JOINT DISLOCATION AND SUBLUXATION –
Types, Causes and Risk Factors,
Clinical Manifestations, Diagnostic Test,
Medical and Nursing Management
JOINT DISLOCATION AND SUBLUXATION – Types, Causes and Risk Factors, Clinical Manifestations, Diagnostic Test, Medical and Nursing Management
Dislocation is a separation of both articulating surfaces of joint. Subluxation is a partial or incomplete displacement of the joint surface. Disclocations and subluxations disrupt a joint by tearing the capsule and ligaments, a displaced bone may impede blood supply, rupture blood vessels, damage nerves and rupture muscle attachments.
TYPES OF DISLOCATION
Dislocation may be congenital, traumatic or pathologic.
- Congenital dislocations are present at birth and mainly seen in hip and knee joints
- Traumatic dislocations result from falls, blows or rotational injuries
- Pathologic dislocations result from disease of the joint including infection, rheumatoid arthritis, paralysis and neuromuscular diseases.
CAUSES AND RISK FACTORS
- Dislocations can occur in contact sports, such as football and hockey, and in sports that may involve falls, such as downhill skiing, gymnastics and volleyball.
- A hard blow to a joint during a motor vehicle accident is another common cause of dislocation, as is landing on an outstretched arm during a fall
- Experiencing a fall increases the possibility of a dislocated joint
- People are born with ligaments that are looser and more prone to injury
CLINICAL MANIFESTATIONS
- Dislocation alters the length of affected extremity
- Pain is usually severe, even upon the slightest of movement
- Swelling and significant hemorrhaging occurs around the joints
- Numbness in contour of joint
- Limited in movement or loss of normal mobility
- Change in the axis of dislocated bones
- A visible deformity is usually present
- Major complications of dislocated joints are open joint injuries, intra articular fractures, fracture dislocation and avascular necrosis and damage to adjacent neurovascular tissue
DIAGNOSTIC TEST
- X- ray: An X-ray of joint is used to confirm the dislocation and may reveal broken bones or other damage to joint
- MRI: Magnetic resonance imaging (MRI) can help doctor assess damage to the soft tissue structures around a dislocated joint
MEDICAL MANAGEMENT
- Immobilize the Joint: Immobilize the affected joint while transportation of patient to hospital. Doctor may immobilize joint with a splint/sling for several weeks. How long splint/sling is used depends on joint involved and extent of damage to nerves, blood vessels and supporting tissues.
- Do Not Attempt to Relocate: Never attempt to relocate the dislocation. Physician referral is mandatory. Subluxations must also be examined by a physician as bone and ligament damage is almost always associated with these injuries
- P.R.I.C.E: Protect the dislocated/sublocated joint (splint) from further injury. Rest the area to promote healing. Ice is definitely indicated, however, compression may elicit more pain, so this may have to be avoided. Elevation also maybe difficult as it would require movement to accomplish
- Reduction: During this process, doctor may try some gentle maneuvers to help bones back into position. Bandages, splints, casts or traction is used to maintain the joint in stable position after reduction
- Medication: Most of pain should go away once the joint is returned to its proper place. However, doctor may prescribe a pain reliever or a muscle relaxant to reduce pain. Over-the-counter medications, such as ibuprofen, naproxen or acetaminophen may help relieve pain
- After reduction and immobilization: Gentle passive ROM may start to restore strength so that patient should be gradually return to normal activities.
NURSING MANAGEMENT
- Nursing management of subluxation or dislocation is directed towards relief of pain, provide comfort and protection of the injured joint
- Nurse should evaluate the neurovascular status of patient by assessing the 5 “P” s: Pain, pulses, pallor, paralysis and paresthesia.
- Nurse should teach the patient regarding management of immobilizing devices, protection of joints from reinjury and use of assistive or adaptive devices
- Nurse should refer the patient to physical and occupational therapy