Dislocation is the term given for a separation of the bones within a joint. Unlike a fracture, a dislocation does not usually mean the bones have been broken. Instead, it usually involves placing the bones back into the joint or socket.
Dislocation may occur following trauma to the joint during an accident, whether that be a motor vehicle accident, a sporting accident, or any other force trauma. Smaller joints are easier to dislocate, and once a joint has been dislocated it is much easier for it to happen again.
Most commonly, dislocations occur to mobile joints. These include moveable joints like the shoulder, knee and hip. Ball and socket joints like those in the hip and shoulder allow for the limb to move in more directions, therefore making them more susceptible to be pulled out of place. Additionally, the shoulder socket is shallower, making it easier for this joint to become dislocated more than any other joint in the body. In children, the elbow is another common joint to become dislocated.
Although it is possible for the hip to become dislocated, it is much more difficult as the socket is deeper and the ligaments much stronger.
Increased Risk Factors
Joints are more likely to become dislocated following a trauma if there is a pre-existing weakness. This is not the only risk factor, however. Those who play contact sports such as rugby may also be at an increased risk due to the high impact nature of the sport.
Other contributing factors include:
- Muscle and ligament weakness,
- Laxness in the ligaments during childhood
- Joint hypermobility
- Inherited diseases such as Ehlers-Danlos Syndrome and Marfan’s Syndrome.
Older people may be at higher risk of dislocation due to weaker muscles and ligaments, but also because they are at a higher risk of falling.
What To Do With A Dislocation
With any form of dislocation, it is vital that you seek medical help and do not try to put the bone back into place yourself. Doing so could cause damage to the ligaments, muscles and blood vessels around the joint. A dislocation usually counts as an emergency, so you should call 999 or make your way, with assistance, to your nearest A+E department. Not seeking medical attention quickly could result in further damage being caused. If you are not sure a dislocation has occurred, you can call your local out of hours service by dialling 111 and speaking to an NHS Direct advisor. They can advise you on the best course of action.
Putting the bone back into place without medical assistance could also cause considerable pain. When the joint is reconnected by a doctor, they will use strong drugs which will make you sleepy, relaxing you enough to place the joint more easily. A doctor will know the best way to place the bone in order to avoid causing any further damage to the surrounding tissues and vessels.
What you can do, however, is support the dislocated joint while you wait for medical attention. You can do this by putting some soft padding around the joint and ensuring as little movement as possible. In the case of some joints, such as the elbow or shoulder, you can use a make-shift sling to support the joint.
In the case of a dislocated hip, it is not advisable to move the sufferer until an ambulance has arrived.
Treating Dislocation – Before and After
In most cases you will first have an x-ray to determine the damage and positioning of the bone. Following your assessment, you will most likely be given painkillers and sedatives to reduce the pain and help to relax you so that the bone can be replaced in A+E. In some cases a general anaesthetic may be used and the procedure may take place in an operating theatre.
Once the joint has been manipulated, it will need to be rested. If damage has been done to the surrounding tissue, surgery may follow. There will be some follow-up care and rehabilitation treatment which could include physiotherapy to re-strengthen the joint and prevent any future injuries.
If you suspect that you have dislocated a joint and require emergency medical assistance, dial 999 immediately. Otherwise, seek further advice by calling NHS Direct on 111.