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Chapter 9 Joints > Details of Dislocations from rattray > Flashcards

Details of Dislocations from rattray Flashcards

1
Q

What is the definition of a Dislocation?

A

It is the complete dislocation of the articulating surfaces of a joint.

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2
Q

What is a Subluxation?

A

This is when the articulating surfaces of a joint remain in partial contact with each other.

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3
Q

What are the most frequently dislocated joints in the body?

A

The most dislocated joint in the body is the glenohumeral joint.
But other joints that are prone to dislocations are the (A/C, Metacarpals and Interphalangeals).

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4
Q

Why is the Glenohumeral joint the most frequently dislocated in the body?

A

This is because only a small portion of the Humerus’s head comes in contact with the Shallow glenoid fossa of the Scapula.

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5
Q

What are some of the most secure Joints in the body?

A

This is going to include (Hip, knee, elbow and ankle joints)

They will likely also have associated fractures when being dislocated.

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6
Q

What occurs in and around the joint capsule when you have a dislocation?

A

A portion of the joint capsule and surrounding ligaments are completely torn or partially ruptured.
The nearby tendons, synovial sheaths and articular cartilage may also be damaged.
Complications may occur (Nerve and vascular damage and fracture)

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7
Q

What are other soft tissue injuries that can occur with a dislocation?

A

Strains & Contusions may also occur with a Dislocation.

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8
Q

What occurs in the joint during a Subluxation?

A

The joint capsule is stretched, Some Subluxations result with joint Sprains.

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9
Q

What is the Cause of a Dislocation?

A

It is Trauma-related, A sudden twist or wrench of the joint beyond its normal ROM.
It can be direct or indirect trauma.

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10
Q

What is the difference between direct and indirect trauma?

A

Direct trauma: Is a direct force on the joint itself, such as a blow to the posterior shoulder when the arm is Abd which produces an anterior glenohumeral dislocation.

Indirect trauma: The joint becomes the weak link in a closed kinetic chain for ex: Falling on the extended and outstretched hand results in an anterior Glenohumeral dislocation.

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11
Q

What are contributing factors to a dislocation of a joint?

A

Pathologies, Congenital ligamentous laxity, Previous dislocations.

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12
Q

What are examples of Pathologies that can contribute to a Dislocation?

A

This can include things such as:

RA), Paralysis & neuromuscular disease

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13
Q

What are examples of Congenital Ligamentous laxity that contribute to a Dislocation?

A

This is referring to things such as Joint malformation.

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14
Q

What is the most common injury in the Glenohumeral Joint?

A

In terms of this joint the most common injury is an Anterior Dislocation.

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15
Q

What are common causes for an Anterior Dislocation?

A

Often excessive abd & external rot of the humerus.
Another mechanism in this type of dislocation is excessive Extension of the Humerus.

Both of these examples force the head of the humerus through the inferior portion of the joint capsule.

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16
Q

Where does the head of the humerus get pushed in an Anterior Dislocation / Subcoracoid dislocation?

A

The head of the humerus get forced though the inferior portion of the joint capsule.

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17
Q

What are all the specific types of dislocations of the Glenohumeral Joint?

A

Anterior / Subcoracoid dislocations, Posterior dislocations.

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18
Q

Where does the head of the Humerus get pushed during a Posterior Dislocation?

A

The head of the humerus is pushed out of the Gleniod cavity posteriorly.

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19
Q

What portions of the joint may be damaged during a Anterior Dislocation of the Glenohumeral joint other than the Joint Capsule?

A

When the Head of the humerus gets forced into the inferior portion of the Coracoid process (A portion of the Glenoid Labrum may be damaged & The Axillary nerve may also be injured).

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20
Q

What is a common cause for a Posterior Dislocation of the Glenohumeral Joint?

A

A common reason for a Posterior dislocation is When a person falls forward onto their flexed arm.
A common position for the Arm to be when a Posterior dislocation occurs is Flx, Add, & internal rot.

21
Q

What is the more common dislocation of the Glenohumeral Joint?

A

Anterior dislocations and Posterior dislocations are less frequent.

22
Q

What is the common position/Direction for the Patella to dislocate?

A

The Patella mostly dislocates Laterally.

23
Q

What is the mechanism of injury for the patellar Dislocation?

A

A common position for the patella to dislocate from is (External rot of the Tibia & the foot when the Knee is flexed).

24
Q

What is a Dislocation of the Lunate?

A

When a person falls on their outstretched hands and forces the wrist into hyper-extension.
The radius pushes the Lunate bone in a palmer direction.

25
Q

What is a Dislocation of the Elbow?

A

It is usually accompanied by a Fracture.
It occurs after a fall on the outstretched hand or in a motor vehicle accident.

The Ulna & the Radius are displaced posteriorly.

26
Q

What is a Hip dislocation?

A

If the person is seated:
The Femur is forced posteriorly by the direct impact to the knee.

Complications of the Dislocation includes:
Fracture of the Rim of the Acetabulum and compression of the Sciatic nerve.

27
Q

What are other structures near the Elbow that may be damaged when an Elbow dislocation occurs?

A

The Brachial Artery, the Median nerve or the ulnar nerve may be involved.

28
Q

What can you observe in a client with an Acute Dislocation?

A

Antalgic gait, occurs only in the weight bearing joints.
The affected Joint may be Supported by tape or a splint or a cast.
The client may have a pained or a Medicated expression.
Some redness may be present local to the Injury.

29
Q

What can you Palpate in a client during an Acute Dislocation?

A

Heat is present over the affected area and surrounding tissue.
tenderness is present local to the affected area and refers to the nearby tissue.
The texture of the Edema is firm.
Protective muscle Spasms are present near / crossing over the affected joint.

30
Q

What can you palpate in a client during a Early - late subacute Dislocation?

A

The temp over the injury site is diminished.
Tenderness is present local to injury.
The texture of the edema is less firm than Acute stage of healing.
The tone of the nearby muscle changes from Spastic to Hypertonic and Tight.
TP’s are present in the Muscles.

31
Q

What can you palpate in a client during a Chronic Dislocation?

A

The injury site may be cool due to Ischemia.
Point tenderness occurs local to the lesion site.
There are adhesions local to the joint capsule and injured ligaments.
Hypertonic muscles and TP’s present local to affected joint and in the compensating muscles.
Disuse atrophy may be present.

32
Q

What is testing of a client with a Dislocation that is in the Acute, Early and late Sub-acute stage?

A

AF ROM of the proximal and distal joints may be slowly and carefully performed in a pain-free manner.

Other testing is CI’d in these stages.

33
Q

What is testing of a client in the Chronic stage of a Dislocation like?

A

This is different than other testing.
The main goal in assessing a dislocated joint before treatment is to determine if the joint is stable or not.

Check rattray page 347 for all testing protocols.

34
Q

What are some special test you can perform on a client with a dislocation in the Acute stage?

A

Only pain free AF ROM

35
Q

What are CI’s of the Acute and sub-acute stage?

A

Testing other than pain free AF rom.
Avoid removing the Supporting splints or tape in these stages.
Distal Circulation.
Joint play.
Frictions if the client is taking anti-inflammatory.
Remedial exorcises.

36
Q

What is a Ligamentous stress test used for?

A

It determine if any specific portion/LIgament of a joint is injured.
The pressure used is enough without damaging the joint capsule.
The end feel is Hyper-mobile.
A dislocation may or may not be painful local to the joint capsule.

37
Q

Why can some ligamentous stress test of a dislocation result in no pain sometimes?

A

This is because If there is a complete Rupture of the connective tissue the client cannot register pain of the tissue stretch.
If some fibres are intact then the client will feel pain.

38
Q

What would a General treatment plan of a Acute Dislocation include?

A

If the gaol is to decrease Edema, Then Lymphatic drainage of the affected limb is used.

The trunk and unaffected limb are treated with light GSM and the Focus of the work is used on the compensating muscles like if the client is using crutches.

39
Q

What would a general Treatment plan of a Sub-acute Dislocation include?

A

Similar to Acute treatment, but added to the plan is encouraged Diaphragmatic breathing.

40
Q

What would a General treatment of a Chronic dislocation include?

A

The only thing added in this that is different for treating is the implementation of Rhythmic Techniques to the unaffected limb and trunk as long as the affected joint is not taken to a position of Dislocation.

41
Q

What stages of a Dislocation are testing other than pain free AF ROM is CI’D to prevent further tissue damage?

A

This is indicated in the Acute and Sub-acute stages of the condition.

42
Q

When should you avoid removing any supporting structures of a Dislocation on a client?

A

This is indicated for the Acute & Early Sub-acute Stages.

43
Q

When can you not use distal circulatory techniques on a client with a Dislocation?

A

This is indicated to avoid in the Acute & Early Sub-acute so the affected area does not get to congested as it is already swollen.

44
Q

If the joint is unstable what is CI’D?

A

You cannot place the limb in a position that the injury occurred in.
This is also avoided when using PR ROM & Rhythmic work on a client.

45
Q

When is Frictions CI’D in treatment?

A

Only when the client is taking anti-inflammatories.

46
Q

When should Heavy hydrotherapy be avoided?

A

In the Acute & Sub-acute Stages.

47
Q

What do you need to avoid when treating a client with a support of a cast for the dislocation?

A

Avoid hot hydrotherapy to not have congestion under the cast.

48
Q

When can you not give a client Remedial Exorcises that have a Dislocation?

A

This is CI’D in the Acute stage.

49
Q

When is it allowed to start to regain the ROM in the direction the Dislocation occurred in?

A

This is only after most of the strength in muscle crossing the joint has come back.

Chapter 9 Joints (20 decks)

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