Dislocations

A dislocation occurs when extreme force is put on a ligament, allowing the ends of two connected bones to separate. Ligaments are flexible bands of fibrous tissue that connect various bones and cartilage.

Ligaments also bind the bones in a joint together. Severe trauma on joint ligaments can lead to dislocation of the joint. The hip and shoulder joints are called "ball and socket" joints. Extreme force on the ligaments in these joints can cause the head of the bone (ball) to partially or completely come out of the socket.

The most commonly dislocated joint is the shoulder.

Dislocations are uncommon in younger children because their growth plates (area of bone growth located in the ends of long bones) are weaker than the muscles or tendons; instead, children are more prone to a fracture than a dislocation.

What are the symptoms of a dislocation?

The following are the most common symptoms of a dislocation. However, each child may experience symptoms differently. Symptoms may include:

• Severe pain in the injured area
• Swelling in the injured area
• Difficulty using or moving the injured area in a normal manner
• Deformity of the dislocated area

The symptoms of a dislocation may resemble other medical conditions. Always consult your child's physician for a diagnosis.

How is a dislocation diagnosed?

The physician makes the diagnosis with a physical examination. During the examination, the physician obtains a complete medical history of the child and asks how the injury occurred.

Diagnostic procedures may help to evaluate the problem. Diagnostic procedures may include:

• X-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of bones onto film
• Magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body

Treatment for dislocation:

Specific treatment for a dislocation will be determined by your child's physician based on:

• Your child's age, overall health and medical history
• The extent of the injury
• The type of injury
• Your child's tolerance for specific medications, procedures or therapies
• Expectations for the course of the condition

All dislocations require immediate medical attention. Fractures can also occur with dislocations.

Initial treatment of a dislocation includes rest, ice and elevation). Dislocations may reduce spontaneously, meaning the bone ends may go back into place by themselves. However, for those dislocations that do not go back into place, your child's physician will need to place the joint back into its proper position so it will heal. Your child will receive sedation to help him/her remain comfortable before the procedure. Sedation will also help the muscles around the dislocated joint relax, so the joint can be put back into place more easily.

Your child's physician may recommend any of the following to help reduce the dislocation or promote healing afterwards:

• Splint/cast - immobilizes the dislocated area to promote alignment and healing; protects the injured area from motion or use
• Medication (for pain control)
• Traction - the application of a force to stretch certain parts of the body in a specific direction. Traction consists or pulleys, strings, weights, and a metal frame attached over or on the bed. The purpose of traction is to stretch the muscles and tendons around the bone ends to help reduce the dislocation.
• surgery (especially for reoccurring dislocations or if a muscle, tendon, or ligament is badly torn)

Additional recommendations may include:

• Activity restrictions (while the dislocation heals)
• Crutches/wheelchair (to enable your child to move around during healing)
• Physical therapy (to stretch and strengthen the injured muscles, ligaments, and tendons)

Long-term outlook after a dislocation:

While dislocations are rare in younger children, they do occur more frequently among adolescents. It is important that the child adhere to the activity restrictions and/or stretching and strengthening rehabilitation programs to prevent re-injury. Shoulder dislocations in children often will need surgery to prevent multiple reocurrances.