Editing Joint dislocation (section)

==Treatment==

=== Non-operative ===

==== Reduction/Repositioning ====
X-rays are taken to confirm the diagnosis and detect any associated fractures. A dislocation is easily seen on an X-ray.<ref name="Dias_1987">{{cite journal | vauthors = Dias JJ, Steingold RF, Richardson RA, Tesfayohannes B, Gregg PJ | title = The conservative treatment of acromioclavicular dislocation. Review after five years | journal = The Journal of Bone and Joint Surgery. British Volume | volume = 69 | issue = 5 | pages = 719–22 | date = November 1987 | pmid = 3680330 | doi = 10.1302/0301-620X.69B5.3680330 }}</ref> Once X-rays are taken, the joint is usually manipulated back into position. This can be a very painful process. This is typically done either in the [[emergency department]] under [[sedation]] or in an [[operating room]] under a [[general anaesthetic]].<ref name="pmid5483077">{{cite journal | vauthors = Holdsworth F | title = Fractures, dislocations, and fracture-dislocations of the spine | journal = The Journal of Bone and Joint Surgery. American Volume | volume = 52 | issue = 8 | pages = 1534–51 | date = December 1970 | pmid = 5483077 | doi = | url = }}</ref> A dislocated joint should be [[reduction (orthopedic surgery)|reduced]] into its normal position only by a trained medical professional. Trying to reduce a joint without any training could worsen the injury.<ref>{{cite journal | vauthors = Bankart AB | title = The pathology and treatment of recurrent dislocation of the shoulder-joint. | journal = Journal of British Surgery | date = July 1938 | volume = 26 | issue = 101 | pages = 23–29 | doi = 10.1002/bjs.18002610104 }}</ref>

It is important to reduce the joint as soon as possible. Delaying reduction can compromise the blood supply to the joint. This is especially true in the case of a dislocated ankle, due to the anatomy of the blood supply to the foot.<ref name="pmid11764423">{{cite journal | vauthors = Ganz R, Gill TJ, Gautier E, Ganz K, Krügel N, Berlemann U | title = Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis | journal = The Journal of Bone and Joint Surgery. British Volume | volume = 83 | issue = 8 | pages = 1119–1124 | date = November 2001 | pmid = 11764423 | doi = 10.1302/0301-620x.83b8.11964 }}</ref> On field reduction is crucial for joint dislocations. As they are extremely common in sports events, managing them correctly at the game at the time of injury, can reduce long term issues. They require prompt evaluation, diagnosis, reduction, and post-reduction management before the person can be evaluated at a medical facility.<ref name="Skelley 246–255" /> After a dislocation, injured joints are usually held in place by a [[Splint (medicine)|splint]] (for straight joints like fingers and toes) or a [[bandage]] (for complex joints like shoulders).

==== Immobilization ====
Immobilization is a method of treatment to place the injured joint in a sling or in another immobilizing device in order to keep the joint stable.<ref name="Skelley 246–255"/> There is no significant difference in healing or long-term joint mobility between simple shoulder dislocations treated conservatively versus surgically.<ref>{{cite journal | vauthors = Taylor F, Sims M, Theis JC, Herbison GP | title = Interventions for treating acute elbow dislocations in adults | journal = The Cochrane Database of Systematic Reviews | volume = 2012 | issue = 4 | pages = CD007908 | date = April 2012 | pmid = 22513954 | pmc = 6465046 | doi = 10.1002/14651858.CD007908.pub2 | collaboration = Cochrane Bone, Joint and Muscle Trauma Group }}</ref> Shorter immobilization periods are encouraged, with the goal of return to increased range-of-motion activities as soon as possible.<ref>{{cite journal | vauthors = Barco R, Gonzalez-Escobar S, Acerboni-Flores F, Vaquero-Picado A | title = Acute elbow dislocation: a critical appraisal of the literature | journal = JSES International | volume = 7 | issue = 6 | pages = 2560–2564 | date = November 2023 | pmid = 37969505 | pmc = 10638560 | doi = 10.1016/j.jseint.2023.03.019 }}</ref><ref name="Breulmann_2024">{{cite journal | vauthors = Breulmann FL, Lappen S, Ehmann Y, Bischofreiter M, Lacheta L, Siebenlist S | title = Treatment strategies for simple elbow dislocation - a systematic review | journal = BMC Musculoskeletal Disorders | volume = 25 | issue = 1 | pages = 148 | date = February 2024 | pmid = 38365699 | pmc = 10874000 | doi = 10.1186/s12891-024-07260-0 | doi-access = free }}</ref> Shorter immobilization periods is linked to increased ranges of motion in some joints.<ref name="Breulmann_2024" />

==== Rehabilitation ====
Muscles, tendons and ligaments around the joint should be strengthened. This is usually done through a course of [[physical therapy]], which will also help reduce the chances of repeated dislocations of the same joint.<ref name="pmid14564258">{{cite journal | vauthors = Itoi E, Hatakeyama Y, Kido T, Sato T, Minagawa H, Wakabayashi I, Kobayashi M | title = A new method of immobilization after traumatic anterior dislocation of the shoulder: a preliminary study | journal = Journal of Shoulder and Elbow Surgery | volume = 12 | issue = 5 | pages = 413–5 | date = 2003 | pmid = 14564258 | doi = 10.1016/s1058-2746(03)00171-x }}</ref> Take the shoulder for example. The most common treatment method for a dislocation of the shoulder joint is exercise based management.<ref>{{cite journal | vauthors = Warby SA, Pizzari T, Ford JJ, Hahne AJ, Watson L | title = The effect of exercise-based management for multidirectional instability of the glenohumeral joint: a systematic review | journal = Journal of Shoulder and Elbow Surgery | volume = 23 | issue = 1 | pages = 128–142 | date = January 2014 | pmid = 24331125 | doi = 10.1016/j.jse.2013.08.006 | doi-access = free }}</ref> For shoulder instability, the therapeutic program depends on specific characteristics of the instability pattern, severity, recurrence and direction with adaptations made based on the needs of the patient. In general, the therapeutic program should focus on restoration of strength, normalization of range of motion and optimization of flexibility and muscular performance. Throughout all stages of the rehabilitation program, it is important to take all related joints and structures into consideration.<ref>{{cite journal | vauthors = Cools AM, Borms D, Castelein B, Vanderstukken F, Johansson FR | title = Evidence-based rehabilitation of athletes with glenohumeral instability | journal = Knee Surgery, Sports Traumatology, Arthroscopy | volume = 24 | issue = 2 | pages = 382–389 | date = February 2016 | pmid = 26704789 | doi = 10.1007/s00167-015-3940-x | s2cid = 21227767 }}</ref>

=== Operative ===
Surgery is often considered in extensive injuries or after failure of conservative management with strengthening exercises.<ref name="McMahon_2021" /> The need for surgery will depend on the location of the dislocation and the extent of the injury. Different methods and techniques exist to stabilize the joint with surgery. One method is through the use of [[Arthroscopy|arthroscopic surgery]].<ref name="Dias_1987" />