Joint dislocations Flashcards
What causes shoulder dislocation?
when humerus pops out of shoulder socket
usually caused by falls or contact sports
History for shoulder dislocation?
AMPLE history
- A – allergies
- M – medications
- P – past medical history
- L – last meal
- E – events leading up to the surgery
Examination for shoulder dislocation?
- LOOK: Compare one side to another - characteristic position of external rotation & slight abduction.
- FEEL: tenderness, swelling.
- MOVE: inability to move joint, severe pain.
How to assess nerve function for shoulder dislocation?
Need to assess Median, Radial, Ulnar & Axillary nerves
Median nerve:
- assess for motor & sensory function
- Supplies skin to palm of hand to thumb, index, middle & half of ring finger
- Motor function = abductorpollicisbrevis(muscle seen under/below thumb)
- Palm to ceiling, thumb to ceiling, feel muscle resisting your resistance when you push down
Radial nerve:
- extensors of arm
- Motor supply tested by having index finger extended and pushing against it
- Sensation is in first web space between thumb and index finger
Axillary nerve:
- loops around shoulder – supplied deltoid & regimental badge area
Ulnar nerve:
- 5th& half of ring finger
- Little finger abduction test (spread fingers out and push together)
- Test for capillary refill on finger (vascular status) - pressure over tip of finger and see how long it takes for fingertip to return to its colour
Management for shoulder dislocation?
- Provide analgesia.
- Reduce dislocation - Kocher’s technique (externally rotate humoral head outwards).
- Reassess neurovascular status.
- Put in sling
- Physiotherapy
- Fix surgically if needed
Complications of shoulder dislocations?
Nerve supply runs close to humoral head so need to ensure blood supply is not cut off.
What causes elbow dislocation? In children?
most common cause is falling & landing on your outstretched hand or arm
Most common site in children= elbow= caused by pulling= partial dislocation= called pulled elbow
Most common elbow dislocations are anterior
Posterior elbow dislocation= a result of mass muscle contraction usually e.g. during seizures or electric shock
Management for elbow dislocation?
Provide analgesia
Treatment by reduction
- Kocher’s technique- externally rotate humeral head outwards in front & back
- Reassess nerovascular status- nerve could get trapped during reaction process- requires surgical intervention
Common hip dislocations?
Commonly at neck of femoral head- femur separates from pelvis
Posterior hip dislocations- hip flexion, internal rotation, adduction
Anterior hip dislocation- external ration, mild flexion, abduction
other symptoms:
- severe pain
- inability to move joint
- tenderness
- swelling
Complications of hip dislocations?
Intracapsular disruption restricts blood supply to femoral head
Femoral head can put pressure on sciatic nerve
What does a kneecap (patella) dislocation look like? Symptoms?
Patella is dislocated upwards &moves over the knee joint
lots of swelling + may not be able to move knee properly or walk
no risk to major nerves or blood vessels
NOTE- look at x-ray!
Treatment for patella dislocation?
-commonly pops back into place before you even see a health professional
-reduced by slowly straightening the leg
-physiotherapy to strengthen the quadriceps muscles
What causes knee joint dislocation? What are the treatments?
most likely caused by road vehicle accident
Treatment:
-needs to be reduced urgently but not before an examination to check blood vessels aren’t damaged and an X-ray to check for fractures
-damage to main blood vessel (popliteal artery) that goes down the back of the knee is common and may require urgent surgery
