Joint dislocations

Question 1

What is an acromio-clavicular joint dislocation

Answer 1

also called ACJ injury- traumatic injury to clavicule/acromion area- often to ligaments (either acromioclavicular or coracoclavicular)

related to direct trauma to shoulder- often when falling onto shoulder

Question 2

Sx of acromio-clavicular joint dislocation

Answer 2

Pain on AC joint
lateral clavicule tenderness
abnormal countour of shouder

stability assess via- cross body adduction (AC ligament
vertical stability (CC ligaments)
brachial plexus injurtes

O brien test- EMPTY CAN TEST - arm extended out with hands down around 30 degree (like emopty a can)_-press down will cause pain if dislocated

Question 3

Ix and Management of acromio-clavicular joint dislocation

Answer 3

xrays- bilateral view of AC joints-
axillary can be useful for assox shoulder dislocation or other

management-
reduce and immobilise
can be non-operative if clavicule not too displaced
might need opern reduce if more worrying

Question 4

What is Elbow dislocation

Answer 4

Dislocation -separation between humerus and distal head of the ulna
2nd most common joint dislocation- POSTERIOR most common (80%)- most in <20y/o)
usually resulting from a fall on the elbow -foosh but with more twisting

can be simple - with no frax (60%)
or complex- wiith frax ( bad one is terrible triad- disloc + LUCL tear and radial head fracture/coronoid fracture)

Question 5

Sx of elbow dislocation

Answer 5

Pain and swelling
Not much proper exam- evaluate skin damage, comparnment syndrome
neurovasc
Status of wrist and shoulder- commonly with issues

Question 6

Ix and mx of elbow disloaction

Answer 6

Xray
rarely ct

Mx-
closed reduce,, splint at 90degree for 5-10d -depending on injury might be better pronated or suppinated
Open reduce + repairs if complex

Question 7

What are shoulder dislocation

Answer 7

dislocation of the head of the humerus from the acropmopn

most common is anterior (90%), which is a result of trauma/ fall onto the shoulder
and 10% are posterior- often assox with epilepsy

Question 8

sx of shoulder dislocation

Answer 8

Anterior
arm in external rotation and slight abduction,
pain of movement
visible shoulder abnormality/”fullness in shoulder”
Deltoid not working
Axillary nerve injury - regimental badge
PAINFUL
assess median nerve (OK signs) and ulnar (sensation over ring /small finger) and radial (thumb extend, sensation over back of hand)

posterior- very rare- epilepsy and electic shock. not as painfl
internal rotation and adduction
unable to external rotate

Question 9

Ix and mx of shoulder dislocations

Answer 9

Xrays - want a AP view and an axillary view-gives the diagnosis immediatly

Mx
assess by ortho if under 25
usually closed reduce in AE and then sling
carefull can become reccurent. but imrpoves as age

Question 10

What is patellar dislocation

Answer 10

dislocation of patella OUT of trochlear groove of femoral chondyles
most occurs as disrution of medial palatofemoral ligament

often in athletes, esp female around 20
often related to non-contact injury - twisting with internal rotation/valgus stress)
or direct trauma (rarer)

Question 11

sx of patellar dislocation

Answer 11

hemarthrosis of knee, caused by rupture of medial restrains. medial swelling
often reduce on own when knee is extended

pain, knee unstable, locking of knee

patelllar apprehension TEST- extend the leg, apply lateral pressure on the patella whilst slowly flexing the knee- patient will resist if dislocated
Patellar Alta -patella too high

Question 12

ix and mx of patellar dislocation

Answer 12

Xrays are usually, lateral view !

mx-
most often closed reduce- 
will often relocated spontaneously on extension
but can be done under local
then immobilise for 6w

surgical-rare, if reccurent or with big injuries around