injuries and poisoning
Overview of Dislocations
Diagnosis of Dislocations
A doctor's evaluation X-rays to identify fractures Sometimes magnetic resonance imaging (MRI) or computed tomography (CT) If a dislocation occurs suddenly, people must decide whether to go to an emergency department, call their doctor, or wait and see whether the problem (pain, swelling, or other symptoms) goes away or lessens on its own. People should be taken to an emergency department, often by ambulance, if any of the following apply: The problem is obviously serious (for example, if it resulted from a car crash or if people cannot use the affected body part). They suspect that they have a severe dislocation or another severe soft-tissue injury. They suspect that they have a fracture (a possible exception is a toe or fingertip injury). They have several injuries. They have symptoms of a complication—for example, if they lose sensation in the affected body part, they cannot move the affected part normally, the skin feels cool or turns blue, or the affected part is weak. They cannot put any weight on or use the affected body part. An injured joint feels unstable. People should call a doctor when The injury causes pain or swelling, but they do not think the injured part is fractured or severely injured and they can move the joint normally If none of the above apply and the injury seems minor, people can call the doctor or wait and see whether the problem goes away on its own. If injuries result from a serious accident, the doctor's first priority is To check for severe injuries and complications, such as a disrupted blood flow, significant blood loss, an open wound, nerve damage, and Compartment Syndrome , which can develop when the blood supply to an injured limb is reduced or blocked If any of these injuries and complications are present, doctors treat them as needed, then continue with the Physical examination . Doctors ask the person (or a witness) to describe what happened. Often, the person does not remember how an injury occurred or cannot describe it accurately. Knowing how the injury occurred can help doctors determine the type of injury. Also, doctors ask in which direction the joint was stressed during the injury. Doctors also ask when the pain started. If it started immediately after the injury, the cause may be a dislocation, fracture, or a severe sprain. If the pain began hours to days later, the injury is usually minor. If the pain is more severe than expected for the injury or if the pain steadily worsens during the first hours after the injury, compartment syndrome may have developed or blood flow may be disrupted. The physical examination includes the following (in order of priority): Checking for damage to blood vessels near the injured body part Checking for damage to nerves near the injured part Checking for open wounds, joints that look misshapen, swelling, bruising, and impaired movement of the joint Examining and moving the injured part Examining the joints above and below the injured part To check for signs of blood vessel damage and disrupted blood flow, doctors check pulses and skin color and temperature. When blood flow is disrupted (as can occur in compartment syndrome), pulses eventually disappear or become weak and the skin becomes pale and cool. Doctors measure blood pressure, which is low in people who have lost a lot of blood. To check for nerve damage, doctors test whether the person can move muscles normally. If the person cannot move the affected muscles, the nerves that control those muscles (called motor nerves) may have been damaged. Doctors also evaluate sensation in the skin—whether the person can feel normally—and ask whether the person has abnormal sensations, such as a pins-and-needles sensation, tingling, or numbness. If sensations are abnormal or decreased, the nerves that are responsible for skin sensation (called sensory nerves) may have been damaged. Doctors gently feel the injured part to determine whether bones are out of place and whether the area is tender. Doctors also check for swelling and bruising. They ask whether the person can use, put weight on, and move the injured part. Doctors test the stability of a joint by gently moving it, but if a fracture or dislocation is possible, x-rays are done first to determine whether moving the joint is safe. Doctors check for grating or crackling sounds (crepitus) when the injured part is moved. These sounds may indicate a fracture. Moving the affected joint can also help doctors determine the severity of an injury. Doctors also check the joint above and below the injured joint. Stress testingmay be done to evaluate the stability of an injured joint. However, if a fracture or dislocation is suspected, stress testing is postponed until x-rays are done to check for these injuries. To stress a joint, doctors gently move the joint in a direction that is usually perpendicular to the joint's normal range of motion. If the joint feels very unstable, doctors suspect a dislocation (or a severe ligament injury). If pain or muscle spasms interfere with the examination, the person may be given a pain reliever and/or muscle relaxant by mouth or injection, or a local anesthetic may be injected into the injured area. Or doctors immobilize the injured joint until the spasm goes away (usually after a few days) and then examine the joint. Imaging tests used to diagnosis dislocations and other musculoskeletal injuries include X-rays None Computed tomography (CT) and magnetic resonance imaging (MRI) None Computed tomography (CT) and magnetic resonance imaging (MRI) None X-raysare useful for diagnosing dislocations, as well as fractures. X-rays are not useful for detecting injuries to ligaments, tendons, or muscles because they show only bones (and the fluid that collects around an injured joint). X-rays are usually taken from at least two angles to show how the bones are aligned. CTorMRImay be done to check for subtle fractures, which may accompany a dislocation. Other testsmay be done to check for other injuries that may result from a dislocation: Angiography (x-rays or CT scans taken after a contrast agent, which can be seen on x-rays, is injected into arteries) to check for damaged blood vessels Nerve conduction studies to check for damaged nerves (usually done as an outpatient procedure) 