Joint dislocation

Differential diagnosis

Differential Diagnosis table forJoint dislocation
ConditionDifferentiating signs/symptomsDifferentiating tests
Proximal humerus fracture
  • There is usually shoulder and upper arm swelling and bruising.

  • Possibility of paraesthesias or weakness in the arm.

  • Anteroposterior (AP) and lateral view x-rays in the scapular plane and an axillary view confirm the fracture.

Distal clavicle fracture
  • Pain, particularly on upper extremity movement, and swelling.

  • After the swelling has subsided, the fracture can often be felt through the skin.

  • AP x-ray shows fracture.

Acromioclavicular joint separation
  • Pain is a common symptom of this injury and is usually severe.

  • Evidence of traumatic injury to the shoulder, such as swelling and bruising, is also commonly found.

  • AP x-ray rules out fractures.

  • If diagnosis is unclear, an x-ray taken while the patient is holding a weight in the hand may be helpful. The force of the weight accentuates any shoulder joint instability and shows the effects of the injury better.

Rotator cuff tear
  • Shoulder pain is the most common presenting symptom.

  • Pain is typically aggravated by over-head activities.

  • Patients may also complain of functional weakness, loss of motion, night pain, and pain in the deltoid region.

  • Acute pain and weakness may be seen following traumatic rotator cuff rupture.

  • AP x-ray or MRI scan rules out fractures.

Soft tissue contusion of the shoulder
  • Tenderness, swelling, and bruising of the shoulder.

  • An x-ray or MRI scan rules out fractures.

Scapula fracture
  • Relatively rare.

  • Most patients present after high-energy trauma.

  • Typically, there is swelling, tenderness, crepitus, and bruising over the scapular region.

  • AP, lateral, and axillary x-ray views of the shoulder/scapula show fracture.

Biceps tendon rupture
  • Some patients report a sudden pain in the anterior shoulder during activity.

  • This acute pain, frequently described as sharp in nature, may be accompanied by an audible pop or a perceived snapping sensation.

  • AP and axillary x-ray views are the most useful and rule out fractures.

Distal humerus fracture
  • Pain occurs with palpation or movement of the shoulder or elbow.

  • Swelling and bruising are usually present.

  • AP and lateral views of the humerus, as well as trans-thoracic and axillary views of the shoulder, should be adequate to visualise a fracture.

Radial head fracture
  • Usually presents with a history of a fall on the outstretched hand.

  • Localised swelling, tenderness, and decreased motion to radial head.

  • The wrist, especially the distal radioulnar joint, may be damaged simultaneously.

  • Most radial head injuries can be adequately assessed with standard plain x-ray of the elbow.

Coronoid fracture
  • Usually occurs in combination with a radial head fracture.

  • Patients often present with a history of a fall on the outstretched hand and a deformity of the elbow.

  • The presence of an unstable reduction of the elbow is suggestive of an associated coronoid fracture.

  • Radiographs of the elbow in the AP, lateral, and, if required, oblique views should be obtained to ascertain clearly the extent of bony injury.

Ulnar collateral ligament injury
  • Medial elbow tenderness and swelling are the most notable findings.

  • Medial elbow pain is the most common symptom in athletes who throw.

  • Plain x-ray or MRI scan rules out fractures.

Monteggia fracture
  • Depending on the type of fracture and severity, patients may experience elbow swelling, deformity, crepitus, and paraesthesia or numbness.

  • Some patients may not have severe pain at rest, but elbow flexion and forearm rotations are limited and painful.

  • Views of the forearm in orthogonal planes (planes at 90° to each other) are needed with the wrist and elbow joints included.

  • Separate radiographs of the elbow should also be obtained to assess the proximal radioulnar joint, ulnohumeral articulation, and radiocapitellar joint.

Soft tissue contusion of the knee
  • Patients usually state that something struck the affected knee.

  • On physical examination, there should not be any valgus laxity on abduction stress testing.

  • Bony pathology can usually be distinguished from soft tissue injury with plain radiographs.

Chondromalacia patellae
  • Softening and fissuring of articular hyaline cartilage.

  • Patients may report anterior knee pain, especially while climbing stairs.

  • Compression of the patella during flexion and extension of the knee elicits crepitation and discomfort.

  • Over-exposed lateral x-ray of the knee.

  • Axillary x-ray views of the knee determine which facet is involved.

Patellar tendon rupture
  • Palpable defect in patellar ligament.

  • With complete tears, patient is unable to extend the knee.

  • With partial tears, patient is able to extend the knee, but extension may not be full.

  • Lateral radiograph of the knee may reveal small avulsion from the inferior patellar pole.

Quadriceps tendon rupture
  • Usually occurs in patients over 40 years of age.

  • Patients typically present with acute knee pain, swelling, and functional loss following a stumble, fall, or giving way of the knee.

  • Obvious suprapatellar swelling, bruising, and tenderness are present.

  • Standing AP x-ray or MRI scan rules out fractures.

Medial synovial plica of the knee
  • Symptoms may mimic those of a torn meniscus (e.g., snapping, clicking, and medial joint line tenderness).

  • Standing AP x-ray or MRI scan rules out fractures.

Anterior cruciate ligament injury
  • Subluxation on twisting, turning, or pivoting. Some patients can feel it coming on; other patients are not able to feel it and may experience frequent falls due to their injury.

  • Standing AP x-ray or MRI scan rules out fractures.

Posterior cruciate ligament injury
  • History of hyper-extension mechanism or a blow to anterior aspect of the knee.

  • Difficulty going down inclines, descending stairs, or running down hills.

  • Standing AP x-ray or MRI scan rules out fractures.

Medial collateral ligament injury of the knee
  • Sensation of side-to-side toggle with activity.

  • Difficulty with twisting or turning.

  • Difficulty with running or pivoting.

  • Standing AP x-ray or MRI scan rules out fractures.

Posterolateral knee injury
  • Sensation of side-to-side toggle of knee with activity.

  • Weakness of foot and ankle that may be secondary to a concurrent common peroneal nerve neuropraxia or complete injury.

  • Standing AP x-ray or MRI scan rules out fractures.

Meniscal tear
  • Patients frequently complain of mechanical symptoms in the knees such as catching, giving way, locking, clicking, and popping.

  • On physical examination, meniscal injuries may present with quadriceps atrophy; they often have an associated knee effusion, and tenderness localised to the joint line may be present.

  • Standing AP x-ray or MRI scan rules out fractures.

Osteochondral fracture of the knee
  • Patients have immediate pain and swelling of the knee at the time of injury.

  • They also have significant pain with weight-bearing.

  • The mechanism of injury usually involves a high-force, twisting injury of the knee.

  • Diagnosis can be confirmed by an MRI scan.

Ligament avulsions of the finger
  • Patients often experience diffuse pain, swelling, and tingling.

  • AP, lateral, and oblique radiographs of the affected digit rule out fractures.

Tendon avulsions of fingers
  • Patients often experience diffuse pain, swelling, and tingling.

  • AP, lateral, and oblique radiographs of the affected digit rule out fractures.

Mallet finger
  • Patients notice the inability to extend the distal joint, although full passive extension remains intact.

  • The dorsum of the joint may be slightly tender and swollen, but often the injury is painless or nearly painless.

  • AP and lateral radiographs centred at the DIP joint of the affected finger are required to rule out fractures.

Gamekeeper's thumb
  • A weakened ability to hold objects, decreased thumb stability (catching the thumb in objects, etc.), local swelling, local pain, and bruising.

  • Plain x-ray or MRI scan rules out fractures.

Last updated: Jan 02, 2013
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