Highlights & Basics
- Joint dislocation is a complete separation of 2 articulating bony surfaces, often caused by a sudden impact to the joint.
- Although any joint may become dislocated, common sites include the shoulder, finger, patella, elbow, and hip.
- X-rays are usually taken to confirm a diagnosis and detect any fractures that may have occurred concomitantly at the time of dislocation.
- Treatment is usually closed reduction as soon as possible to decrease potential complications, which may include soft tissue injury, articular surface injury, and neurovascular compromise.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Dislocated distal phalanx, index finger, left hand
Patellar dislocation: knee held in partial flexion with a visible mass lateral to the lateral femoral condyle
Left knee radiograph demonstrating lateral patella dislocation
Right elbow dislocation: dislocated radial head (a), olecranon (b), and tensed triceps tendon (c) resulting in a skin depression (d) just proximal to the radial head
Scapular Y x-ray view showing an anterior dislocation of the shoulder
Scapular Y x-ray view showing an anterior fracture dislocation of the shoulder and fracture of the greater tuberosity
Anteroposterior x-ray view of a shoulder showing an anteroinferior dislocation
Anteroposterior x-ray view of a shoulder showing a missed posterior dislocation: the glenohumeral joint appears reduced
Axillary lateral of a shoulder with a missed posterior dislocation: humeral head clearly is not reduced and is locked on the posterior rim of the glenoid
X-ray showing dislocation of the proximal interphalangeal joint, left index finger
Anteroposterior x-ray view of an elbow dislocation
Lateral x-ray view of a posterolateral elbow dislocation
X-ray showing bilateral hip posterior dislocation
Traction-countertraction method: with patient supine on the bed, a sheet is looped around the axilla with one free end on the chest and the other underneath the back; the 2 ends should be of even length and are used by an assistant to apply countertraction. The practitioner abducts the arm to 90° and flexes the elbow to 90°; the forearm is used to apply slow longitudinal traction to the affected extremity
Milch technique for shoulder reduction, part 1: patient is positioned supine on a bed with the head of the bed elevated about 20° to 30°, then the arm is slowly abducted and externally rotated without application of longitudinal traction (in case of pain or resistance, the practitioner pauses)
Milch technique for shoulder reduction, part 2: once the arm has reached a position of 90° abduction and 90° external rotation, the shoulder dislocation should spontaneously reduce; if not, the humeral head can be palpated in the axilla and superolateral pressure can then be applied using the thumb and index finger to help guide the humeral head back into the glenoid
Stimson method: patient is positioned prone on the stretcher with the affected shoulder slightly off the stretcher; arm is placed perpendicular to the floor (90° forward flexion) with the stretcher high enough to keep the hand from resting on the floor, then weights of 2.3 to 4.5 kg or 1-L bottles of sterile water are wrapped around the wrist using stockinet and hung high enough to not touch the floor
Scapular manipulation technique: one hand is placed on the superolateral border of the scapula with the other hand on the inferomedial border of the scapula, and pressure is applied to rotate the superior border laterally and the inferior border medially
External rotation method for shoulder reduction, part 1: patient is positioned supine, and affected extremity is gently adducted until it is parallel to the long axis of the body; elbow is then flexed to 90°
External rotation method for shoulder reduction, part 2: by applying gentle pressure to the wrist, the practitioner slowly externally rotates the arm, taking time to allow spasms and contractions to pass; finally, the arm is externally rotated to 90° (i.e., perpendicular to the long axis of the body); shoulder dislocation should reduce after about 5 minutes
Kocher method of shoulder reduction, part 1: inline traction of the arm while abducted to 45°; while traction is maintained, arm is externally rotated and elbow is brought across the chest to the midline
Kocher method of shoulder reduction, part 2: arm is internally rotated until the patient's hand touches the shoulder
Normal axillary x-ray view of a reduced shoulder dislocation, showing congruency of the glenohumeral joint
Anteroposterior x-ray view of a reduced elbow dislocation
Citations
Patrick CM, Snowden J, Eckhoff MD, et al. Epidemiology of shoulder dislocations presenting to United States emergency departments: an updated ten-year study. World J Orthop. 2023 Sep 18;14(9):690-7.[Abstract][Full Text]
Expert Panel on Musculoskeletal Imaging: Amini B, Beckmann NM, et al. ACR appropriateness criteria: shoulder pain-traumatic. J Am Coll Radiol. 2018 May;15(5s):S171-88.[Abstract][Full Text]
Expert Panel on Musculoskeletal Imaging: Taljanovic MS, Chang EY, et al. ACR appropriateness criteria: acute trauma to the knee. J Am Coll Radiol. 2020 May;17(5s):S12-25.[Abstract][Full Text]
Rozzi SL, Anderson JM, Doberstein ST, et al. National Athletic Trainers' Association position statement: immediate management of appendicular joint dislocations. J Athl Train. 2018 Dec;53(12):1117-28.[Abstract][Full Text]
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