Joint dislocation

Joint dislocation: Introduction, definition, causes, sign and symptoms, diagnosis and management

1. PRESENTED BY : MRS. HARMEET KAUR NURSING TUTOR UCON, FARIDKOT JOINT DISLOCATION

2. introduction A joint dislocation is an injury to a joint, a place where two or more bones come together, in which the ends of the bones are forced from their normal positions. This painful injury temporarily deforms and immobilizes the joint. Dislocation is most common in shoulders and fingers. Other sites include elbows, knees and hips.

3. definition It is complete or persistent displacement of a joint in which at least part of the supporting joint capsule and some of its ligaments are disrupted. An injury where a joint is forced out of normal position. Joints can be dislocated from injury. This usually happen from a fall, motor vehicle accident or participation in sports.

4. dislocated joints

5. causes

6. causes of dislocation May occur in any situation, whether it being the sporting arena or routine daily chores. Trauma, falls or motor vehicle accidents Underlying pathological condition such as TB, inflammatory disorders. Adults are more prone to dislocation than children. Previous joint dislocation result in weakening of tendons, ligament and muscle which may be a cause of recurrent dislocations.

7. Cont... Most commonly dislocation occurs in following joints: Shoulder, hip, elbow, metacarpophalengal joint Facet joint dilocation in cervical spine. Acromiclavicular joint.

8. Types of dislocations Congenital Acquired: Traumatic Pathological e.g. TB Hip, Septic arthiritis . Paralytic e.g. Poliomyelitis, cerebral palsy. Inflammatory disorders: rheumatoid arthritis.

9. Sign and symptoms SIGN Swelling Tenderness Warmth, bruising or redness. Deformities that may be sign of dislocation : Shoulder abduction deformity Elbow flexion deformity

10. Sign Hip anterior- flexion, abduction and internal rotation deformity Hip posterior- flexion, adduction and internal rotation deformity Knee flexion deformity Ankle varus deformity

11. Cont... SYMPTOMS Severe pain Joint locked in one position. Difficulty using or moving the joint Loss of sensation Weakness

12. Diagnostic evaluations Signs and symptoms would assist with early diagnosis and assist immediate first aid.

13. Cont... X-ray: radiograph of the affected part should include anterior posterior and lateral views and sometimes special view may be needed. It is used to produce image of internal tissues, bones and organs onto film. CT scan

14. Cont... Magnetic Resonance imaging (MRI): a diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce more detailed and precise image of structures within the body than X-ray.

15. complications Acute injury to peripheral nerve and vessels Chronic: Unreduced dislocation Recurrent dislocation Traumatic osteoarthritis Joint stiffness Avascular necrosis Myositis ossificans

16. First aid Reduction: Closed reduction Open reduction Nursing management management

17. Principles of management Acute dislocation should be reduced as soon as possible. Open reduction is rarely necessary for acute dislocation. Close reduction with intravenous analgesia and sedation or under GA (general anaesthesia) should be attempted first for most uncomplicated dislocation.

18. Initial first aid management STOP S: (Stop) Immediately immobilize the patients dislocated joint as there may be strong positivity of fracture. T: (Talk), ask the questions if the patient is conscious O: Observe closely for any injury, swelling, deformity or bleeding. P: Prevent further injury to the patient by conducting a whole body assessment.

19. rice R : (Rest) sit or lie the patient down in comfortable position. I: (Ice) use cold packs to cool compress the affected area C: (Compression) wrap the compression bandage around the limb to support it and restrict movement. E: (Elevate) the injured limb should be supported above the level of the heart.

20. Cont.... Refer the patient to the hospital if required. Ascertain if the patient is conscious by verbal and physical needs If patient is unconscious then follow: C: (Compression) initiate CPR A: (Airway) ensure airway is clear by jaw thrust, chin lift head tilt manuvear B: (Breathing) listen and feel the signs of life. D: (Defibrillator) perform defibrillation if CPR fails

21. reduction TYPE OF REDUCTION Closed reduction Open reduction

22. Closed reduction

23. Closed reduction techniques FOR SHOULDER DISLOCATION: Patient is kept in prone position on bed. The affected shoulder is supported and the arm is left to hang over the edge of bed. A weight is attached to the elbow or wrist. It is usual to begin with 2 kg upto 10 kg. Gravity stretches the muscles and reduction occurs. This method takes 15 to20 minutes. STIMSON’S GRAVITY TECHNIQUE

24. Stimson’s gravity technique FOR HIP DISLOCATION: Patient is in prone position with lower limbs hanging from the end of the table. Assistant immobilizes the pelvis by applying pressure on the sacrum. Hold knee and ankle flexed to 90 degree and apply downward pressure to leg just distal to the knees. Gentle rotatory motion of the limb may assist in reduction .

25. Kocher’s technique FOR SHOULDER DISLOCATION

26. Open reduction

27. After care To promote healing after closed or open reduction doctor may recommend : Splint/Cast: immobilizes the dislocated area to promote alignment. Medications for pain control: Ibuprofen, Naproxen, Acetaminophen. Traction: the application of a force to stretch certain part of body in certain direction. It consists of pulley, strings, weights, metal frame attached over or on the bed.

28. Nursing diagnosis Acute pain related to soft tissue injury or surgical incision. Impaired physical mobility related to pain, restricted movement or unfamiliarity with the use of immobilization devices. Impaired skin integrity related to open wound or surgical repair/incision. Self care deficit related to physical limitations present with cast or immobilizers. Constipation related to immobility or administration of opioid analgesics.

29. Cont... Risk for Peripheral Neurovascular Dysfunction related to interruption of blood flow/tissue trauma. Risk for Impaired Gas Exchange related to disturbed blood flow; blood/fat emboli. Risk for Infection related to Inadequate primary defenses: broken skin, traumatized tissues or Invasive procedure. Deficient knowledge related to unfamiliarity to information resources .

30. Acute pain Assess and record the patient’s level of pain utilizing pain intensity rating scale. Maintain immobilization of affected part by means of bed rest, cast, splint, traction. Elevate and support injured extremity. Avoid use of plastic sheets and pillows under limbs in cast. Medicate before care activities. Let the patient know it is important to request medication before pain becomes severe. Perform and supervise active and passive ROM exercises.

31. Cont... Provide alternative comfort measures  (massage, backrub, position changes). Provide emotional support and encourage the use of stress management techniques (progressive relaxation, deep-breathing exercises, visualization or guided imagery); provide Therapeutic Touch . Identify diversional activities appropriate for patient age, physical abilities, and personal preferences. Apply cold or ice pack first 24–72 hr and as necessary. Administer medications as indicated by physician.

32. Impaired physical mobility Assess the degree of immobility produced by injury or treatment and note patient’s perception of immobility. Encourage participation in diversional or recreational activities. Maintain a stimulating environment (radio, TV, newspapers, visits from family and friends). Teach patient or assist with active and passive ROM exercises of affected and unaffected extremities. Place in supine position periodically if possible, when traction is used to stabilize lower limb fractures.

33. Cont.... Assist with self-care activities (bathing, shaving). Provide and assist with the use of mobility aids such as wheelchair, walker. Reposition periodically and encourage coughing and deep-breathing exercises. Provide a diet high in proteins, carbohydrates, vitamins, and minerals.

34. Cont... Increase the amount of roughage or fiber in the diet. Limit gas-forming foods. Initiate bowel program (stool softeners, enemas, laxatives) as indicated. Consult with a physical, occupational therapist or rehabilitation specialist.

35. Impaired skin integrity Examine the skin for open wounds, foreign bodies, rashes, bleeding, discoloration, duskiness, blanching. Assess the position of splint ring of traction device. Massage skin and bony prominences. Keep the bed linens dry and free of wrinkles. Place water pads, other padding under elbows or heels as indicated. Reposition frequently. Encourage use of trapeze if possible.

36. Cont.... Cleanse skin with soap and water. Rub gently with alcohol as it is useful for padding bony prominences, finishing cast edges, and protecting the skin. Apply tincture of benzoin as it toughens the skin for the application of skin traction.

37. THANK YOU