The foot bone’s connected to the leg bone and the leg bone’s connected to the knee bone.
Bones are connected at a joint, which is held together by ligaments. If two bones get separated, that’s a dislocation.
“A dislocation of a joint is a ligamentous injury,” explained Bruce Heck, an orthopedic surgeon in Findlay. “It is basically a disruption of the ligaments around the joint, as opposed to a fracture, which is a disruption of the bone.”
The most common places to experience a dislocated joint are the shoulder and fingers – the shoulder is a dynamic ball-and-socket joint, and each finger has three joints, Dr. Heck said.
“Think of a golf ball sitting on a tee and it's just balanced by the muscles,” he said. “Because of the great degree of freedom or motion that we have, it also makes that joint susceptible to dislocating or separating.
“The fingers get involved because they are how we interact with the world,” Dr. Heck continued. “They’re commonly used, they get caught up in machines, they get pinched.”
Other joint dislocations, such as the elbows, knees, and hips, are much less common and are often due to severe trauma like motor vehicle collisions.
Dislocations make up about 5 to 10 percent of the injuries treated in Dr. Heck’s practice, Northwest Ohio Orthopedics and Sports Medicine, which has locations in cities across the region.
Who is at risk?
These injuries are most common in athletes and people in occupations that involve heavy machinery.
“Younger people tend to do more stuff that puts them at risk of being injured,” said Scott Deering, an orthopedic surgeon at Bowling Green Orthopaedics.
“But on the other hand, their muscles are stronger, their soft tissue is a little stretchier, so they can tolerate a little more,” Dr. Deering said. “Older people have tighter tissues, they have a greater risk of more serious damage with lower energy injuries.”
Dr. Heck noted that dislocations become more frequent as a person becomes more skeletally mature. When the growth plates are still weak, a fracture is more common than a dislocation, he said. And when older people fall, they typically get fractures as opposed to dislocations.
One exception, he noted, is patients who have had a hip replacement, because cutting the soft tissues around the hip makes the joint more vulnerable to dislocating.
“Over 40, if you have a shoulder dislocation, you must be evaluated for a rotator cuff tear because the incidence of a rotator cuff tear after the age of 40 with a shoulder dislocation goes way up,” Dr. Heck said.
The majority of patients who have a shoulder dislocation under the age of 18 will sustain additional dislocations in the future that end up requiring surgery, he added.
Genetic disorders like Ehlers-Danlos syndrome and Marfan syndrome affect the connective tissue around the joints.
“That makes collagen, one of the proteins that helps to hold your ligaments intact, less springy and [more] stretched out,” Dr. Deering said. “So the joints are more inherently unstable.”
Common medical conditions are not associated with dislocation.
“If it’s related to some sort of traumatic event, then that’s less likely to be concerning,” Dr. Deering said. “If it just pops out when you’re sleeping or something like that, then there’s a higher concern of an underlying connective tissue disorder.”
When something pops out
If you’re a bystander to an injury and have a medical background, you can try to put the bone back in place, said Dr. Deering, who sees many dislocated fingers while working with Bowling Green State University’s football team.
Otherwise, you should immobilize the joint and bring the person to a medical facility sooner than later – Dr. Heck said lay people should not try to reduce the joint, or put it back in place.
He suggested making a temporary finger splint with a popsicle stick or piece of cardboard. For a shoulder injury, the arm should be held to the side with a wrap or even a shirt.
Dr. Deering said some people may initially think they sprained their shoulder or finger, emphasizing the need to have it evaluated by a professional. Dr. Heck recommends having an X-ray to check whether a fracture occurred alongside the dislocation.
“Generally, once the joint is back in place, the pain is significantly improved,” Dr. Deering said. “Further treatment ... can involve a period of immobilization to let the ligaments heal. [It] can involve therapy to get strength and movement going. And if it’s a recurrent dislocation ... it can require surgery to put it back in place and stabilize it to keep it from happening again.”
Staying strong
“The best thing you can do to prevent the dislocation of a joint is to stay fit,” Dr. Heck said. “You want to keep the muscles strong.”
He explained that a joint’s primary stabilizers are the ligaments, which can’t be strengthened. But muscles act as secondary stabilizers for the joints.
In addition to strengthening the muscles, he advises wearing a brace to support a joint that feels unstable and avoiding positions that put stress on a joint.
“Don’t do dumb stuff like crash your motorcycle,” Dr. Deering advised. “Staying healthy, making sure your muscles are strong ... and maintaining flexibility.”
Contact Sarah Readdean at: sreaddean@theblade.com.
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