Common Joint Dislocations and Their Acute Management 1. Shoulder Dislocation: Clinical Presentation: • • Anterior Dislocation: Most common type, typically due to forced abduction and external rotation. Presents with the arm held in abduction and external rotation, with prominent anterior shoulder deformity ("square shoulder"). Posterior Dislocation: Less common, often due to forced adduction and internal rotation. May present with a flattened appearance of the shoulder and restricted external rotation. Acute Management: • • • • Reduction: Manual reduction performed in the emergency department under sedation or anesthesia. Techniques include the Kocher method (gentle traction and external rotation) for anterior dislocations and the modified Cunningham method (traction in adduction and internal rotation) for posterior dislocations. Immobilization: After reduction, immobilize the shoulder in a sling or shoulder immobilizer for comfort and support. Post-reduction Imaging: Confirm reduction with X-rays to assess for associated fractures or joint stability. Early Rehabilitation: Initiate early range of motion exercises and strengthening under guidance to prevent stiffness and recurrent dislocation. 2. Elbow Dislocation: Clinical Presentation: • • Posterior Elbow Dislocation: Most common type, often due to a fall onto an outstretched hand with the elbow extended. Presents with severe pain, swelling, and a prominent posterior olecranon process. Anterior Elbow Dislocation: Less common, typically due to hyperextension injuries. Presents with a prominent anterior bulge and limited elbow flexion. Acute Management: • Reduction: Urgent reduction required to restore joint alignment and prevent neurovascular compromise. Techniques include traction-countertraction maneuvers or direct pressure on the olecranon for posterior dislocations. • • • Immobilization: After reduction, immobilize the elbow in a splint or posterior splint with the elbow flexed at 90 degrees. Post-reduction Imaging: Obtain X-rays to assess for associated fractures or joint stability. Early Mobilization: Begin gentle range of motion exercises and progressive strengthening under supervision to regain elbow function and prevent stiffness. 3. Finger Dislocations (Metacarpophalangeal and Interphalangeal Joints): Clinical Presentation: • • Metacarpophalangeal (MCP) Dislocation: Commonly due to axial loading or hyperextension injuries. Presents with pain, swelling, and visible deformity at the joint. Interphalangeal (IP) Dislocation: Often caused by hyperextension or direct trauma. Presents with pain, deformity, and loss of normal joint alignment. Acute Management: • • • • Reduction: Manual reduction performed by applying traction and gentle pressure to realign the joint. In complex or irreducible dislocations, surgical intervention may be necessary. Immobilization: After reduction, immobilize the finger in a splint or buddy taping to an adjacent finger for support. Post-reduction Imaging: X-rays to confirm reduction and assess for associated fractures or joint stability. Hand Therapy: Early mobilization and range of motion exercises under supervision to prevent stiffness and promote healing. 4. Hip Dislocation: Clinical Presentation: • • Posterior Hip Dislocation: Most common type, typically due to high-energy trauma or motor vehicle accidents. Presents with severe pain, inability to move the hip, and leg held in adduction and internal rotation. Anterior Hip Dislocation: Less common, often due to forced abduction and external rotation. Presents with hip held in abduction and external rotation. Acute Management: • • • • Emergency Reduction: Immediate reduction under sedation or anesthesia in the emergency department. Techniques include gentle traction and manipulation to relocate the femoral head into the acetabulum. Immobilization: After reduction, immobilize the hip joint in a hip spica cast or brace to prevent recurrent dislocation. Post-reduction Imaging: Obtain X-rays to confirm reduction and assess for associated fractures or joint stability. Rehabilitation: Early mobilization and weight-bearing as tolerated, guided by physical therapy to regain hip strength and function.