Dislocation: Symptoms, Types, Causes and Treatment

Dislocations are dramatic injuries where bones are forced out of their normal positions in a joint, often resulting in pain, deformity, and loss of function. Whether caused by trauma, underlying medical conditions, or surgical complications, dislocations demand prompt recognition and appropriate management. This comprehensive guide explores the symptoms, types, causes, and treatments of dislocations, drawing on the latest clinical evidence and expert consensus.

Symptoms of Dislocation

Dislocations are characterized by sudden, alarming symptoms that often make the injury obvious to both patient and observer. Recognizing these symptoms is crucial for early intervention and preventing long-term complications.

Symptom	Description	Typical Joints	Sources
Pain	Intense, acute pain at the joint	Shoulder, knee, hip	1 4 6
Deformity	Visible misshaping or displacement	Elbow, finger, hip	3 6 12
Swelling	Rapid swelling around the joint	Knee, ankle, hip	1 11
Loss of Function	Inability to move the joint	All major joints	6 11
Numbness	Tingling or numbness due to nerve injury	Knee, wrist, spine	4 6
Instability	Feeling that the joint is "loose"	Knee, shoulder	1 11

Table 1: Key Symptoms

Overview of Dislocation Symptoms

Dislocations typically present with a combination of pain, swelling, and a noticeable change in the contour or alignment of the affected joint. The severity and specific features of symptoms can vary depending on the location and mechanism of the injury.

Pain and Deformity

• Acute Pain: Pain is immediate and severe, often worsening with movement attempts 1 4 6.
• Visible Deformity: The joint often appears deformed, with abnormal angulation or displacement. For example, a dislocated elbow or finger may appear grossly misaligned 3 12.

Swelling and Loss of Function

• Rapid Swelling: Dislocation causes bleeding and inflammation, leading to rapid swelling of the joint area 1 11.
• Impaired Mobility: Movement is usually severely limited or impossible. Patients may be unable to bear weight or use the affected limb 6 11.

Neurological Symptoms

• Numbness and Tingling: Dislocations may stretch or compress surrounding nerves, causing numbness, tingling, or even loss of sensation and muscle function 4 6. This is especially concerning in knee, wrist, or spinal dislocations.

Instability and Recurrent Dislocation

• Joint Instability: After initial trauma, the joint may feel unstable or "give way," making recurrent dislocations more likely if not properly treated 1 11.

Types of Dislocation

Dislocations are classified by the joint involved, the direction of displacement, the presence of associated fractures, and underlying causes. Understanding these types helps guide appropriate treatment and prognosis.

Type	Defining Feature	Example Joints	Sources
Simple Dislocation	No associated fracture	Shoulder, elbow	5 12 15
Complex/Fracture-Dislocation	With fracture of adjacent bone	Knee, finger, forearm	1 3 5 6 12
Directional	Dorsal, volar, anterior, posterior	Wrist, elbow, hip	2 4 7
Joint-Specific	Unique to certain joints	Hip, spine, patella	6 14
Prosthetic	Involving artificial joints	Hip arthroplasty	7 8 9 10

Table 2: Dislocation Types

Classification by Associated Injury

• Simple Dislocation: The bone is displaced without a concurrent fracture. These are often easier to reduce and may heal with conservative management 5 12 15.
• Complex or Fracture-Dislocation: Both the joint is dislocated and adjacent bones are fractured. These injuries are more severe, often requiring surgical intervention 1 3 5 6 12.

Directional Types

• Dorsal/Volar: Refers to the direction in which the bone is displaced. For instance, radiocarpal dislocations can be dorsal (backward) or volar (palm-side) 2 4.
• Anterior/Posterior: Common descriptors for shoulder or hip dislocations. Posterior dislocations are more common in the hip, while anterior dislocations may occur after certain surgical procedures 7.

Joint-Specific Variations

• Knee Dislocations: These may be associated with significant ligament and neurovascular injury and are considered orthopedic emergencies 1 11.
• Elbow and Finger Dislocations: Can involve multiple patterns such as dorsal, volar, and pilon, with varying severity and requirements for surgical intervention 3 12.
• Spine Dislocations: Classified by the mechanism (flexion, extension, rotation, shearing) and are often associated with neurological injury 6.

Prosthetic Joint Dislocations

• Total Hip Arthroplasty Dislocation: Unique classification systems exist for dislocations after joint replacement, taking into account causes such as position, component malalignment, and soft tissue imbalance 7 8 9 10.

Causes of Dislocation

Dislocations can result from a wide range of causes, including traumatic events, structural abnormalities, and complications from medical or surgical interventions. Identifying the underlying cause is crucial for effective prevention and management.

Cause	Description/Mechanism	High-Risk Joints	Sources
Trauma	Direct blow, fall, accident	Knee, elbow, hip, spine	1 3 4 6 11 12
Congenital/Structural	Anatomical abnormalities, ligament laxity	Shoulder, patella	14
Surgical Complications	Component malposition, soft tissue imbalance	Hip arthroplasty	7 8 9 10
Degeneration	Chronic wear/tear, muscle weakness	Hip, shoulder	7 8 10
Repetitive Stress	Overuse, sports injuries	Fingers, patella	3 14

Table 3: Causes of Dislocation

Traumatic Causes

• High-Energy Trauma: Most dislocations are caused by significant trauma, such as motor vehicle accidents, sports injuries, or falls 1 3 4 6 11 12.
• Low-Energy Trauma: In joints with predisposing anatomical factors or prior injury, even minor trauma can result in dislocation 14.

Structural or Congenital Abnormalities

• Ligamentous Laxity: Some individuals have inherently loose ligaments, making certain joints (like the shoulder or patella) more prone to dislocation 14.

Surgical and Iatrogenic Factors

• Prosthetic Joint Dislocation: Dislocations following joint replacement surgery are often due to technical factors such as component malposition, inadequate soft tissue balancing, or muscular deficiency 7 8 9 10.
  • Malposition of the prosthetic components is a major factor 10.
  • Muscular imbalance, particularly of the abductor muscles, can also contribute 8 10.

Degenerative and Repetitive Stress

• Chronic Degeneration: Age-related weakening of muscles or ligaments can predispose to dislocation, especially in prosthetic joints 7 8.
• Repetitive Microtrauma: Recurrent stress and overuse, especially in athletes, can weaken joint stability and cause dislocations over time 3 14.

Treatment of Dislocation

The treatment of dislocations is tailored to the specific joint, type, and severity of injury, as well as patient factors. The main goals are to restore joint alignment, preserve function, and prevent recurrence or complications.

Treatment	Description	Typical Indications	Sources
Closed Reduction	Manual repositioning of joint	Simple dislocations	2 4 11 14 15
Immobilization	Splints, casts, braces	Post-reduction, minor injuries	14 15
Surgery	Open reduction, ligament/bone repair	Complex or recurrent injuries	1 3 5 6 11 12 13
Physical Therapy	Restore strength and mobility	All dislocations	14 15
Prosthetic Revision	Reoperation for prosthetic dislocation	Hip arthroplasty	7 8 9 10

Table 4: Treatment Options

Nonoperative Management

Closed Reduction and Immobilization

• Closed Reduction: Most simple dislocations are managed by carefully manipulating the joint back into place under sedation or anesthesia 2 4 14 15.
• Immobilization: After reduction, the joint is often immobilized temporarily in a splint, cast, or brace to allow healing and prevent recurrent dislocation 14 15.
• Physical Therapy: Early and progressive rehabilitation is critical to restore range of motion, strength, and joint stability. Delayed or inadequate therapy can increase the risk of stiffness and recurrence 14 15.

Nonoperative Outcomes

• For certain injuries, such as first-time lateral patellar dislocations, nonoperative management is common, but recurrence rates can be high (up to 31%) 14.

Surgical Management

Indications for Surgery

• Complex/Fracture-Dislocations: Surgical intervention is required when there is an associated fracture, gross instability, or failure of closed reduction 1 3 5 6 11 12.
• Ligament/Bone Repair: Surgery may involve repair or reconstruction of torn ligaments, fixation of fractures, or removal of loose bodies within the joint 12 15.
• Joint-Specific Approaches:
  • Knee: Surgical repair or reconstruction, often using allograft tissue, can restore stability and function, especially if performed acutely 1 11.
  • Elbow: Operative treatment is indicated for instability or intra-articular fractures; repair of the lateral collateral ligament is often sufficient 12 15.
  • Acromioclavicular (AC) Joint: Both operative and nonoperative approaches are used; evidence does not strongly favor one over the other, though surgery may reduce persistent pain 13.

Prosthetic Joint Dislocations

• Revision Surgery: In cases of dislocation after total hip arthroplasty, revision may be necessary for persistent instability or component malposition 7 8 9 10.
• Prevention: Proper surgical technique and component positioning are the best strategies for preventing dislocation of prosthetic joints 10.

Rehabilitation and Prognosis

• Early Motion: Modern protocols encourage early mobilization to avoid stiffness, except in cases where stability is a concern 11 12 15.
• Long-Term Outcomes: Most patients regain good function if the dislocation is treated promptly and appropriately, though high-demand activities may be limited, especially after severe or recurrent injuries 11 13 14.

Conclusion

Dislocations are serious injuries that demand prompt recognition and individualized management to restore joint function and prevent complications. Here’s a summary of the main points covered:

• Symptoms: Include pain, deformity, swelling, loss of function, numbness, and instability.
• Types: Range from simple (no fracture) to complex (with fracture), vary by joint and direction, and include unique patterns in prosthetic joints.
• Causes: Most commonly trauma, but also congenital factors, surgical complications, degeneration, and repetitive stress.
• Treatment: Varies from closed reduction and immobilization to complex surgical reconstruction, with physical therapy being key for all patients.

Understanding the nature of dislocations—how they present, why they occur, and how to treat them—is essential for anyone involved in injury prevention, emergency care, or orthopedic rehabilitation. Prompt and appropriate care ensures the best possible outcomes for patients of all ages and activity levels.