Summary
Definition
History and exam
Key diagnostic factors
- characteristic posturing of joint
- pain
- inability to move joint
- tenderness
- swelling
- sciatic nerve injury with hip dislocation
- injury to the femoral artery, vein, or nerve with hip dislocation
- concomitant injury with hip dislocation
- cruciate ligament injury with patellar dislocation
- meniscal tears with patellar dislocation
- ligamentous injuries of the knee with patellar dislocation
- patellar or quadriceps tendon rupture with patellar dislocation
Other diagnostic factors
- ecchymosis with finger dislocation
- hemarthrosis with patellar dislocation
Risk factors
- sports-related activities
- motor vehicle accident (hip dislocation)
- ligamentous laxity
- Ehlers-Danlos syndrome
- males between adolescence and 30 years of age
- women ages 61-80 years (shoulder dislocation)
- prior history of joint instability
- skeletal or muscular dysplasia
- high Q angle (patellar dislocation)
- external tibial torsion (patellar dislocation)
- patella alta (patellar dislocation)
Diagnostic tests
1st tests to order
- plain x-rays of the shoulder
- plain x-rays of the finger
- plain x-rays of the knee
- plain x-rays of the elbow
- plain x-rays of the pelvis
Tests to consider
- MRI scan of the knee
- MRI scan of the shoulder
- CT scan of the elbow
- CT scan of the pelvis
- arteriogram of the knee or shoulder
Emerging tests
- ultrasound of the shoulder
Treatment algorithm
shoulder dislocation
finger dislocation
patellar dislocation
elbow dislocation
hip dislocation
Contributors
Authors
Thomas M. DeBerardino, MD
The San Antonio Orthopaedic Group
San Antonio
TX
Disclosures
TMD is a paid consultant and receives royalties from Arthrex, Inc. He serves on the Data Safety Monitoring Board for Aesculap and is a paid consultant for Arthrex, Inc., Emovi, ConMed, Icarus, JRF, and LinX Robotics. He has patents with Arthrex, Inc. TMD declares that none of these relationships relate to this topic.
Acknowledgements
Dr Thomas M. DeBerardino would like to gratefully acknowledge Dr Paul Novakovich and Dr Brent Ponce, previous contributors to this topic.
Disclosures
PN and BP declare that they have no competing interests.
Peer reviewers
Daniel J. Solomon, MD
Co-director of Orthopedic Sports and Shoulder Service
Department of Orthopedic Surgery
Naval Medical Center San Diego
San Diego
CA
Disclosures
DJS declares that he has no competing interests.
Matthew T. Provencher, MD
Assistant Director
Orthopaedic Shoulder and Sports Surgery
Naval Medical Center San Diego
San Diego
CA
Disclosures
MTP declares that he has no competing interests.
Peter Cundy, MBBS, FRACS
Head of Orthopaedic Surgery
Women's & Children's Hospital
Adelaide
South Australia
Australia
Disclosures
PC declares that he has no competing interests.
References
Key articles
Patrick CM, Snowden J, Eckhoff MD, et al. Epidemiology of shoulder dislocations presenting to United States emergency departments: an updated ten-year study. World J Orthop. 2023 Sep 18;14(9):690-7.Full text Abstract
Expert Panel on Musculoskeletal Imaging: Amini B, Beckmann NM, et al. ACR appropriateness criteria: shoulder pain-traumatic. J Am Coll Radiol. 2018 May;15(5s):S171-88.Full text Abstract
Expert Panel on Musculoskeletal Imaging: Taljanovic MS, Chang EY, et al. ACR appropriateness criteria: acute trauma to the knee. J Am Coll Radiol. 2020 May;17(5s):S12-25.Full text Abstract
Rozzi SL, Anderson JM, Doberstein ST, et al. National Athletic Trainers' Association position statement: immediate management of appendicular joint dislocations. J Athl Train. 2018 Dec;53(12):1117-28.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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