed the norm of articular mobility. More rarely, you can find dislocation, which was the result of direct injury to the joint.
It is often found that a person is diagnosed with a dislocation due to a previous illness. This includes the appearance of tuberculosis, osteomyelitis, arthrosis, arthritis, etc. Such damage to the joints can be both acquired and congenital. The emergence of congenital dislocation is due to the fact that the child’s musculoskeletal system is formed incorrectly, which develops in the womb.
How to help a person with a dislocation
It must be remembered that self-medication for dislocation is strictly contraindicated. Otherwise, you can irreparably damage the joint that has been damaged. As for the people around them, they can only provide first aid. Namely
Immobilize and fix the injured joint. For this, a medical splint or any other means at hand is used.
If there is damage to the skin at the site of the dislocation, it is necessary to process them. For processing, alcohol, hydrogen peroxide is used.
Put a cold one on the damaged place. This will help reduce the swelling.
The victim must take a position due to which the intensity of the pain syndrome will decrease.
A mandatory rule is to call an ambulance or self-transport the victim to a medical center. This must be done within the first two hours of the injury.
In the event of a hand injury, the victim is transported to the clinic while sitting. If the lower limbs are injured, you should adhere to a horizontal position.
How to diagnose dislocation
On examination by a traumatologist or surgeon, the patient is palpated the damaged area of the body, then sent for a hardware examination.With the help of an X-ray, it is determined in what place the dislocation occurred and its degree. After confirming the preliminary diagnosis with an X-ray, the victim will be given appropriate medical measures.
Dislocation of the hand – symptoms, what will happen if you do not correct
Dislocation of a joint on the hand is an injury associated with displacement of the articular surfaces of the bones due to any external influence.Damage usually manifests itself in swelling, deformation of the hand and is accompanied by sharp pain, while normal hand movements are either severely limited or completely impossible.
In case of suspicion of dislocation, it can only be confirmed by conducting a diagnostic study based on the history and complaints of the victim. After diagnosis, the doctor chooses the appropriate treatment that fully corresponds to the degree of damage and the patient’s condition. Experts strongly advise against self-treatment of hand dislocation at home.Any wrong action can cause complications and more serious problems.
This type of injury is extremely common, about 5% of all dislocations occur in this area.
Types of hand dislocations
Specialists identify several types of dislocations, which differ in complexity, localization and other individual characteristics:
- True dislocations. The so-called injuries in which the hand and articular parts of the wrist bones are displaced in relation to the radius.They are quite rare, and sometimes they are combined with fractures.
- Perilunar dislocations of the hand. The most common dislocations of the lunate hand, the proportion of which reaches approximately 90% of all dislocations of the hands. The cause of the problem is often falls, as well as a sharp, often violent extension of the hand. With such damage, contact between the bones is maintained. Sometimes the injury can be accompanied by fractures.
- Perilady-lunar. With such damage, the semilunar-navicular region does not suffer, the rest of the bones are displaced.
- Peritrihedral lunar. One of the most rare types of injury, in which the scaphoid and triangular remain in place, while the rest are displaced.
- Perilunar-perilunar. Such injuries always appear with fractures.
- Trans-lunar-trans-lunar. Displacement injury is accompanied by a simultaneous fracture.
Additional types of dislocations include those that are localized in the metacarpal bones and fingers.
What causes injuries?
The most common cause of dislocation is direct physical impact on the hands, which can have a variety of origins. Often, the type of exposure affects not only the type of injury, but also the complexity of its treatment and professional medical prognosis.
Most common reasons:
- fall – when a person falls, he puts his hand in front of him, a large load from the entire body weight and speed acts on the hand;
- receiving a blow – a shock effect occurs in sparring and when hitting the hands of heavy objects;
- striking – when the fist comes into contact with hard surfaces;
- strong jerk – can occur, for example, if an adult sharply pulls a child by the hand;
- Sloppy movements are another common cause of injury that occurs in a person when making sudden movements with his hands, injuries often occur in people suffering from any pathologies or abnormalities in the development of joints.
How to identify a dislocated hand
Such an injury is accompanied by vivid and clearly visible symptoms, thanks to which the victim can independently determine the type of injury received. However, the final diagnosis can only be confirmed by a professional specialist on the basis of examination and the use of modern diagnostic tools.
So what a dislocated hand looks like:
- Painful sensations.With an injury of this nature, a person experiences very severe pain, localized in the joint itself, and well felt, even if the hand is in a static position immediately after the injury. The pain will only get worse if the victim tries to move his hand. Sometimes painful sensations spread far beyond the wrist – to the forearm, shoulder, neck, cheekbones.
- Stiffness. The victim will experience severe limitations in the movement of the injured limb, sometimes, the hand completely stops working, which the person may not know about, since he himself tries not to move his hand so as not to feel sharp pain.
- Spasms. A person may experience spasms in all injured limbs.
- Edema. It develops around the damaged area and only increases over time.
- color. The skin tone changes over the injured area, which can turn red, purple or blue.
- Malaise. Simultaneously with pain, the victim may feel chills, high temperature up to 38+ degrees, increased excitability after injury, which is quickly replaced by general fatigue.
Naturally, the symptoms of hand dislocation are not universal, the injured person may not experience all the sensations described, but this does not mean that there is no dislocation or other serious injury. If there are at least a few of the symptoms described, it is necessary to seek professional medical help in a timely manner.
How to distinguish between dislocation and contusion hand injuries
A professional examination in a hospital is necessary so that a qualified professional can confirm the diagnosis and the absence of other injuries.
At the same time, there are several symptoms that allow, upon careful examination, to determine the nature of the damage with a high degree of accuracy, namely:
- Deformation. The brush is not deformed in case of bruises.
- Changing the brush axis. The symptom may not accompany a bruise.
- Inability to actively use the brush. After receiving a bruise, a person does not have any special difficulties in moving a limb, although this will happen with obvious pain.
That is, it is much more difficult to distinguish a dislocation from a broken limb than from a bruise. To increase the likelihood of more or less accurate home diagnostics, you can compare your injury with a photo of a dislocation of the hand, however, this approach does not give a 100% guarantee of a correct diagnosis, which must be entrusted to professionals.
How is it diagnosed?
Most often, a standard X-ray machine is used to diagnose dislocated hand dislocations and fractures, but sometimes injuries are poorly distinguishable, especially due to the inability to correctly position the injured limb.But all the same, the diagnosis begins with an X-ray, which makes it possible to identify dislocations of bones, as well as fractures.
However, it is almost impossible to detect a crack or rupture with X-ray. If the diagnosis cannot be made immediately, the attending physician may resort to other means, in particular: CT or MRI.
MRI makes it possible to identify a number of pathologies, in particular: dislocations, fractures, ruptures, hematomas, necrotic processes and even osteoporosis.CT is less effective, but sometimes doctors prescribe it, especially if the patient has individual features of the structure of the hand.
In addition to this, the victim may be assigned a general blood test, which is necessary to confirm or deny the infection of the joint. Additionally, the analysis can reveal an increased number of leukocytes and an increased erythrocyte sedimentation rate.
The treatment procedure usually includes the following steps:
- Pain relief.Before the start of the reduction of the dislocation of the hand, the damaged area must be anesthetized so that the victim can normally endure the upcoming procedure.
- Direction. The specialist sets the dislocated bone in such a way as to return it to the joint and not harm the patient.
- Fixation. If it is not necessary to carry out the operation, the arm is fixed with a plaster cast.
After that, the victim is prescribed anesthetics, physiotherapy and physiotherapy exercises, if surgery is not required, otherwise the operation is performed first, and then the final stages of treatment.
The conservative method of treatment involves the reduction of the dislocation, which is always painful for the victim. That is why anesthesia for adults and general anesthesia for children under the age of five are carried out beforehand. Then the doctor intensively stretches the patient’s arm in the longitudinal plane in order to correct the perilunar dislocation, while simultaneously bending the hand to the back.
If the procedure is successful, then a plaster cast is applied to the arm, with which it will take 3 weeks.The hand is fixed in such a way that it is bent at an angle of about 130 degrees. After that, the plaster is removed, the hand is given a functional position and fixation is again applied for another 3 weeks.
During the reduction, a characteristic click occurs, which indicates the success of the procedure.
It should be borne in mind that the victim may require surgical intervention. Most often, the operation is prescribed if the dislocation is accompanied by severe damage to the skin, rupture of ligaments, twisting of the bones, etc.etc.
Many victims are interested in what will happen if the dislocation of the hand is not corrected? An old dislocation is also the basis for surgical intervention, therefore, experts strongly do not recommend delaying a visit to a medical facility.
Dislocation can be treated at home only when it is adjusted in a hospital setting. Usually, a person is discharged from the hospital immediately after conservative treatment and 3-5 days after the operation.There are no secrets in this procedure, the victim just needs to follow all the doctor’s recommendations and wear a plaster cast for the specified period, and also be sure to take prescribed medications that relieve puffiness and pain.
At home, the victim is advised to maintain a proper diet, eat foods rich in vitamins C, B6 and B12, which are necessary for effective regeneration.
When the fixation is removed, the patient is prescribed exercise therapy and physiotherapy.Until then, only the lightest exercises are allowed, involving the fingers and muscles of the forearm, for no more than 30 seconds, 2-3 sets per day.
While wearing the plaster, it is recommended to check the sensitivity of the fingers in order to exclude the negative consequences of the dislocation on the median nerve and blood vessels.
After removing the plaster, the victims are usually prescribed electrophoresis with paraffin applications. If the patient has special equipment at home, he can take procedures at home, without visiting the hospital.
At the next stage of therapy, the patient is prescribed massage or self-massage. The stroking and sliding movements from the fingers to the forearm make it possible to improve blood circulation in the hand and generally speed up the regeneration process. Sometimes it is allowed to use the massage immediately after removing the fixation.
All exercises from the complex of physiotherapy exercises should be performed as prescribed by the doctor and in the form in which they were recommended. Do not overwork the injured hand in order to eliminate the likelihood of unnecessary negative consequences and complications.
Dislocation of the elbow joint
Many people in their lives have faced various joint dislocations. Injury can occur at work, on vacation, or during exercise. Dislocation of the elbow joint is one of the most common injuries of the upper limbs.
As a result of the injury, severe pain, swelling and deformity in the area of the elbow joint. This disease requires mandatory consultation with traumatologists and further treatment.
There are three types of elbow dislocation:
- First . Against the background of arthritis or arthrosis and weakening of the ligaments and muscles, there is a change and destruction of the bones of the joint.
- Second . Dislocation of the ulna is the result of displacement of the articular end of one of the bones due to direct impact on the elbow.
- Third . The mechanism of injury is indirect pressure on the joint when force is applied to the humerus or radius, resulting in a lever.
The second option is considered the most common case of dislocation of the ulna and radius.
Causes of elbow dislocation:
- Getting hit. During serious physical activity, in an accident or in a fight, a person can get such an injury. And also dislocation can occur when hitting patients on a hard surface.
- Fall. A falling person intuitively puts his hands forward to soften the fall.The hand has a high load. The trauma is influenced by the angle at which the person exposes the upper limbs, his body weight and the speed of the fall.
- Sharp dash. Dislocation of the elbow joint with displacement can occur if a person’s arm is pulled violently. Typically, such an injury can occur during judo or sambo training.
- Occupational injury. A person usually receives such injuries at work associated with hard physical labor.Representatives of blue-collar occupations are most often injured during work.
Symptoms of dislocation of the elbow joint:
With a dislocated elbow, the following signs are considered characteristic symptoms:
- Change in the shape of the joint. Outwardly, it will be noticeable that the elbow does not look the same as before.
- Severe pain. The patient may feel severe pain in the elbow area, and when trying to move the arm, the movements will be difficult and painful.At rest, the patient will not feel relief. The painful sensations may involve the shoulder and forearm.
- Limited movement. A patient with a dislocated elbow has partial or even complete limitation when trying to wiggle or move the arm. If, nevertheless, efforts were made to bend the arm, this ends with a sharp pain in the affected area.
- Puffiness. The elbow area is swollen and the swelling does not subside immediately after reduction, the swelling subsides gradually.
- Color Due to inflammation, the skin at the site of the dislocation and throughout the limb turns red or purple.
- Decrease in sensitivity. Hand may go numb with this type of injury.
- Spasms. Damage to blood vessels, ligaments and muscles often causes spasms in the injured arm.
- Deterioration of health. The trauma will cause the patient to experience general malaise, such as fever, fever, or chills.The pulse can be quickened or, conversely, slowed down.
The traumatologist, before determining the method of treatment, necessarily conducts a thorough diagnosis in order to distinguish the problem from others. For example, from a closed fracture or ulnar bursitis.
First of all, the doctor collects anamnesis, finds out what preceded the injury, then conducts a thorough examination and palpation, determines the sensitivity in the injured limb.
Then the patient undergoes diagnostics:
- vascular ultrasound;
- general blood and urine tests;
- biopsy of intra-articular substance.
Additionally, tests are taken to identify concomitant chronic pathologies, which will determine the method of treatment.
After taking the history, the traumatologist will most likely resort to joint repositioning. Before this, the patient is shown taking painkillers, blockade of the joint with anesthetics is possible, muscle relaxants should also be injected intramuscularly, aimed at relaxing muscle fibers.Only a professional should correct the affected joint.
Depending on the degree and type of lesion, the doctor will choose a specific reduction method.
Further, to alleviate the patient’s condition, high-quality immobilization is required for 2 weeks. With a dislocated elbow in a child, whose symptoms are much brighter, the correct elimination of any movements in the joint will lead to rapid recovery.
During the period of treatment, the patient needs to take medications:
90,020 90,021 painkillers;
90,021 muscle relaxants;
90,021 vitamin complexes.
The expediency of therapy for certain drug groups and the course of treatment are chosen by the traumatologist, depending on the age characteristics of the patient, the complexity of the injury.
First aid for dislocation: what can and cannot be done
How to find out if it is a dislocation
Dislocation is an injury that everyone can face. Unsuccessfully jumped off the curb or landed on the elbow when falling, or hit a basketball too vigorously, or even just yawned too wide … it jammed.
First of all, don’t panic. Perhaps the painful sensation is just a muscle spasm caused by a blow, or, let’s say, a sprain. Unpleasant, but relatively safe. So take a deep breath (this will help relieve pain) and look at the affected body part.
Dislocation is a displacement of the bones in the joint.
Appearance may differ depending on the degree of displacement. But in general it doesn’t matter. Remember only four symptoms.With any of them, you need to go to a traumatologist as soon as possible!
- The affected joint looks strange – for example, the bone is taking on an unnatural angle.
- The joint has increased in size, there is swelling, and the skin above this area has changed color – it has reddened or, on the contrary, has become waxy-pale.
- You feel severe pain in the joint area. Another option is numbness: if the nerve endings were damaged during the dislocation, loss of sensitivity is possible.
- You cannot move the bones in the affected joint. For example, bend or straighten a bruised finger or close a “jammed” jaw. And if you succeed, then with great difficulty and through an attack of acute pain.
What not to do in case of dislocation
If you suspect a dislocation, in no case make these common mistakes.
Don’t expect it to heal itself
Dislocation is the closest relative of a fracture. Even if the bones are still intact, blood vessels and nerves could be damaged if displaced.The same nerves, perhaps, will “heal”, but they will remind you for years of injury with aching pain, or even a serious limitation of mobility in the affected joint.
Do not try to correct the dislocation yourself
First of all, because you may not have a dislocation, but a fracture. The symptoms of these injuries are very similar , and sometimes it is possible to distinguish one from the other only with the help of X-rays. Trying to repair broken bones will only increase the damage.
Do not slow down
Dislocation is always accompanied by edema, and often also internal bleeding.The more time has passed since the injury, the more fluid accumulates near the joint and the more difficult it will be to correct it. So do not hesitate – run to the emergency room. If “running” does not work – for example, a leg is injured – do not hesitate to call an ambulance.
How to provide first aid for dislocation
1. Provide the affected joint with maximum stiffness: do not bend your knees, elbows, fingers, do not move your jaw …
2. Apply something cold to the injured area – an ice pack or frozen vegetables (do not forget to wrap it in a thin cloth), a heating pad with ice water.The cold will stop the development of swelling and reduce pain.
3. Take an ibuprofen or acetaminophen pain reliever.
4. And hurry up to the doctor!
How will the dislocation be treated
Treatment begins with a medical examination. A traumatologist or surgeon will most likely send you for an x-ray to make sure it is a dislocation and not a fracture or cracked bone. In some cases, an MRI scan may be required: CT scans can help the physician assess the damage to the soft tissue around the joint.
Further actions depend on what the doctor discovers. Most often, treatment includes the following items.
The medic will try to set the joint
That is, return the shifted bones to the correct position. This procedure is quite painful and may require local or general anesthesia.
It may be necessary to perform surgery
It is used if it was not possible to cope with the dislocation manually. Also, surgery is prescribed for significant damage to the nerves, blood vessels and ligaments, or repeated dislocations in the same area.
You will have to temporarily immobilize the joint
After the bones return to their natural position, the surgeon can immobilize the joint by applying a splint or hanging it on a sling. How long you have to wear this “harness” – several days or several weeks – depends on the degree of damage to the joint, nerves, blood vessels and soft tissues.
You will need to rehabilitate
Having got rid of a splint or a sling, prepare for a long time and persistently to do joint exercises and undergo physiotherapy procedures.This is an important step that is necessary to regain the former mobility.
By the way, keep in mind: if the joint has been dislocated at least once, there is a high probability that it will happen again one day. To reduce the risks, follow all your doctor’s recommendations. And of course, take care of yourself.
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Joint dislocation | Beethoven – veterinary clinic, Krasnoyarsk
Dislocation is the most common diagnosis made by owners of their suddenly lame dog or cat.And it doesn’t matter that at the same time it is sometimes difficult even to understand which of the paws the patient is limping on. And whether he is lame at all. But the word “dislocation” is somehow heard by everyone and in the mind.
What is a dislocation?
Dislocation – pathological (that is, not normal, impairing the function of the organ), often reversible, violation of the anatomical location of the organ. Most often, the term “dislocation” is used in relation to the joints, although there are dislocations of the eyeball. We will focus on joint dislocations.
Dislocation of a joint (any) means a violation of its structure due to the mutual displacement of the bones forming the joint without violating their integrity.Dislocation is always accompanied by damage to the soft tissue structures of the joint: blood vessels, joint ligaments, its capsule, tendons of the adjacent muscles are torn. All this inevitably leads to serious violations of the function of the organ – both an individual joint and the entire limb.
What are its causes, symptoms, dangers? Do dislocations really happen so often? And what if there really is a dislocation? We will try to answer these and other questions in a simple and understandable form.
Why is this happening?
There may be several reasons for dislocations.Basically, there are traumatic and congenital dislocations. In order for a dislocation of a healthy joint to occur, significant efforts are required, therefore, the main causes of traumatic dislocations are car injuries, falls from a great height, collisions with an obstacle at high speed, stuck limbs during movement, violent games. The most common traumatic dislocations of the hip and elbow joints.
Congenital dislocations and subluxations develop due to genetic marriage, improper joint structure.Often these pathologies are recognized already at a fairly mature age (6 – 8 months and older), sometimes as an accidental find. The most common are congenital dislocations of the knee cup (in dwarf breeds), elbow joint, subluxation (not complete dislocation) of the hip joint. There is also something in between: an injury insignificant for a healthy animal leads to dislocation of a joint genetically predisposed to dislocation (underdeveloped, altered) joint. This is how dislocations of the knee cap and cervical vertebrae occur in dwarf breeds, dislocation with dysplasia of the hip joints.
What does it look like?
The main signs of dislocation are lameness (with congenital) or complete lack of support for a limb (with traumatic dislocation). After injury, the animal jumps on three legs. Externally, a close examination reveals swelling and deformation of the contours of the damaged joint (in comparison with the limb of the opposite side).
In case of dislocation of the lower jaw, the mismatch of the teeth is clearly visible. Palpation (probing) with traumatic dislocations is usually difficult.When palpating and trying to make movements, very strong soreness comes to light. A characteristic symptom is elastic (“rubber”) fixation of the joint, which normally functions as a perfectly lubricated hinge. Friction of bone against bone, grinding, clicks, displacement of anatomical landmarks (for specialists) is also felt.
What to do
If your pet is injured and you suspect a dislocation, follow these guidelines:
- Do not try to correct the dislocation yourself – it hurts!
- Try to immobilize the animal and the injured limb before visiting a doctor.To do this, you can place it in a limited space (cage, box, aviary, car, leash). It is necessary to avoid using a sore paw, do not wrinkle, do not jerk or shift the animal again.
- It is advisable to place ice in the damaged area for 20-30 minutes (wrap anything from the freezer in a towel and attach).
- Do not feed the dog – anesthesia may be needed.
- Deliver the animal to a doctor as soon as possible. If there is a choice – to the clinic, where there is an experienced orthopedist, X-ray, operating room.
How do you know exactly?
The doctor makes a diagnosis based on the entire set of information: history of the disease (significant trauma), examination and palpation data, X-ray examination. The latter is the only reliable test for certain dislocations (eg cervical vertebrae, hip or shoulder joints in very obese or muscular dogs.
How to treat?
The main treatment for traumatic dislocations is reduction (closed or open – surgical) and fixation.Reduction of the dislocation should be done as urgently as possible (based on the patient’s condition).
When the reduction is delayed for more than 1-2 days, contracture (contraction) of the muscles develops, a dense, fixed clot of fibrin (blood) forms in the joint cavity, and scar tissue is formed. All this makes closed reduction difficult and sometimes impossible. In addition, during this time, the articular surfaces and the surrounding soft tissues can be significantly damaged.
Open reduction is done when closed is impossible. In this case, a surgical access is made to the damaged joint, fibrin clots and destroyed fragments of articular structures are removed from its cavity. After that, with the help of special levers (and sometimes significant physical efforts), the joint returns to its original position.
Reduction of the dislocation by any means requires general anesthesia and complete muscle relaxation.
After reduction – closed or open – the joint must be fixed.For this, all kinds of fixing bandages or splints are used. In some cases, surgical fixation of the joint is used – with special wires for dislocation of the hip or wrist joints, screws and wire for dislocation of the elbow and ankle joints. In case of dislocation of the lower jaw, to immobilize the joint, sometimes it is necessary to sew the mouth for 5 to 10 days. Cruel, but there is nothing to be done. And only in rare cases with timely reduction of and minor damage to the periarticular structures, immobilization is not required.
If the dislocation is not corrected either after 2 days or after 20, the consequences can be dire. Persistent, irresistible muscle contracture develops. The scar tissue firmly fixes the elements of the joint in the wrong position. The articular surfaces are destroyed. With such changes, it is not always possible to save the joint. To help the animal, instead of reduction, it is necessary to do arthrodesis (rigidly splicing the bones that form the joint) or resect (remove) the joint.
Treatment of congenital dislocations is usually much more complicated than traumatic, and almost always surgical.Although in some cases (congenital dislocation of the patella in dwarf dog breeds), treatment may not be required at all.
Dislocation of the hip | POMC
In recent decades, there has been a sharp increase in the number of vehicles and, as a consequence, road traffic accidents; in the structure of injuries, there has been an increase in combined and multiple injuries, including trauma of the hip joint.
The biomechanics and blood circulation of the hip joint are such that bruises do not go unnoticed.A feature of damage to this joint is the possibility of the development of various complications in the long term.
Traumatic hip dislocations account for 5-8% of the total number of dislocations. Hip dislocations occur mainly in young and middle-aged men.
Long-term results of treatment largely depend on the first-line doctor, on the correctness of the first aid. Road traffic accidents are of great importance in the occurrence of traumatic dislocations. To solve the problem of treating the pathology under consideration, an important role belongs to the creation of road injury departments in hospitals of the first and second link according to the national project.
The hip joint is formed by the head of the femur and the acetabulum of the pelvic bone. It is a type of ball joint – it is a cup-shaped joint.
The powerful tendon-capsule apparatus of the hip joint determines the fact that traumatic dislocations occur with a high-energy nature of the injury. Traumatic dislocations in the hip joint occur as a result of the indirect application of significant force. In this case, the femur with the knee joints is a kind of lever with a fulcrum, which is located intra-articular.
An indispensable condition for the occurrence of dislocation is flexion in the hip joint, since during its extension the joint is blocked by the tension of powerful ligaments and further movements, especially rotation, are possible only together with the pelvis.
Mechanism of origin
This injury is mainly caused by drivers and passengers of cars and motorcycles who do not wear seat belts. A typical mechanism of injury is a violent knee strike by a bent leg against the dashboard of a car in a collision with an obstacle…. In this regard, there are concomitant injuries caused by the impact of the knee on the dashboard: contusion of the distal thigh, fracture of the patella, with an extended knee – fractures in the ankle joint.
The second, less common cause, falling from a height, is observed in elderly patients.
Out of more than a hundred patients observed by the author, several people suffered dislocations when falling from a height, and one when being run over by his car. One also received this injury when falling from a horse at the racetrack, while in the historical literature earlier this was the main mechanism of damage.All the rest were drivers and passengers sitting in the front seat of passenger cars.
The type of dislocation depends on the degree of hip flexion, the presence of adduction or abduction, external or internal rotation at the time of injury.
Thus, posterior dislocation usually occurs with at least 45 ° flexion, adduction and internal rotation of the thigh. With each type of dislocation, the head of the femur and the entire lower limb take a certain position. For all types of dislocations, hip flexion is detected, however, its degree is different for each type.In addition, adduction and internal rotation are characteristic of posterior dislocations. In iliac dislocations, adduction and internal rotation are less pronounced than in sciatic ones. With posterior dislocations, a large roundness of the gluteal region is determined.
For anterior dislocation to occur, flexion is also necessary, but in combination with abduction and external rotation.
Isolated dislocations occur only in 10-20% of all dislocations. But even among them, as a result of the study of isolated hip dislocations using computed tomography, it was found that in reality in 13% of cases they are accompanied by a fracture of the anterior part of the femoral head, combined with a fracture of the posterior edge of the acetabulum.
For the diagnosis of hip dislocations and acetabular fractures, it is optimal to use computed tomography, three-dimensional computer reconstruction of the damaged joint. Computed tomography provides a lot of additional information regarding, for example, punctured fractures of the acetabular wall, the presence of bone fragments in the joint, the degree of their fragmentation, unrecognized dislocation, and the pathology of the sacroiliac region. The main advantages of CT include the ability to reconstruct the circular shape of the pelvis, allowing the complete picture to be visualized.
Marginal fractures account for 40% of all acetabular fractures. Despite the fact that many authors consider fractures of the posterior wall of the acetabulum to be simple fractures, unrecognized or discovered late, they cause a rapid progression of anatomical, vascular, trophic disorders in all structures and tissues of the hip joint, which often leads to severe disability.
Complications of dislocations
In case of dislocations, the following complications can occur: venous thrombosis, including pulmonary embolism (PE), nerve damage, primarily sciatic, avascular necrosis of the femoral head, repeated dislocation, chronic pain, coxarthrosis.
Not only the trauma itself, but also the reduction and subsequent immobilization, translate the dislocation of the hip into a category of moderate risk of thrombotic complications, and in case of associated injuries, into a high one.
The sciatic nerve is damaged in 10-19% of cases. Clinically, this usually manifests itself in the form of loss of sensitivity of the posterior surface of the leg and foot, loss of dorsiflexion of the foot and, more rarely, plantar flexion, and loss of deep tendon reflexes of the foot. The femoral nerve suffers less often and its damage manifests itself in the form of loss of sensitivity of the corresponding surface of the thigh, weakness of the quadriceps muscle and loss of tendon reflexes of the extensor apparatus of the knee joint.
Avascular necrosis of the femoral head (ANFH) occurs due to damage to the vessels supplying the head, such as the artery of the round ligament of the head and arteries passing through the joint capsule. The timing of the provision of qualified medical care is important for the prognosis. Avascular necrosis of the femoral head after immediate reduction of dislocation occurs in 30% of cases. If the reposition was carried out after 6 hours from the moment of injury, then the number of avascular necrosis of the femoral head increases sharply.
Conservative treatment of dislocations
Treatment of hip dislocation consists of three stages: a) reduction; b) long rest; c) complex physiotherapy and functional treatment.
Upon admission, the victim should perform a blockade according to Shkolnikov, correct the dislocation of the hip, apply skeletal traction.
In case of dislocation, the ligaments, muscles and, consequently, the vessels passing through them are torn, through which the main power of the femoral head is carried out, and the remaining intact vessels can become thrombosed due to stretching and twisting, which leads to impaired blood circulation in the hip joint.Early elimination of hip dislocation contributes to the normalization of blood supply.
The criterion for a successful reduction is the absence of a “springy” resistance symptom and the ability to fully extend the hip.
Closed adjustment of hip dislocation is possible in 74% of cases, and even with reduction, the probability of relaxation is 12%.
We usually perform hip dislocation reduction under general anesthesia with the use of muscle relaxants. At the same time, two assistants fix the patient to the table, the adjuster pulls along the axis of the bent thigh through his own shoulder, using the patient’s shin as a lever, in combination with rotational and adduction-abduction movements of the thigh, whereby the reduction is carried out.After reduction, we perform a control X-ray and apply skeletal traction. We give preference to holding the wire for the supracondylar region, and not for the tuberosity of the tibia, so that the knee joint does not suffer, and the patient has the opportunity to engage in physiotherapy exercises from the first days. The preservation of the function of the hip and knee joints is facilitated by laying the limb on a functional splint, the angle of which changes during the day.
Treatment of central hip dislocations is especially difficult.In these cases, the preferred technique is double skeletal traction, in which traction along the thigh axis is complemented by perpendicular traction in the subtrochanteric region or along the axis of the femoral neck, lasting 8-12 weeks.
Surgical treatment of dislocations
Surgical treatment of injuries of the hip joint is diverse. Indications for surgical treatment of hip dislocation are: relaxation, interposition, displacement of fragments, irreducibility, persistent paresis of the sciatic nerve, combination of dislocation with fractures of the femur, large size of bone fragments, incongruence of articular surfaces after reduction in the form of a rupture of Shenton’s line and an increase in the articular space compared to a healthy joint, which may indicate undiagnosed intra-articular injuries that subsequently lead to the development of coxarthrosis (Karthik K., et al, 2011).
Often, with closed reduction of hip dislocation, repeated several times or for a long time, additional damage to the articular cartilage and subchondral bone occurs. Therefore, T. Billroth warned back in 1879: “As for the time during which it is possible to make a violent repression, then we consider half an hour as the maximum …”. In this regard, if closed reduction is unsuccessful, an early open reduction is necessary, the timeliness of which ensures satisfactory results.
Reduction of hip dislocation should be performed as soon as possible. When combined with a fracture of the acetabulum with significant damage to it, osteosynthesis is required as one of the main factors preventing relaxation. The optimal and least traumatic approach in most cases is the posterior-external approach with cutting off the greater trochanter. One of the most important tasks of the postoperative period is the fastest activation of the patient and movement in the operated joint.
Postoperative treatment of patients
After the operation, all patients need rehabilitation treatment with the appointment of physiotherapy, massage, therapeutic exercises and medications.
After reduction of the dislocation of the hip, immobilization with a plaster cast is unacceptable. Static loads arising from muscle contraction due to a painful reaction are especially unfavorable for the nutrition of damaged cartilage. In addition, immobilization leads to muscle atrophy and a decrease in their contractility due to the loss of myofibril and sarcoplasmic proteins with a simultaneous increase in intermuscular connective tissue. It is no coincidence that one of the models of the degenerative-dystrophic process in the joint is its immobilization.The possibility of reverse development of these changes depends on the duration of the plaster immobilization.
After intra-articular injury (or surgery), movements in the damaged joint are necessary, which have a beneficial effect on the matrix of regenerating tissues. Along with anatomical reduction and internal fixation, they are the most important factors leading to positive results, including in acetabular fractures. The importance of passive movements in the joint after injury, surgery or inflammation is explained by the optimization of conditions for the free flow of synovial fluid and the stimulation of cartilage formation.These physiological exercises help to increase the production of synovial fluid, which is the main source of nutrition for the articular cartilage. The technique of passive movements after surgery is widely used in clinical practice, including on the Artromot – K4 functional bus.
Function bus Artromot – K4.
After the dislocation has been reduced, drug therapy is necessary. To improve the regeneration of cartilage, we prefer to use such chondroprotectors as chondrolone, alflutop, rumalon, dona.The use of non-steroidal anti-inflammatory drugs (indomethacin) significantly reduces the likelihood of developing heterotopic ossificates after surgery, but it must be borne in mind that these drugs can inhibit the synthesis of sulfated mucopolysaccharides, and therefore their prolonged use is undesirable.
Physiotherapy during the immobilization period is aimed at optimizing the conditions for healing a postoperative wound, reducing infiltration, edema, and pain. From the 3rd day after the operation, we recommend UFO in small erythemal doses daily to the area of postoperative sutures, from 3 to 8 sessions per course.From the 5-8th day after the operation on the area of the operated joint, through a dry gauze bandage, we carry out magnetotherapy with the Magniter apparatus, we use a sinusoidal or pulsating magnetic field.
Therapeutic gymnastics of this period is aimed at preventing intestinal atony, congestion in the lungs, activating the cardiovascular system, improving blood circulation in the operated limb, preventing muscle atrophy, preparing the muscles of the upper limbs for using crutches.
For medical gymnastics, morning hygienic and therapeutic exercises are required in the form of classes conducted with an instructor and independently. During this period, patients are prescribed general strengthening, respiratory, static and dynamic exercises, active movements in the joints of the operated limb, free from immobilization, and in the joints of a healthy limb.
Particular attention is paid to isometric exercises for the quadriceps femoris, gluteal muscles, calf muscles.Exercises for the shoulder girdle are performed with weights with dumbbells weighing 2-3 kg. To improve the conditions of blood circulation and prevent impaired lung function, the patient is allowed to actively raise the body from the 3rd day using the Balkan frame.
After 1 year and in the future, patients are advised to carry out sanatorium-resort treatment annually for several years using physiotherapy, massage and physiotherapy.
The best results are obtained in patients who have undergone the entire range of rehabilitation measures.The fastest activation of the patient is required, including making passive movements in the damaged joint when unloading it. The load on the leg can only be allowed under X-ray control, with attention to the structure of the femoral head and not earlier than 6 months after injury in case of isolated dislocations or fractures, and not earlier than 8 months in case of fracture dislocations.