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Dislocations

Dislocations

Complete dislocations of the articulating surfaces of a joint
Subluxation is when the articulating surfaces of a joint remain in partial contact with each other

 Cause
Trauma related sudden twist or wrench of the Jt beyond its normal ROM

Risk factors
Pathologies such as RA, paralysis, NM dz
Congenital ligament laxity, Jt malformation
Previous dislocation
MC location of dislocation

Ant. GH jt
Lunate dislocation by fall on the outstretched hand, forcing the hyper extension
Elbow dislocation is usually accompanied by Fx

Palpation

Acute: Heat, tender to touch, firm edema, protective mxl spasm
Subacute: Heat diminishes, tenderness still present, Adhesion starts to form
High mxl tone, TrP are present 
Chronic: cool to touch d/t ischemia
Tenderness to the lesion site
Adhesions to jt. capsule and injured lig.
High tone mxl and TrP
Disuse atrophy may be present d/t casting or taping

Testing

Acute: AROM, other testing are contraindicated
Chronic: Apprehension test, AROM, patellar apprehension test, Apley's scratch test, Ligamentous stress test
Acromioclavicular shear test

Treatment goals

Acute: RICE, Reduce pain, reduce edema
Direct tx is contraindicated
Mid-range PROM on proximal jt 
Subacute: Reduce inflammation, reduce pain, reduce edema, TrP, Proximal lymphatic drainage
Direct tx can be introduced to the site of injury
Careful pain-free ROM
Hydrotherapy: Hot/Cold contrast
Ice is applied after the friction tissue to reduce inflammation
Chronic: Hydrotherapy:Deep moist heat such as was, hydrocollator, Hot/Cold contrast to increase local circulation

Tx frequency and outcome


Shorter more frequent tx  during inflammatory process in acute stage
Weekly tx for chronic stage

 Outcome is variable depending on the severity of the injury, age, general health, past hx of dislocation

 They could return to activity when apprehension test is negative
Complete healing may take up to 6 months

Self care

Hydrotherapy
Self massage

Caution!


Dislocation may cause jt laxity leading to repeated dislocations or subluxations

Contraindication


ARROM especially acute and subacute stage
Don't put joint in the position that the injury occurred
No Jt mobs

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