Joint dislocation: Introduction, definition, causes, sign and symptoms, diagnosis and management

1. PRESENTED BY:
MRS. HARMEET KAUR
NURSING TUTOR
UCON, FARIDKOT
JOINT DISLOCATION

2. introduction
A joint dislocation is an injury to a joint, a
place where two or more bones come together, in
which the ends of the bones are forced from their
normal positions. This painful injury temporarily
deforms and immobilizes the joint.
Dislocation is most common in shoulders
and fingers. Other sites include elbows, knees
and hips.

3. definition
It is complete or persistent displacement of a joint in which
at least part of the supporting joint capsule and some of its
ligaments are disrupted.
An injury where a joint is forced out of normal position.
Joints can be dislocated from injury. This usually happen from a
fall, motor vehicle accident or participation in sports.

4. dislocated joints

5. causes

6. causes of dislocation
 May occur in any situation, whether it being the
sporting arena or routine daily chores.
 Trauma, falls or motor vehicle accidents
 Underlying pathological condition such as TB,
inflammatory disorders.
 Adults are more prone to dislocation than children.
 Previous joint dislocation result in weakening of
tendons, ligament and muscle which may be a cause of
recurrent dislocations.

7. Cont...
 Most commonly dislocation occurs in following joints:
 Shoulder, hip, elbow, metacarpophalengal joint
 Facet joint dilocation in cervical spine.
 Acromiclavicular joint.

8. Types of dislocations
1) Congenital
2) Acquired:
o Traumatic
o Pathological e.g. TB Hip, Septic arthiritis.
o Paralytic e.g. Poliomyelitis, cerebral palsy.
o Inflammatory disorders: rheumatoid arthritis.

9. Sign and symptoms
SIGN
Swelling
Tenderness
Warmth, bruising or redness.
Deformities that may be sign of dislocation:
oShoulder abduction deformity
o Elbow flexion deformity

10. Sign
oHip anterior- flexion, abduction and internal
rotation deformity
oHip posterior- flexion, adduction and internal
rotation deformity
oKnee flexion deformity
oAnkle varus deformity

11. Cont...
SYMPTOMS
Severe pain
Joint locked in one position.
Difficulty using or moving the joint
Loss of sensation
Weakness

12. Diagnostic evaluations
 Signs and symptoms
would assist with
early diagnosis and
assist immediate first
aid.

13. Cont...
 X-ray: radiograph of the
affected part should
include anterior posterior
and lateral views and
sometimes special view
may be needed. It is used
to produce image of
internal tissues, bones and
organs onto film.
 CT scan

14. Cont...
 Magnetic Resonance imaging (MRI): a
diagnostic procedure that uses a combination of
large magnets, radiofrequencies and a computer
to produce more detailed and precise image of
structures within the body than X-ray.

15. complications
1) Acute injury to peripheral nerve and vessels
2) Chronic:
o Unreduced dislocation
o Recurrent dislocation
o Traumatic osteoarthritis
o Joint stiffness
o Avascular necrosis
o Myositis ossificans

16. FIRST AID
REDUCTION:
Closed reduction
Open reduction
NURSING MANAGEMENT
management

17. Principles of management
Acute dislocation should be reduced as soon as possible.
Open reduction is rarely necessary for acute dislocation.
Close reduction with intravenous analgesia and sedation
or under GA (general anaesthesia) should be attempted
first for most uncomplicated dislocation.

18. Initial first aid management
STOP
S: (Stop) Immediately immobilize the patients
dislocated joint as there may be strong positivity of
fracture.
T: (Talk), ask the questions if the patient is conscious
O: Observe closely for any injury, swelling, deformity
or bleeding.
P: Prevent further injury to the patient by conducting a
whole body assessment.

19. rice
R: (Rest) sit or lie the patient down in comfortable
position.
I: (Ice) use cold packs to cool compress the affected
area
C: (Compression) wrap the compression bandage
around the limb to support it and restrict movement.
E: (Elevate) the injured limb should be supported
above the level of the heart.

20. Cont....
Refer the patient to the hospital if required.
Ascertain if the patient is conscious by verbal and
physical needs
If patient is unconscious then follow:
C: (Compression) initiate CPR
A: (Airway) ensure airway is clear by jaw thrust, chin
lift head tilt manuvear
B: (Breathing) listen and feel the signs of life.
D: (Defibrillator) perform defibrillation if CPR fails

21. reduction
TYPE OF REDUCTION
Closed reduction
Open reduction

22. Closed reduction

23. Closed reduction techniques
FOR SHOULDER DISLOCATION:
a) Patient is kept in prone position on bed.
b) The affected shoulder is supported and the arm is left to hang over the edge
of bed.
c) A weight is attached to the elbow or wrist. It is usual to begin with 2 kg upto
10 kg.
d) Gravity stretches the muscles and reduction occurs.
e) This method takes 15 to20 minutes.
STIMSON’S GRAVITY
TECHNIQUE

24. Stimson’s gravity technique
FOR HIP DISLOCATION:
a. Patient is in prone position with
lower limbs hanging from the end
of the table.
b. Assistant immobilizes the pelvis by
applying pressure on the sacrum.
c. Hold knee and ankle flexed to 90
degree and apply downward
pressure to leg just distal to the
knees.
d. Gentle rotatory motion of the limb
may assist in reduction.

25. Kocher’s technique
FOR SHOULDER DISLOCATION

26. Open reduction

27. After care
To promote healing after closed or open reduction doctor
may recommend:
 Splint/Cast: immobilizes the dislocated area to promote
alignment.
 Medications for pain control: Ibuprofen, Naproxen,
Acetaminophen.
 Traction: the application of a force to stretch certain part of
body in certain direction. It consists of pulley, strings,
weights, metal frame attached over or on the bed.

28. Nursing diagnosis
1) Acute pain related to soft tissue injury or surgical
incision.
2) Impaired physical mobility related to pain, restricted
movement or unfamiliarity with the use of
immobilization devices.
3) Impaired skin integrity related to open wound or
surgical repair/incision.
4) Self care deficit related to physical limitations present
with cast or immobilizers.
5) Constipation related to immobility or administration of
opioid analgesics.

29. Cont...
6. Risk for Peripheral Neurovascular Dysfunction related to
interruption of blood flow/tissue trauma.
7. Risk for Impaired Gas Exchange related to disturbed
blood flow; blood/fat emboli.
8. Risk for Infection related to Inadequate primary
defenses: broken skin, traumatized tissues or Invasive
procedure.
9. Deficient knowledge related to unfamiliarity to
information resources.

30. Acute pain
 Assess and record the patient’s level of pain utilizing pain
intensity rating scale.
 Maintain immobilization of affected part by means of bed rest,
cast, splint, traction.
 Elevate and support injured extremity.
 Avoid use of plastic sheets and pillows under limbs in cast.
 Medicate before care activities. Let the patient know it is
important to request medication before pain becomes severe.
 Perform and supervise active and passive ROM exercises.

31. Cont...
 Provide alternative comfort measures (massage, backrub,
position changes).
 Provide emotional support and encourage the use of stress
management techniques (progressive relaxation, deep-breathing
exercises, visualization or guided imagery); provide Therapeutic
Touch.
 Identify diversional activities appropriate for patient age, physical
abilities, and personal preferences.
 Apply cold or ice pack first 24–72 hr and as necessary.
 Administer medications as indicated by physician.

32. Impaired physical mobility
 Assess the degree of immobility produced by injury or treatment
and note patient’s perception of immobility.
 Encourage participation in diversional or recreational activities.
Maintain a stimulating environment (radio, TV, newspapers,
visits from family and friends).
 Teach patient or assist with active and passive ROM exercises of
affected and unaffected extremities.
 Place in supine position periodically if possible, when traction is
used to stabilize lower limb fractures.

33. Cont....
 Assist with self-care activities (bathing, shaving).
 Provide and assist with the use of mobility aids such as
wheelchair, walker.
 Reposition periodically and encourage coughing and deep-
breathing exercises.
 Provide a diet high in proteins, carbohydrates, vitamins, and
minerals.

34. Cont...
 Increase the amount of roughage or fiber in the diet.
Limit gas-forming foods.
 Initiate bowel program (stool softeners, enemas,
laxatives) as indicated.
 Consult with a physical, occupational therapist or
rehabilitation specialist.

35. Impaired skin integrity
 Examine the skin for open wounds, foreign bodies, rashes,
bleeding, discoloration, duskiness, blanching.
 Assess the position of splint ring of traction device.
 Massage skin and bony prominences. Keep the bed linens dry and
free of wrinkles. Place water pads, other padding under elbows or
heels as indicated.
 Reposition frequently. Encourage use of trapeze if possible.

36. Cont....
 Cleanse skin with soap and water.
 Rub gently with alcohol as it is useful for padding bony
prominences, finishing cast edges, and protecting the
skin.
 Apply tincture of benzoin as it toughens the skin for the
application of skin traction.