Dislocations and sprains
The 206 bones that make up the human skeleton are held together by the joints that are classified, according to the degree of mobility, in fixed, mobile and semi-mobile. Each mobile joint is in turn surrounded and supported by ligaments and a fibrous sleeve, called the joint capsule, which covers the entire joint. The stability of the two bony heads is also guaranteed by the tendons of the muscles that are inserted near the joint line.
The dislocations are divided into complete and incomplete. In the first case there is a clear separation between the two articular surfaces, while in the second case the bony heads remain partially in contact with each other. In both cases, external intervention is required to bring the two articulated surfaces that have come out back into place. On the contrary, if after the accident the two bone ends reposition themselves, we no longer speak of dislocation but of joint distortion.
The dislocations more frequently affect the shoulder (about 50% of cases), the elbow, the hip, the fingers and the patella; subluxations are more common in the ankle and knee area.
A dislocation manifests itself in the vast majority of cases when a strong trauma affects the joint or when it, during a movement, exceeds the limit of normal mobility. Not by chance the most affected joints are also the most mobile ones; at an articular level, therefore, mobility and instability go hand in hand.
For this reason those who practice sports such as rugby, horse racing, skiing, volleyball, basketball, wrestling or other contact sports run a greater risk of suffering this type of injury.
Symptoms
- Joint instability
- Impossibility in the movements that involve the affected joint
- Visible and palpable joint deformation
- Sudden and acute pain emphasized by palpation
- Swelling, abrasion, skin with bruising
To learn more: Symptoms Luxation
Diagnosis
The diagnosis of dislocation is often rather immediate, given that joint damage is visible to the naked eye or otherwise palpable. However, in order to have a complete clinical picture it is good to undergo, before repositioning, diagnostic investigations such as radiographs and magnetic resonance imaging. These tests can highlight any complications (bone fractures, lesions of vessels, nerves, etc.). The radiographic examination will then be repeated after the repositioning procedure to verify the articular alignment.
Treatment and rehabilitation
In the acute phase of the trauma, the task of reducing the dislocation lies exclusively with the doctor who, thanks to his knowledge, will be able to put the joint surfaces back into place without creating, or at least minimizing, further injuries. Sometimes this maneuver is performed under local anesthesia.
When suffering a dislocation it is important to intervene promptly (within 24-48 hours). If it were delayed to reduce the dislocation after just a couple of days, scarring phenomena would arise that would require surgical repositioning. The patient or the rescuers, of course, will not have to try in any way to fix the joint. While waiting for help, they will instead try to immobilize the joint with utmost care and avoid sudden movements. Always in the acute phase of the trauma, to reduce swelling and painful symptoms, ice can be applied to the affected area.
Once the dislocation is reduced, the rehabilitative treatment will aim to restore the lost mobility and functionality to the joint.
In most cases it is followed by a more or less long period of absolute rest (1-6 weeks). In less severe cases it is possible to intervene on the injured joint with early mobilization procedures. In this first phase, if very severe pain is present, anti-inflammatory and pain-relieving drugs are administered orally or through local infiltration.
Once the immobilization phase is complete, the rehabilitative treatment is continued, aimed at muscle strengthening and regaining lost mobility. The toning exercises allow you to quickly recover the lost tone by considerably increasing the stability of the joint. This intervention is nothing short of FUNDAMENTAL, since it avoids the persistence of chronic instability that would considerably increase the risk of new dislocations.
Only after these phases, which on average take about 6-10 weeks, can the athlete gradually resume training. In case of subluxation the return to normal sports and work activities is much faster (thirty to forty days).
Prevention
The prevention of dislocations is aimed primarily at muscle strengthening. Maintaining an active life and practicing a bit of movement is in fact possible to improve the health of tendons and joints by increasing joint stability and removing the risk of dislocations. In contact sports it is also useful to make use of adequate protection devices.
To learn more: Shoulder dislocation
Knee subluxation and leg extension
