What is dislocation?
Joint disruption : the articulating bones of a joint are not in correct relationships
Which one occurs when joint surfaces have NO contact?
Dislocation
Which one occurs when joint surfaces have only partial contact?
Subluxation
Which one occurs when bony deformation prevent normal articulation?
Dysplasia
What is the etiology of dislocation?
- Trauma
- Impact - Often the result of a sudden twist or wrench of a joint beyond its normal range of motionW
What is the etiology of subluxation?
- Related trauma
- Degenerative diseases
What is the etiology of dysplasia?
Congenital
Where are the common joint disruptions?
- Shoulder
- Wrist
- Patella
- Elbow
What are the mechanisms of injury for anterior shoulder dislocation?
Excessive abduction & external rotation
Which joint is the most common dislocation?
Anterior, subcoracoid
What is the MOI of posterior shoulder dislocation?
- Flexion
- Adduction
- Internal rotation
of the humerus
What is the MOI of wrist dislocation?
- Perilunate (lunate & capitate)
- Lunate (Lunate & radius)
- Great force applied to extended wrist
- FOOSH
- MVA
What is the MOI of patella dislocation?
- External rotation of the tibia flexed
- ex. football players
What is the MOI of elbow dislocation?
- FOOSH
- MVA
What are the signs & symptoms?
- Acute trauma : pain, swelling, damage to nearby tissues, torn or irritated nerves, damaged ligaments, muscles & tendons
- Snapping or popping sound at time of injury
- Intense & sickening pain
- Deformity until the joint is reduced
- External supports
- Decreased ROM d/t spasm, edema and pain (acute / early subacute)
- Adhesions forming in (early subacute / late subacute)
- HT & TPs
- Loss of proprioception
- Instabilities
- Full rom remains restricted & tissue may be cool due to ischemia
What is ischemia?
Blood flow is restricted or reduced in a part of the body
What are the CI’s & Precautions?
- Acute traumatic dislocations are a local CI - compensatory focus
- Acute / Early subacute :
- No testing other than pain free AROM
- Do not completely remove protective spasm
- No distal circulatory techniques - Subacute / Chronic - limitations in ROM must be respected
- Do not place an unstable joint into the position of injury
- No joint play if the joint is unstable
- If a joint has been surgically repaired, do not restore full ROM in the direction that will stretch the repaired tissue
- No frictions with anti inflammatories
- No remedial exercises in acute
If a dislocation is casted, what should you not apply immediately proximal to the cast?
Heat applications
Before attempting to restore ROM in the direction of injury, ensure the majority of ______ is regained.
- Increase _____ then ______
- Strength
- Strength, stretch
What are assessment findings in acute dislocation?
- Antalgic gait and/or posture
- joint dependent - External supports may be place
- Possible pained facial expression
- Signs of inflammatory may be observed
- Protective spasm palpated in muscles crossing the joint
- AROM limited (PROM & RROM CI’d in acute) - direction of injury
- Likely impact on ADLs
What are assessment findings in subacute / post acute?
- Antalgic gait and/or posture + ADL impacts may persist
- External supports are still in place
- Pained facial expression
- Signs of inflammation decreasing
- Adh, HT & TPs palpated in mm crossing the joint
- AROM ilmited (PROM & RROM CI’d in subacute)
What are assessment findings in chronic?
- Habituated antalgic gait & posture
- External supports may still be in place
- AROM limited; if apprehension is shown in the range that caused injury PROM is CI’d
- PROM use extreme caution in the range that caused injury; empty end feels due to apprehension
- RROM reveal weakness
- Palpation findings are similar to late subacute and may show residual edema
What are goals?
Acute :
- Reduce edema and pain
- Prevent excess adhesion formation
- Maintain function & mobility
Subacute :
- Gradual return to movement within pain tolerance to avoid excess scar tissue formation
- Reduce risk of reinjury via proprioceptive training
Chronic :
- Increase local circulation
- Restore stability via strengthening of muscles that cross the joint
- Normalize mobility & muscle tone
- Reduce TPs & adh
What are homecare exercises in acute, subacute/post acute?
- RICE or PRICES (acute)
- POLICE (subacute / post acute)
- Breathing exercises for pain reduction (acute & subacute)
- Pain free at proximal & distal joints (acute)
