Dislocated Joints

by Dr Y.L.M

My mother fell down the other day and dislocated her hip. I’m not sure what dislocation means as opposed to fracture. Are they different?

Yes. A fracture is when your bone breaks. Dislocation is what happens when the ends of your bones at a joint are forced from their normal positions. There is no break.

Fractures and dislocations often occur together.

Dislocations may occur in your big joints, such as your hip, shoulder, knee, and elbow, or your smaller joints, such as that of your fingers, thumbs, and toes.

How will I know if I have a shoulder dislocation as opposed to a fracture?

Sometimes it can be difficult to ascertain. The shoulder is the most common joint to dislocate.

The shoulder joint is made out of the shoulder blade socket and the ball at your upper arm bone (humerus). There’s a cartilage rim that lines the socket that makes it deeper. The joint is supported at all sides by ligaments in a joint capsule, and the whole thing is covered by the muscle tendons of the rotator cuff.

The weakest point of the rotator cuff is in the lower front portion of the joint, which is very often the point of dislocation.

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Shoulders may dislocate if you wrench it upward and backward, thereby pulling the ball head of the humerus out of its socket.

This happens when you collide with another person (for example, when you are playing sports) or fall. The joint capsule, cartilage, and ligaments are usually torn when this happens.

There is a lot of pain when this occurs. But fractures also present with a lot of pain. If your joint is hanging at an odd angle, chances are it is dislocated.

I have heard of partial dislocations. What is that?

Partial dislocations are known as subluxations. This happens when the two joint surfaces have lost their usual contact.

Subluxations can be measured in percentages. Such as – 50% subluxation, which means the joint has lost 50% contact with its counterpart.

A full 100% loss of contact is a full dislocation.

What about hip dislocation?

The hip, like the shoulder joint, is also a ball and socket joint. The head of your thigh bone (femur) is shaped like a ball.

It fits nicely into the deep socket of the pelvis.

It actually takes a very great force to make your femur head pop out of its socket, such as a car accident or fall from a height. Hip dislocations usually come with fractures of the thigh and leg bones and pelvic bones.

In 90% of hip dislocation cases, the femur is pushed backwards from its socket rather than forwards, like the shoulder. This leaves your leg twisted towards the middle of your body.

Once you get a hip dislocation, you will be unable to move your leg. It is extremely painful, and if your nerves are involved, you can lose sensation in the affected leg.

Is a knee easily dislocated?

No, they are rare. When the bones of your lower leg – called the tibia and fibula – get dislocated from where they about against your femur, that is when a knee dislocation happens. It is also most often caused by car accidents and falls.

What is more common is kneecap dislocation, or patellar subluxation. This happens when your kneecap, the triangle-shaped bone covering your knee (called the patella) moves out of place, usually towards the outside of your leg.

Kneecap dislocation usually occurs in women when you make a sudden change in your direction while running.

What about fingers and toes?

Finger dislocation is quite common. It occurs most commonly in the middle knuckle of the little, ring, middle, or index fingers. This usually happens when a 'jamming' force is applied to the end of the finger, or when the finger is overextended, e.g. when you are playing basketball and the ball strikes the tip of your outstretched finger, or when you fall onto your outstretched hand.

A toe dislocation can leave your toe feeling numb, painful, and cold. This is usually caused by a direct blow on your toe, such as dropping a heavy object on the toe, or sports involving running or hiking with thin-toed shoes, or playing football barefoot.

What should I do about dislocations?

They are a medical emergency! Go to the hospital at once to have them treated. You should not attempt to treat them on your own. The initial treatment for a dislocation is R.I.C.E – Rest, Ice, Compression, Elevation of the involved joint.

Then pain control can be given, and splints can be applied once the joint is manoeuvred (usually under anaesthesia) back to its place.

More info on DISLOCATED JOINTS here.

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