Editing Joint dislocation (section)

==Diagnosis==
Initial evaluation of a suspected joint dislocation begins with a thorough patient history, including mechanism of injury, and physical examination. Special attention should be focused on the neurovascular exam both before and after [[Reduction (orthopedic surgery)|reduction]], as injury to these structures may occur during the injury or during the reduction process.<ref name="Skelley 246–255"/> Imaging studies are frequently obtained to assist with diagnosis and to determine the extent of injury.
[[File:Dislocated Finger XRay.png|thumb|Radiograph of right fifth finger dislocation]]

=== Imaging Types ===

==== [[X-ray]], usually a minimum of 2-views ====
* Generally, pre- and post-reduction X-rays are taken. Initial X-ray can confirm the dislocation and evaluate for any fractures. Post-reduction x-rays confirm successful joint alignment and can identify any injuries that may have been caused during the reduction procedure.<ref>{{cite journal | vauthors = Chong M, Karataglis D, Learmonth D | title = Survey of the management of acute traumatic first-time anterior shoulder dislocation among trauma clinicians in the UK | journal = Annals of the Royal College of Surgeons of England | volume = 88 | issue = 5 | pages = 454–458 | date = September 2006 | pmid = 17002849 | pmc = 1964698 | doi = 10.1308/003588406X117115 }}</ref>
* If initial X-rays are normal but additional injury is suspected, there may be a benefit of obtaining stress/weight-bearing views to look for injury to ligamentous structures and/or need for surgical intervention. One example is with [[Separated shoulder|AC joint separations.]]<ref>{{Cite web|url= https://radiopaedia.org/articles/acromioclavicular-injury |title=Acromioclavicular injury | work = Radiology Reference Article | publisher = Radiopaedia.org| vauthors = Gaillard F |language=en|access-date=21 February 2018}}</ref>

==== [[Ultrasound]] ====
* Ultrasound may be useful in an acute setting, and is a bedside test that can be performed in the Emergency Department. Ultrasound accuracy is dependent on user ability and experience. Ultrasound is nearly as effective as x-ray in detecting shoulder dislocations.<ref>{{cite journal | vauthors = Abbasi S, Molaie H, Hafezimoghadam P, Zare MA, Abbasi M, Rezai M, Farsi D | title = Diagnostic accuracy of ultrasonographic examination in the management of shoulder dislocation in the emergency department | journal = Annals of Emergency Medicine | volume = 62 | issue = 2 | pages = 170–175 | date = August 2013 | pmid = 23489654 | doi = 10.1016/j.annemergmed.2013.01.022 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Gottlieb M, Patel D, Marks A, Peksa GD | title = Ultrasound for the diagnosis of shoulder dislocation and reduction: A systematic review and meta-analysis | journal = Academic Emergency Medicine | volume = 29 | issue = 8 | pages = 999–1007 | date = August 2022 | pmid = 35094451 | doi = 10.1111/acem.14454 }}</ref> Ultrasound may also have utility in diagnosing AC joint dislocations.<ref>{{cite journal | vauthors = Heers G, Hedtmann A | title = Correlation of ultrasonographic findings to Tossy's and Rockwood's classification of acromioclavicular joint injuries | journal = Ultrasound in Medicine & Biology | volume = 31 | issue = 6 | pages = 725–732 | date = June 2005 | pmid = 15936487 | doi = 10.1016/j.ultrasmedbio.2005.03.002 }}</ref>
* In infants <6 months of age with suspected [[Hip dysplasia|developmental dysplasia of the hip]] (congenital hip dislocation), ultrasound is the imaging study of choice. This is due to the lack of ossification at this age, which will not be apparent on x-rays.<ref>{{Cite web|url=https://radiopaedia.org/articles/developmental-dysplasia-of-the-hip |title=Developmental dysplasia of the hip | work = Radiology Reference Article | publisher = Radiopaedia.org | vauthors = Gaillard F |date=2 May 2008 |language=en|access-date=21 February 2018}}</ref>

==== Cross-sectional imaging ([[CT scan|CT]] or [[Magnetic resonance imaging|MRI]]) ====
* X-rays are generally sufficient in confirming a joint dislocation. However, additional imaging can be used to better define and evaluate abnormalities that may be missed or unclear on plain X-rays. CT and MRI are not routinely used for simple dislocation, however CT is useful in certain cases such as hip dislocation where an occult [[femoral neck fracture]] is suspected .<ref name="Wolters Kluwer_2020" /> CT angiogram may be used if vascular injury is suspected.<ref name="Wolters Kluwer_2020" /> In addition to improved visualization of bony abnormalities, MRI permits for a more detailed inspection of the joint-supporting structures in order to assess for ligamentous and other soft tissue injury.

=== Classification ===
Dislocations can either be full, referred to as luxation, or partial, referred to as subluxation. Simple dislocations are dislocations without an associated fracture, while complex dislocations have an associated fracture.<ref name="Wolters Kluwer_2020">{{Cite book |title=Rockwood and Green's fractures in adults |date=2020 |publisher=Wolters Kluwer |isbn=978-1-4963-8651-9 | veditors = Tornetta P |edition=9th |location=Philadelphia }}</ref> Depending on the type of joint involved (i.e. ball-and-socket, hinge), the dislocation can further be classified by anatomical position, such as an anterior hip dislocation.<ref name="Wolters Kluwer_2020" /> Joint dislocations are named based on the distal component in relation to the proximal one.<ref>{{Cite web |title=Introduction to Trauma X-ray - Dislocation injury |url=https://www.radiologymasterclass.co.uk/tutorials/musculoskeletal/trauma/trauma_x-ray_page6 |access-date=15 February 2018 |website=www.radiologymasterclass.co.uk |language=en-US}}</ref>