Joint Dislocation

A dislocation happens when the bone ends that form a joint are forced completely out of position. A partial slip is called a subluxation. The shoulder is affected most often, followed by the fingers, kneecap, elbow and hip; artificial hips can also dislocate. The ligaments and capsule that hold the joint are always stretched or torn, and nearby nerves, blood vessels and bone can be injured.

Putting the joint back (reduction) is urgent, because the longer it stays out the greater the risk of damage to cartilage, nerves and blood supply. After reduction most joints recover well with a short period of protection and then rehabilitation. The main long-term problem is recurrence, which is especially frequent after a first shoulder dislocation in teenagers and young adults.

Symptome

• Sudden severe pain at the moment of injury
• A visibly deformed or out-of-place joint
• Inability to move the joint
• Rapid swelling and bruising
• Numbness, tingling or weakness beyond the joint
• A cold or pale hand or foot, which signals a threatened blood supply
• A feeling that the joint slips or is about to go out in recurrent cases

Ursachen und Risikofaktoren

Most dislocations follow falls, sports collisions and road accidents. Hip and knee dislocations need high energy, such as a car crash, except in artificial hips, which can come out when bending or twisting beyond the safe range. Risk is increased by previous dislocation, naturally loose joints and connective tissue conditions such as Ehlers-Danlos syndrome, a shallow socket, and muscle weakness or seizures. In toddlers, a pulled elbow occurs when the arm is tugged. Developmental dysplasia of the hip in infants is a separate condition.

Wie es diagnostiziert wird

• Examination of nerves and circulation: Pulses, skin colour, sensation and movement are checked before and after the joint is put back.
• X-rays in two planes: Confirm the direction of dislocation and any fracture, and are repeated after reduction.
• CT scan: Shows bone loss from the socket or fragments trapped in the joint, particularly at the shoulder, hip and elbow.
• MRI or MR arthrogram: Shows torn labrum, ligaments and cartilage when planning stabilisation surgery.
• Vascular imaging: CT angiography after a knee dislocation, because the artery behind the knee is injured in a significant minority.

Behandlungsmöglichkeiten

• Closed reduction: The joint is manoeuvred back under sedation, a nerve block or a short anaesthetic, in an emergency department.
• Short immobilisation: A sling, splint or brace, usually for 1 to 3 weeks; prolonged immobilisation causes stiffness, especially at the elbow.
• Physiotherapy: Restores movement, then strength and joint control. This is the main treatment for most first dislocations.
• Open reduction and fixation: Surgery when the joint cannot be reduced closed, or when fractures or trapped tissue are present.
• Stabilisation surgery: Arthroscopic labral (Bankart) repair or a Latarjet bone block for recurrent shoulder instability; MPFL reconstruction for the kneecap; ligament reconstruction for the knee.
• Revision of an artificial joint: Considered when a hip replacement dislocates repeatedly.

Wenn es dringend ist

Every suspected dislocation is an emergency: go to the nearest emergency department. Do not try to force the joint back yourself. Support the limb, take nothing by mouth in case sedation is needed, and report numbness or a cold, pale hand or foot immediately.

Reisen nach Türkiye zur Behandlung

The dislocation itself is treated locally, the same day. Travel has a place afterwards, for planned surgery to stop repeated dislocations of the shoulder or kneecap, or for a second opinion on an unstable joint replacement. Shoulder stabilisation typically needs 7 to 10 days in Istanbul, followed by about 4 to 6 months of guided rehabilitation at home before contact sport. Bring your X-rays, MRI or CT images and details of each episode.

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