Dislocations and instability of the shoulder, elbow and fingers

Dislocations and joint instability in the hand and upper extremity can occur when extreme force causes a child’s bones to separate or become unstable.

About hand and upper extremity dislocations and instability in kids

Bones are normally connected by ligaments, which are flexible bands of tissue. The point of connection between two bones is called a joint. In the hand and upper extremity, there are a few types of joints:

• Ball and socket in the shoulder
• Hinge joint in the elbow
• Ellipsoidal joint in the wrist

The shoulder is the most commonly dislocated joint and occurs when an injury forces the ball at the end of the upper arm bone (the humerus) completely or partially out of the scoop-shaped socket in the shoulder bone (the scapula). Dislocations can occur on their own or with a fracture. These injuries are more common in adolescents than in young children.

Experts in hand and upper extremity dislocations and instability

As the only comprehensive pediatric hand and upper extremity program in the state, Children’s Wisconsin provides expert care to kids and teens with a wide range of common and rare conditions affecting the shoulder, arm, elbow, wrist and hand. With our team’s specialized training, vast experience and deep knowledge of the unique challenges of children’s growing bodies, we can ensure the best possible outcomes for your child’s recovery after a dislocation or instability-causing injury. Our child-centered environment and wraparound services are designed to support the whole family and provide comfort when your child is stressed and in pain. If your child has already been diagnosed at another center, we invite you to get a second opinion at Children’s Wisconsin.

What causes dislocations and instability in the hand and upper extremity?

Severe trauma, such as a car accident or collision during contact sports, can force a joint out of place. Weaker muscles and tendons (such as after a ligament or tendon injury) can also make a child more susceptible to dislocations or instability in the shoulder, elbows or fingers.

Why are hand and upper extremity dislocations and instability a concern?

These injuries can cause kids a significant amount of pain. If not properly managed by a pediatric expert, a dislocation or instability in the hand or upper extremity can lead to long-term problems that affect your child’s functioning and range of motion.

What are the symptoms of dislocations and instability?

Signs of a joint dislocation or instability may include:

• Severe pain
• Swelling
• Numbness/tingling
• Difficulty using the injured area
• Joint is visibly out of place

If you suspect your child might have a dislocation, seek medical assistance right away.

How are hand and upper extremity dislocations and instability diagnosed?

The physician will evaluate your child’s injury through a physical examination and imaging. At Children’s Wisconsin, we use imaging procedures that ensure your child is exposed to the smallest amount of radiation possible. Imaging procedures may include:

X-rays – Uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs onto film

Magnetic resonance imaging (MRI) – Uses a combination of large magnets, radio frequencies and a computer to produce detailed images of organs and structures within the body

Computed tomography scan (CT scan) – Uses a combination of X-rays and computer technology to produce detailed, cross-sectional images of the body, including the bones, muscles, fat and organs

Treatment for hand and upper extremity dislocations and instability

Treatment will vary depending on the type and severity of your child’s injury.

Your child’s treatment plan may include:

Closed reduction – Sometimes bones move back into place on their own. Other times the doctor might try to gently guide the bones back into place. This procedure, known as a closed reduction, does not involve cutting open the skin.

Surgical repair – In rare cases, a surgery called an open reduction might be required to treat a complicated dislocation or repeated dislocations due to weak joints and ligaments. Our highly skilled pediatric orthopedic surgeon will surgically repair the bones, tendons and soft tissue in a precise and delicate manner to preserve your child’s movement and function in the future.

Sling/splint/cast – Once your child’s bones are in the right place, they will need to wear a sling, splint or cast (depending on the area injured) to immobilize and protect the area so the bone can heal.

Medical management – Anti-inflammatory medications and muscle relaxants can relieve a child’s pain immediately after the injury and as they recover.

Hand therapy – Hand therapy  is a critical part of the postsurgical and nonsurgical process to promote healing, increase range of motion and maximize functional use of your child’s hand/arm. Our certified hand therapist offers serial casting, custom splinting, paraffin wax treatments, scar massage and more.

Rest – Your child will need to take a break from athletics or other activities that worsen their discomfort.

Long-term outlook for hand and upper extremity dislocations and instability

Dislocations in the hand and upper extremity can heal in a few weeks, but they can make a child more susceptible to future injuries in the same area. Children’s team will advise your family on how to prevent future injuries and help your child recuperate so they can get back to doing the things they love.