Joint Dislocation: Recognition, Emergency Reduction & Rehabilitation

A dislocation (luxation) is complete loss of articular contact. Subluxation = partial. Requires urgent reduction to minimize neurovascular damage and articular cartilage injury.

Common Sites

• Shoulder (anterior 95%) — most frequent.
• Elbow (posterior) — 2nd most common adult.
• Finger (PIP, MCP), Patella (lateral), Hip (posterior — high energy).

Signs

• Deformity, palpable defect, "locked" position.
• Severe pain, guarding, refusal to move.
• Neurovascular deficit (check pulses, sensation, motor distal).

Management

1. Immobilize in position found; splint.
2. Neurovascular exam pre/post reduction.
3. Imaging: X-ray (AP/lateral) pre-reduction if delay feasible; post-reduction mandatory.
4. Reduction: Procedural sedation + technique (Stimson, Hippocratic, traction-countertraction).
5. Post-Reduction: Sling/brace 1–3 wks. Early protected ROM.
6. PT: Rotator cuff/scapular stabilizers (shoulder); quadriceps/VMO (patella).

Complications

Recurrence (high in young), Hill-Sachs/Bankart lesions, osteonecrosis (hip), nerve injury (axillary, ulnar, peroneal).