Sideline Management Of Dislocations Flashcards
Should you attempt to relocate dislocation on field?
PT’s can’t, but it can be tried on the field if fracture is not suspected. It’s easier to do on the field before muscle spasms set in. Some opponents say you won’t be able to tell if it’s fractured and can make it worse.
What to do before and after relocation?
Check neuro vascular status before and after. Make sure to follow up with radiographs to confirm reduction and no fracture. Area should be immobilized after reduction.
How to reduce anterior shoulder dislocation?
In supine, elevate the arm fully. Apply traction upwards/outwards while using other hand to push humeral head over the glenoid rim.
Most common complications after shoulder dislocation?
- Injury to axillary nerve . Usually a traction neuropathy and should resolve over time (innervation Teres Minor/deltoid and shoulder joint/skin over deltoid)
- Bankart lesion (tear of anterior labrum
- Bony Bankart lesion (fracture on anterior glenoid)
- Hill-Sachs Lesion (Indentation of posterior humeral head when it dislocates)
- RTC tear
Most common direction the elbow is dislocated?
Usually posterior or posterolateral. Anterior dislocations much less common an occur from blow to posterior elbow. Pure medial or lateral dislocations are rare.
How to reduce posterior elbow dislocation?
Stabilize distal humerus and apply longitudinal traction to proximal forearm with gentle anterior force until pronounced “cluck” is heard. Flexion of elbow should be avoided until reduction to avoid damaging brachial artery. Following reduction the stability through range is verified but be careful with increasing extension (can cause redislocation)
Aftercare for elbow dislocation?
Place in splint or cast in 90 flex for 5-10 days after. Need radiographs. Don’t immobilize more than 3 weeks, will result in poor ROM. Can do early ROM right away in rehab (stable reductions). If unstable, use an extension block that is gradually decreased over 3 weeks. When getting back to sports may want a brace that limits hyperextension.
Complications after elbow dislocation?
Long-term loss of extension most common. Recurrent instability in simple dislocations is rare. Can fracture coronoid, olecranon, or radial head. May have medial epicondyle fracture. 20% have compromise of brachial artery, ulnar, median, radial, or anterior interosseous nerves.
Knee dislocation
Usually both cruciates and one collateral ligament need to be torn. Significant concern for popliteal vessels. Need doppler or angiography after this. Most common is anterior dislocation. Can have medial or lateral dislocations with varus/valgus forces. PCL and PLC can be injured with posteriorly/lateral directed force (peroneal nerve most common nerve injured with this).
How to relocate knee?
Gentle axial traction for anterior dislocation. Flexion and anterior pull for posterior dislocation.
Complications with knee dislocation?
Popliteal artery disruption in 20-40% (highest with posterior). Peroneal nerve injury (poor prognosis). Gross fracture or osteochondral injuries.
Presentation with patellar dislocation?
Popping sensation in the knee, followed by giving out. TTP over medial retinaculum.
How to relocate patella?
Spontaneous reduction occurs when knee is brought back into extension. Otherwise, can extend then and push patella medially.
Aftercare for patellar dislocation?
Knee immobilized locked in extension. Advisable to use a pad laterally. Early AROM exercises. Usually return to sports in 6-8 weeks wearing sleeve with lateral buttress.
Complications with patellar dislocation?
Osteochondral fractures occur up to 30% of time. Loose bodies require removal. Recurrent dislocations require surgery. May have other ligaments fractured.
