Brief overview
- Treatment: First aid: immobilization, cooling, reassurance of the affected person; doctor manually dislocates the joint, followed by X-ray and immobilization with bandages or splints, in case of concomitant injuries or failure of the dislocation possibly surgical measures
- Symptoms: Severe pain, relieving posture, immobility of affected body part, tingling and insensitivity due to nerve injuries.
- Diagnosis: physician checks position of affected joint, blood flow, mobility and sensation of stimuli, imaging procedures (such as X-ray, ultrasound, computed tomography), rarely arthroscopy of joint
- Causes: Force due to fall or accident, congenital or acquired joint instability (due to loose ligaments), chronic joint damage or inflammation, malformation (dysplasia) of the joint, instability due to age-related wear and tear
- Prognosis: complication due to bone fracture (dislocation fracture), usually complete healing in case of one-time dislocation, persistent complaints possible in case of renewed dislocation
What is a luxation?
“Luxation” is the medical term for a dislocation. In this case, the joint head – the bone that normally lies in the socket – pops out of it. The two joint components therefore lose contact with each other.
This occurs mainly in joints that are more prone to injury because of their position on the body or their anatomy, such as the shoulder, elbow or (artificial) hip.
Dislocation is also possible at the following locations, for example:
- Foot (ankle, toes, Chopart or Lisfranc joint line).
- Temporomandibular joint
- Wrist (perilunate dislocation)
- Teeth (positional change in the recess for the tooth root in the jawbone)
- Larynx (mainly due to traffic accidents)
- Sternoclavicular joint (sternoclavicular joint)
In general, it happens especially easily with very mobile joints: normally, attaching muscles and ligaments stabilize a joint. But if these structures are damaged or overstretched, for example, a careless, jerky movement or a fall is often enough – and a dislocation occurs.
Children before the age of seven rarely suffer a dislocation. This is because their bones are still more flexible and yield better when force is applied.
What types of dislocations are there?
There are different types of dislocations – depending on which joint is dislocated and whether the joint surfaces are completely or partially dislocated. Some examples:
Shoulder joint dislocation
The shoulder joint is the most mobile joint in humans. It is most commonly affected by dislocation of all joints. You can read about how to give first aid for a shoulder joint dislocation in the article Shoulder dislocation.
Elbow dislocation
A dislocated elbow is the second most common type of joint dislocation, accounting for about 20 percent of all dislocations. It results from a fall on the outstretched arm. Often, such an elbow dislocation is accompanied by other injuries such as torn ligaments, broken bones or nerve injuries. You can read more about it in the article Elbow luxation.
Patellar luxation
Finger luxation
When the volleyball or basketball bounces violently against an outstretched finger during sports, a finger joint easily slips out of its normal position. With a dislocated finger, please be sure to see a doctor! You can read why and how to give proper first aid for such an injury in the article Finger dislocation.
Subluxation
In a dislocation, the ends of the bones forming the joint are completely displaced. If, on the other hand, there is only a partial drifting apart of the joint surfaces, as in the case of vertebral bodies, for example, a subluxation is present. If this special form occurs in the elbow joint, it is called Chassaignac paralysis (radial head subluxation). It occurs almost exclusively in children and occurs when a child is pulled jerkily on the arm. You can read more about it in the article Subluxation.
What to do in case of a dislocation?
Never try to set a dislocated joint by yourself! There is a risk of pinching or tearing nerves, blood vessels or ligaments! Therefore, always leave the dislocation to a doctor.
First aid measures
- Immobilization: The first thing to do is immobilize the dislocated joint with a wrap or bandage. For dislocations of the arm, it is best to ask the affected person to hold it still. Additionally, it is sometimes helpful to stabilize the arm by carefully clamping a pad between the arm and the trunk.
- Cooling: When a dislocation occurs, the affected area usually swells quickly. There is also severe pain. Both swelling and pain can be relieved by cooling. Ice cubes wrapped in a cloth or a cool pack are suitable for cooling. Never apply ice directly to the skin!
Medical treatment
In the case of a dislocation without concomitant injuries, the doctor will usually reduce the dislocated joint manually. This can be very painful. Therefore, the patient is usually given a strong painkiller or a short anesthetic beforehand. This also has the advantage that the muscle tension is then reduced. This makes it easier to reinsert the bone into the socket.
In some cases of dislocation, manual adjustment is unsuccessful or concomitant injuries occur (for example, injury to nerves, vessels or muscles, or a bone fracture). In such cases, surgical intervention is necessary. Surgery is also often performed on dislocations in younger, athletically active people to reduce the risk of re-dislocation. During the operation, the surgeon tightens the overstretched capsular or ligamentous apparatus and thus restores stability to the joint.
What are the symptoms of a dislocation?
A traumatic dislocation caused by external force is usually very painful. Therefore, the patient immediately adopts a protective posture. For example, in the case of a dislocated shoulder, he instinctively presses the affected arm against the trunk.
It is also typical of a dislocation that the affected body part can suddenly be moved only slightly or not at all (such as the finger in the case of a finger dislocation or the arm in the case of a shoulder dislocation).
If the ligaments and muscles are already overstretched and dislocation occurs repeatedly, this so-called habitual dislocation is often less painful than a traumatic one.
How is the diagnosis made?
The doctor first gives the patient painkillers to make the subsequent physical examination more bearable. During this examination, the physician takes a close look at the affected joint itself and its position. He also checks the blood circulation, mobility and stimulus perception of the affected body part.
For example, if the hand of a dislocated shoulder or elbow joint appears pale or even bluish, a vessel has probably been injured. If the patient can no longer move the arm or fingers properly or feels a tingling sensation in the corresponding areas, then the nerves are most likely injured.
The next step is to X-ray the dislocated joint. In this way, the doctor determines whether it is really completely dislocated and whether bones have also been injured in the process. Occasionally, a dislocation can already be seen on the ultrasound image (especially in children).
In rare cases, a joint endoscopy (arthroscopy) is necessary for a dislocation.
What are the causes of a dislocation?
Depending on how the dislocation occurs, doctors distinguish between the following dislocations:
Traumatic luxation
Experts speak of this when a joint dislocates as a result of direct or indirect force (for example, in an accident or fall).
Habitual luxation
Habitual dislocation is due to congenital or acquired joint instability (for example, due to very loose ligaments). In this case, a minimal strain is often sufficient and the affected joint is dislocated. A dislocation without any force at all is also called spontaneous dislocation.
Pathological dislocation
It occurs, for example, as a result of chronic joint damage or joint inflammation with capsular overstretching. Pathological dislocation also occurs in the case of joint destruction and as a result of muscle paralysis.
Congenital luxation
Older people are more prone to dislocations than younger people. This is because tendons, ligaments and bones wear out with age, making joints more unstable. In principle, young men also dislocate joints more often than women because they tend to engage in risky sports more often.
What is the prognosis of a dislocation?
A possible complication of dislocation is that one of the bones involved in the joint breaks completely or a small piece of bone splinters off during dislocation. Doctors then speak of a luxation fracture (dislocation fracture). This risk exists, for example, in the case of falls with high forces acting on the joint.
In most cases, one-time dislocations heal completely after appropriate therapy. However, if dislocation occurs again, the joint in question sometimes becomes increasingly unstable. As a result, persistent complaints are possible.
In general, the course and duration of healing depend on possible concomitant injuries, the therapy, the age and the assistance (e.g. through active muscle development) of the person affected.
Are there preventive measures?
If someone suffers a dislocation more frequently (for example, due to a weakness of the connective tissue), it may be advisable to refrain from certain activities or sports.
