Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Intro to Ortho > Dislocations > Flashcards

Dislocations Flashcards

1
Q

what is Dislocations ?

A
  1. A dislocation is the complete dissociation of the articulating surfaces of a joint
  2. A subluxation is when the articulating surfaces of a joint remain in partial contact with each other

In a dislocation, a portion of the joint capsule and surrounding ligaments are either completely torn or partially ruptured

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Causes of Dislocations

A

A trauma related sudden twist or wrench of the joint beyond its normal ROM

This can be direct or indirect trauma

Contributing Factors

Pathologies such as RA, paralysis and neuromuscular diseases

Congenital ligamentous laxity or joint malformation

Previous dislocations of the joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Medical Treatment of Dislocations

A

Medical treatment involves tractioning the bones that comprise the joint to bring the articulating surfaces back into normal contact-this is called joint reduction

The earlier the joint is reduced after the injury, the easier the procedure will be

If protective muscle spasm has set in, an injection of a muscle relaxant or an anesthetic is used before the joint is reduced

The joint is supported for several weeks to allow the joint capsule and ligaments to heal

Limited pain-free movement and strengthening of the muscles that cross the joint are usually encouraged

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Dislocation of Glenohumeral Joint-Anterior dislocation

A

The most common form of this injury is an anterior dislocation

Also called a subcoracoid dislocation

Mechanism of injury is often excessive abduction and external rotation of the humerus (ex. Tackled from behind while throwing a ball)

Another mechanism of injury is extension of the humerus where the person falls backwards onto his outstretched hand (FOOSH)

The head of the humerus is forced through the inferior portion of the joint capsule where it lodges inferior to the coracoid process

There may be damage to the glenoid labrum (Bankart lesion)
The axillary nerve may be injured

Following reduction, the joint is usually stable if it is held in internal rotation

A sling is used to support the arm

Recurring anterior dislocations may be treated surgically to stabilize the joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Dislocation of Glenohumeral Joint-Posterior dislocation

A

Less frequent is a posterior dislocation of the glenohumeral joint

The mechanism of injury is usually flexion, adduction and internal rotation of the humerus (ex. A person falls forward onto his flexed elbow)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Dislocation of Patella

A

Usually dislocated laterally

Mechanism of injury involves external rotation of the tibia and foot when the knee is flexed

Following reduction, the knee is bandaged for several days

With repeated dislocations, the tibial insertion of the quadriceps may be surgically transposed to a more medial location

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Dislocation of Lunate

A

Dislocates in a palmar direction

Mechanism of injury is usually by a fall on the outstretched hand, forcing the wrist into hyperextension

The radius forces the lunate in a palmar direction, displacing the lunate anteriorly into the wrist between the flexor tendons and the capitate bone

Open reduction may be necessary

After reduction, the wrist is immobilized in 20 degrees of flexion for up to 4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Dislocation of Elbow

A

A dislocation of the elbow is usually accompanied by a fracture

The mechanism of injury occurs after a fall on the outstretched hand or in a MVA

The ulna and radius are displaced posteriorly

The elbow is usually immobilized for 3 weeks following reduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Dislocation of Hip

A

Uncommon

Mechanism of injury is following a car or motorcycle accident

If the person is seated, the femur is forced posteriorly by a direct impact to the knee

Following reduction, the limb is tractioned for up to 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Symptoms Acute

A

Complete rupture of the joint capsule and surrounding ligaments or an avulsion fracture of the capsular attachments

Snapping or popping noise is heard at the time of injury

Pain is intense and sickening at the time of injury

Joint usually appears deformed before reduction

Marked local edema and heat are evident

Joint is unstable

Bruising is black, blue and red

Decreased ROM at the joint as protective muscle spasm, edema and pain limit movement

Client cannot continue activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Symptoms
Early Subacute

A

Joint is unstable

Bruising is black and blue

Hematoma is still present but diminished

Pain, edema and inflammation are still present but reduced

Adhesions are developing around the injury

Because the joint capsule and its supporting ligaments are hypovascular, they heal relatively slowly

Protective muscle spasm diminishes

Muscles crossing the injured joint provide the only stability

The injured joint is taped, splinted or immobilized

ROM is reduced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Symptoms
Late Subacute

A

Bruising changes to yellow, green and brown

Pain, edema and inflammation are diminishing

Adhesions are maturing around the injury

Protective muscle spasm is replaced by an increased tone in the muscles crossing the joint

Muscles crossing the joint still provide the stability

Affected joint is supported or immobilized

ROM is reduced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Symptoms
Chronic

A

Pain is local to the joint capsule when the capsule is stressed

Bruising is gone

Adhesions have matured around the injury

HT and TPs are present in muscles crossing the joint and in compensating structures

Full ROM of the joint is restricted

A pocket of chronic edema may remain local to the ligament

Tissue may be cool due to ischemia

Joint may be unstable in the direction the injury occurred unless it is surgically repaired

Muscle weakness or disuse atrophy may be present in muscles crossing the affected joint

Loss of proprioception at the joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Health History Questions

A
  1. What is your overall health history?
  2. Do you have any contributing conditions that predispose you to ligament injuries?
  3. Has there been a history of recurrent dislocations?
  4. When did the injury occur?
  5. Do you know the mechanism of injury?
  6. Have you seen any other health care practitioner for this injury?
  7. Was the joint immobilized or surgically repaired?
  8. Are you using any supports?
  9. Are you taking any medication for the dislocation?
  10. What symptoms are you currently experiencing?
  11. What aggravates or relieves the pain?
  12. Is there any edema or bruising?

13.What activities are difficult to complete?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Observations-Acute

A

Antalgic gait if the dislocation is to a weight bearing joint

Antalgic posture may be present

The affected joint may be supported

The client may have a pained facial expression

Edema is observed at the affected joint and maybe distal

Some redness may be present

Red, black or purple bruising over the injury site

There may be a hematoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Observations-
Early & Late Subacute

A

Antalgic gait is still present with dislocations of a weight bearing joint

Antalgic posture will also still occur

Supports for the limb are still present

Edema diminishes from the early to late subacute stage

Bruising over the injury site changes to brown, yellow and green

Hematoma is diminishing if present

Joint capsule and ligaments that were surgically repaired have scars present

17
Q

Observations-
Chronic

A

Habituated antalgic gait may be observed with a dislocation of a weight bearing joint

Habituated antalgic posture may be present with an upper limb dislocation

Taping or other supports may be used during activities that stress the joint

There may be some residual chronic edema local to the injury

Scarring following surgery

18
Q

Palpation-Acute

A

Heat is present over the injured joint and possibly in the surrounding tissue

Tenderness is present local to the lesion site and refers into the nearby tissue

Texture of the edema is firm

Protective muscle spasm is present in muscles crossing the affected joint

19
Q

Palpation-Early & Late Subacute

A

Temperature over the injury site diminishes from the early subacute to the late subacute stage

Tenderness is present local to the injury

Texture of the edema is less firm and adhesions are present as healing progresses

Tone of the muscles crossing the joint changes from spasmodic to tightness and HT

20
Q

Palpation-Chronic

A

The injury site may be cool due to ischemia

Point tenderness occurs local to the lesion site

Adhesions local to the joint capsule and injured ligaments

HT and TPs are present local to the injured joint and in the compensating muscles

21
Q

Testing
Acute, Early & Late Subacute

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 the acute or subacute stage

22
Q

Testing
Chronic

A

The main goal in assessing a dislocated joint before treatment is to determine if the joint is stable or unstable

An AF apprehension test is used if the mechanism of injury is known. The client moves the limb active free towards the position that the joint was in when it dislocated. If the client is unable to perform this action due to apprehension, it is considered a positive for joint instability

If the active free apprehension test is positive, PR testing is not performed because the joint is unstable

Isometric AR testing of the muscles that cross the joint are performed. This will not harm the joint capsule or cause redislocation because the joint is not moving

If the mechanism of injury is unclear, AF ROM is performed on the cardinal planes of motion of the affected joint

If the active free apprehension test is negative, the therapist performs a PR apprehension test, slowly moving the limb towards the position in which the injury occurred. If the client stops the testing due to apprehension that the joint may re-dislocate, this is considered a positive for joint instability. The end feel is empty due to apprehension and the therapist moves to isometric AR testing of the muscles crossing the joint

23
Q

Testing Protocol for Dislocations

A
24
Q

Contraindications

A

In acute and subacute, testing other than pain-free AF ROM is CI’d to prevent further tissue damage

Avoid removing the protective muscle splinting of acute and early subacute dislocations

Distal circulation techniques are CI’d in the acute and early subacute stages to avoid increasing congestion through the injury site

If the joint is unstable, do not place the limb in the position that the injury occurred

Joint play is CI’d following dislocations where the capsule has not been surgically reduced and the joint is unstable

Frictions are CI’d if the client is taking anti-inflammatories or blood thinners

Avoid heavy hydrotherapy applications applied to the joint in the acute & subacute stages

With dislocations that are casted, avoid hot hydrotherapy applications to the tissue immediately proximal to the cast to prevent congestion

Remedial exercise in the acute stage of a dislocation is CI’d

Before attempting to restore range in the direction that the dislocation occurred, ensure that the majority of strength is regained in the muscles crossing the joint

Where the joint capsule and ligaments have been surgically repaired, full ROM of the affected joint should not be restored in the direction that will stretch the repaired capsule and ligaments

25
Q

Treatment
Acute

A

The joint is treated with RICE

Positioning of the client depends primarily on client comfort and on keeping the limb secure so no stress is placed on the injured joint
Hydrotherapy is cold applications

Reduce edema on the injured limb

Maintain local circulation proximal to the injury only

Do not remove protective muscle spasms in muscles that cross the affected joint by overtreating the proximal tissue

On site work is CI’d

Distal work is light stroking and muscle squeezing

Maintain ROM with mid-range PR ROM on the proximal joints that are not crossed by muscles that also cross the dislocated joint

26
Q

Treatment
Early Subacute

A

Positioning of the client depends primarily on client comfort and on keeping the limb secure so no stress is placed on the injured joint

Hydrotherapy applications on site are cold/warm contrast

Reduce edema and prevent adhesion formation proximal to the injury

Maintain local circulation proximal to the injury

Reduce but do not remove protective muscle spasm in muscles that cross the affected joint

Reduce TPs

On-site work is now indicated

Maintain ROM with pain-free mid range PR ROM on the proximal joints

Distal techniques are light stroking the muscle squeezing

27
Q

Treatment
Late Subacute

A

The limb is elevated without placing stress on the joint

Hydrotherapy applications local to the injury are cold/hot contrast

Reduce remaining edema

Reduce HT and TPs in the entire area

Prevent excess adhesion formation on site

After frictions are performed, only a partial stretch is placed on the muscles and than ice

Maintain ROM with joint play movements in the direction that the dislocation did not occur

Gradually increase ROM with pain-free active assisted ROM and pain-free mid-range PR ROM

28
Q

Treatment
Chronic

A

Positioning is for comfort and accessibility to the structures being treated

Hydrotherapy applications proximal to the injury is deep moist heat

Reduce any chronic edema that remains

Reduce HT and TPs to the entire area

Reduce adhesions, stretch and ice

Restore ROM with joint play techniques to the proximal and distal joints and PR ROM to the proximal, affected and distal joints

Increase local circulation

29
Q

Self-Care

A

Educate the client on the appropriate hydrotherapy for the stage of healing they are in

Self-massage for the muscles that cross the dislocated joint in the late subacute and chronic stages

Remedial exercise that is appropriate for the stage of healing

Maintain ROM in the acute stage with pain-free AF ROM of the proximal and distal joints

Increase strength in the early subacute stage with pain-free AF ROM of the proximal and distal joints

Increase strength in the late subacute stage with maximal, pain-free AR isometric exercises

Strengthen muscles in the chronic stage

Encourage activity

Intro to Ortho (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions