Jumat, 10 November 2017

Dislocations - When There Is No Doctor

The bones that form a joint are normally congruous and in apposition to each other. When this relationship is altered due to injury, it leads to a separation of these bones, called a dislocation.

What you shouldn't do is as important as what you should when someone has suffered a dislocation. Let's discuss how to recognize when bones have gone astray, and the correct way to handle such an emergency.

A fracture is often mistaken for a dislocation especially if it occurs near a joint, such as the upper end of the thighbone (femur) which is near the hip joint, or the upper end of the arm bone (humerus) which is near the shoulder joint. What distinguishes the two is that a fracture is a break in the continuity of any one bone.

The elderly are more susceptible to dislocations because, with age, the muscles and ligaments that form the support system around the joints lose their tone, weakening their hold over the joints.

Other susceptible groups, especially for shoulder dislocation, are those involved in active sports like gymnastics and cricket (bowling and fielding).

SHOULDER DISLOCATION

This is the commonest site of dislocation because the socket of the shoulder joint is shallow compared to the other ball-and-socket joint - the hip, which is deeper and hence more stable. The cause is usually an injury, typically when, during a fall, the person lands on his outstretched hand (thus throwing his entire body weight on it) and the rest of his body is thrown backwards.

Symptoms:

When the two shoulders are compared, the affected one will appear flatter (the normal shoulder has a rounded outline) because the ball has shifted out its place.
There will be pain and swelling around the area, and the person will be unable to move the affected arm.
First Aid:
DO NOT

attempt to click the joint into place, especially if you are not trained in this, and the dislocation has occurred for the first time. In fact, do not even move the arm; let the person hold it in the position he finds most comfortable.
give anything by way of mouth, including a pain-killer (even if the person is yelling for it), in case anaesthesia is to be later administered at the hospital.
WHAT TO DO:
Your priority should be to transport the person to a hospital urgently. Sometimes if the circumflex nerve at the shoulder joint is injured, it could lead to paralysis of the deltoid muscles (of the shoulder), leading to an inability to raise the arm.

If time permits (while transport is being arranged) the affected hand could be supported by a cuff-and-collar sling, i.e. a bandage gauze going around the neck and the wrist, or by a triangular sling.

(At the hospital after an x-ray is taken, the bone will be set into position, very often under general anaesthesia.)

Recurrent dislocations of the shoulder, in which the shoulder keeps getting dislocated as a result of trivial injury or even an action which involves raising the arm above the shoulder are common. The reason is a tear in the tissue surrounding the joint which becomes a weak area through which the bone comes out easily.

As the frequency of such dislocations increases, the pain reduces to the point, where the person learns to click hi shoulder back into place without much ado.

HIP DISLOCATIONS

The hip joint has a deeper socket compared to the shoulder joint and has the body's strongest ligaments surrounding it, which is why it is inherently a very stable joint. But it may dislocate as a result of a high-velocity vehicular accident. If a person sits in the front seat of a vehicle with his legs crossed at the knee, when the dashboard hits against the knee, the force is transmitted from the knee along the thighbone to the hip joint which usually dislocates the hip joint.

Symptoms:

Severe pain in the area; the person will not be able to stand on the affected leg.
The leg will appear flexed (bent) at the knee and hip.
The limb may also appear shortened.
First Aid:
DO NOT:

attempt to click the joint into place or to move the leg in any way.
give the person anything to eat or drink in case he is required to be given anaesthesia later.
WHAT TO DO:
Immediately arrange to transport the person, lying on his back and preferably in an ambulance. If treatment is delayed and the surrounding blood vessels are disrupted, the blood supply to the ball of the hip joint may be permanently cut off, leading to early wear-and-tear of the hip joint and arthritis of the hip. If the dislocation is associated with an injury to the sciatic nerve which is in close proximity to the hip it could lead to a paralysis of the foot muscles or a foot-drop. (At the hospital, under general anaesthesia, the hip will be manipulated into position or surgery may be required.)

Usually a hip dislocation is non-recurrent except in the case of an associated fracture of the socket. (In this case, to prevent re-dislocation, the fractured socket has to be reconstructed by surgery.)

SPINAL DISLOCATIONS

As a result of injury, the spine could dislocate either at the cervix (back of the neck) or in the dorso-lumbar area (the junction of the middle and lower back). It may or may not be associated with neurological deficit (paralysis).

Symptoms:

Severe pain in the area.
If there is paralysis, there may be reduced sensation or a lack of sensation below the point of injury.
If the body is paralysed below the level of injury there will be a loss of bladder and bowel movement.
First Aid:
DO NOT

delay transportation in any way.
impart any movement to the spine.
WHAT TO DO
As soon as possible, rush the person to the hospital in the position that he is lying, as a change of position could worsen his condition. In the event of paralysis below the point of injury, early treatment plays a crucial role in ultimate recovery.

OTHER DISLOCATIONS

Other superficial dislocations include those of the elbow joint, finger joints and ankle joints.

Symptoms:

Pain, swelling and an inability to move the affected joints.

First Aid:

DO NOT

attempt to click the joint into place, however easy it may seem, as an injury to a nearby nerve or blood vessel during the process could bring on long-lasting complications or could produce a fracture of a nearby bone which was not initially present.
WHAT TO DO
The elbow joint may be placed in a triangular sling to provide support to it till the person can be taken to hospital.

In case of an ankle dislocation, the victim should not be made to walk or to exert any pressure on the affected leg. He should be carried to the transport and, later, from the vehicle to the hospital.

Finger joint dislocations may appear minor but they too need the attention of an orthopaedic surgeon who will usually click them into place under local anaesthesia. However, if there are complications involved, surgery may be required.

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