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
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 spasmSubacute: 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 contraindicatedChronic: Apprehension test, AROM, patellar apprehension test, Apley's scratch test, Ligamentous stress test
Acromioclavicular shear test
Treatment goals
Acute: RICE, Reduce pain, reduce edemaDirect 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
HydrotherapySelf 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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