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Shoulder/Knee/Elbow Dislocations

Shoulder Dislocation

Playing more overhead sports activities and repeated use of shoulder at workplace may lead to sliding of the upper arm bone, the ball portion, from the glenoid–the socket portion of the shoulder. The dislocation might be a partial dislocation (subluxation) or a complete dislocation causing pain and shoulder joint instability. Shoulder joint often dislocates in the forward direction (anterior instability) and it may also dislocate in backward or downward direction.

Most common symptoms of shoulder dislocation are pain and shoulder joint instability. Other symptoms such as swelling, numbness and bruising may occur. At times, it may cause tear in the ligaments or tendons of the shoulder and nerve damage. Your doctor will examine your shoulder and may order an X-ray to confirm the diagnosis.

The condition is treated by a process called closed reduction which involves placing the ball of the upper arm back into the socket. Following this, the shoulder will be immobilized using a sling for several weeks. Ice may be applied over the area for 3-4 times a day. Rehabilitation exercises may be started to restore range of motion, once the pain and swelling decrease.

Elbow Dislocation

The elbow is a hinge joint made up of 3 bones – humerus, radius and ulna. The bones are held together by ligaments to provide stability to the joint. Muscles and tendons move the bones around each other and help in performing various activities. Elbow dislocation occurs when the bones that make up the joint are forced out of alignment.

Elbow dislocations usually occur when a person falls onto an outstretched hand. Elbow dislocations can also occur from any traumatic injury such as motor vehicle accidents. When the elbow is dislocated you may have severe pain, swelling, and lack of ability to bend your arm. Sometimes you cannot feel your hand, or may have no pulse in your wrist because arteries and nerves run along your elbow may be injured.

To diagnose elbow dislocation your doctor will examine your arm. Your doctor will check the pulses at the wrist and will evaluate the circulation to the arm. An X-ray is necessary to determine if there is a break in the bone. An arteriogram, an x-ray of your artery can be helpful to know if the artery is injured.

An elbow dislocation is a serious injury and therefore requires immediate medical attention. At home, you may apply an ice pack to the elbow to ease pain and swelling. However it is important to see your doctor for help. You can also check if the arteries and nerves are injured or remain intact. You can feel your pulse by pressing tips of your fingers at the base of your wrist. They should turn white or blanch and a pink color should come back in 3 seconds. To check for nerves, first bend your wrist up and move your fingers apart and then touch your thumb to your little finger. You can also check for numbness all over your hand and arm. If you have problem with any of these tests you need to see your doctor right away.

You doctor will put your dislocated elbow back in place by pulling down your wrist and levering your elbow. This procedure is known as reduction. As it is a painful procedure you may be given medications to relieve your pain before the procedure. After the reduction you may have to wear a splint to immobilize your arm at the elbow. After few days you may also need to do gentle motion exercises to improve the range of motion and strength.

Elbow dislocations may be prevented if you avoid falling on outstretched arm or avoid situations that may cause falls such as walking at night or walking on slippery floors.

Patellar Dislocation

Patella (knee cap) is a protective bone attached to the quadriceps muscles of the thigh by quadriceps tendon. Patella attaches with the femur bone and forms a patellofemoral joint. Patella is protected by a ligament which secures the kneecap from gliding out and is called as medial patellofemoral ligament (MPFL).

Dislocation of the patella occurs when the patella moves out of the patellofemoral groove, (called as trochlea) onto a bony head of the femur. If the knee cap partially comes out of the groove, it is called as subluxation and if the kneecap completely comes out, it is called as dislocation (luxation). Patella dislocation is commonly observed in young athletes between 15 and 20 years and commonly affects women because of the wider pelvis creates lateral pull on the patella.

Some of the causes for patellar dislocation include direct blow or trauma, twisting of the knee while changing the direction, muscle contraction, and congenital defects. It also occurs when the MPFL is torn. The common symptoms include pain, tenderness, swelling around the knee joint, restricted movement of the knee, numbness below the knee, and discoloration of the area where the injury has occurred.

Your doctor will examine your knee and suggests diagnostic tests such as X-ray, CT scan, and MRI scan to confirm condition and provide treatment. There are non-surgical and surgical ways of treating patellofemoral dislocation.

Non-surgical or conservative treatment includes:

  • PRICE (protection, rest, ice, compression, and elevation)
  • Non-steroidal anti-inflammatory drugs and analgesics to treat pain and swelling
  • Braces or casts which will immobilize the knee and allows the MPF ligament to heal
  • Footwear to control gait while walking or running and also decreases the pressure on the kneecap.
  • Physical therapy is recommended which helps to control pain and swelling, prevent formation of scar of soft tissue, and also helps in collagen formation. Physiotherapist will extend your knee and applies direct lateral to medial pressure to the knee which helps in relocation. It includes straightening and strengthening exercises of the hip muscles and other exercises which will improve range of motion.

Surgical treatment is recommended for those individuals who have recurrent patella dislocation. Some of the surgical options include:

  • Lateral-release– ­It is done to loosen or release the tight lateral ligaments that pull the kneecap from its groove which increases pressure on the cartilage and causes dislocation. In this procedure, the ligaments that tightly hold the kneecap are cut using an arthroscope.
  • Medial patellofemoral ligament reconstruction – In this procedure, the torn MPF ligament is removed and reconstructed using grafting technique. Grafts are usually harvested from the hamstring tendons, located at the back of the knee and are fixed to the patella tendon using screws. The grafts are either taken from the same individuals (autograft) or from a donor (allograft). This procedure is also performed using an arthroscope.
  • Tibia tubercle realignment or transfer– Tibia tubercle is abony attachment below the patella tendon which sits on the tibia. In this procedure the tibia tubercle is moved towards the center which is then held by two screws. The screws hold the bone in place and allow faster healing and prevent the patella to slide out of the groove. This procedure is also performed using an arthroscope.

After the surgery, your doctor will suggest you to use crutches for few weeks, prescribe medications to control pain and swelling, and recommend physical therapy which will help you to return to your sports activities at the earliest.

Other Sports Medicine List

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  • Mount Sinai
  • American Board
  • AAOS
  • AMA