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Joint dislocation

A joint dislocation occurs when the bones forming a joint are forced out of their normal anatomical positions, disrupting the joint's structure and function.^[1] This injury typically affects weight-bearing or highly mobile joints such as the shoulder, elbow, hip, knee, or fingers, and can be complete (full displacement) or partial (subluxation).^[2] It is considered a medical emergency due to the risk of associated damage to surrounding tissues.^[3] Joint dislocations most commonly result from high-impact trauma, including falls, motor vehicle accidents, or direct blows during contact sports.^[4] In children, partial dislocations like nursemaid's elbow (a subluxation of the radial head in the elbow) can occur from pulling on the arm.^[1] The shoulder is the most frequently dislocated joint in the body, owing to its wide range of motion and relative instability.^[5] Symptoms of a joint dislocation include intense pain that worsens with movement, significant swelling and bruising, visible deformity such as a bulge or unnatural angulation, and limited or complete loss of joint mobility.^[2] Additional signs may involve numbness, tingling, or weakness if nerves or blood vessels are compressed or damaged.^[1] Diagnosis typically involves a physical examination and imaging studies like X-rays to confirm the dislocation and rule out fractures.^[6] Treatment begins with immediate immobilization of the joint using a splint or sling to prevent further injury, followed by reduction (repositioning) of the bones by a healthcare professional, often under sedation or anesthesia.^[4] Post-reduction care includes rest, ice application, pain management, and physical therapy to restore strength and range of motion, with healing generally taking 6 to 12 weeks.^[1] In cases of recurrent dislocations or severe ligament tears, surgical intervention may be required to stabilize the joint.^[2] Complications from untreated or improperly managed dislocations can include nerve or vascular injuries leading to long-term numbness or circulation issues, and chronic instability.^[1] Additional risks include avascular necrosis (bone tissue death due to interrupted blood supply, particularly in hip dislocations)^[7] and increased risk of osteoarthritis.^[8] Prevention strategies emphasize protective equipment during sports, fall-proofing environments (especially for children and the elderly), and avoiding high-risk activities without proper training.^[4]

Definition and Anatomy

Definition

A joint dislocation, also known as luxation, is the complete separation of the articular surfaces at a joint where two or more bones meet, resulting in the displacement of the bones from their normal anatomical positions.^[9]^[10]^[1] This injury disrupts the normal alignment and function of the joint, often requiring prompt medical intervention to restore stability.^[11] The concept of joint dislocation has historical roots in ancient medicine, with the term first described in the works of Hippocrates, who provided detailed observations on the clinical signs and management of shoulder dislocations around the 5th century BCE.^[12]^[13] Joint dislocation must be differentiated from related conditions such as subluxation, which involves only partial separation of the joint surfaces without complete loss of contact between the bones.^[14]^[15] Unlike fractures, which entail a break or crack in the bone itself, or sprains, which are injuries to the ligaments supporting the joint without bone displacement, a dislocation specifically refers to the full derangement of the joint's articulating components.^[16]^[17] Dislocations are broadly classified into simple and complex types based on associated injuries. Simple dislocations involve no accompanying fractures and primarily affect the soft tissues around the joint, while complex dislocations are characterized by the presence of one or more fractures involving the bones of the joint.^[18]^[19]^[20]

Joint Anatomy Relevant to Dislocation

Synovial joints, the most common type in the human body, consist of articular surfaces covered by hyaline cartilage, a fibrous joint capsule enclosing the joint cavity, and an inner synovial membrane that secretes lubricating synovial fluid.^[21] The capsule, reinforced by ligaments, provides containment and passive restraint to joint motion, while additional structures like the labrum—a fibrocartilaginous rim deepening the articular socket—enhance stability in certain joints, such as the glenoid labrum in the shoulder that extends the glenoid fossa to better accommodate the humeral head.^[22] Muscles and tendons surrounding the joint contribute to its dynamic support, compressing the articular surfaces during movement.^[23] Joint stability arises from a combination of static and dynamic stabilizers. Static stabilizers include the joint capsule, ligaments, and bony architecture, which passively limit excessive translation or rotation by providing tensile resistance.^[24] Dynamic stabilizers, primarily muscles and their tendons, actively modulate joint position through contraction, generating compressive forces that centralize the joint surfaces and counteract destabilizing loads.^[25] Vulnerable synovial joints include ball-and-socket types like the shoulder (glenohumeral joint), where the rounded humeral head articulates with the shallow glenoid fossa of the scapula, allowing extensive motion but inherent instability, and the hip, where the femoral head fits into the deeper acetabulum of the pelvis for greater inherent congruence.^[26] In contrast, hinge joints such as the elbow (humeroulnar articulation) and knee (tibiofemoral joint) permit primarily uniaxial flexion-extension, with the elbow's trochlea-groove interface and the knee's condylar shapes providing more constrained motion through interlocking bony contours.^[27] The degree of joint congruence—the closeness of fit between articular surfaces—and socket depth significantly influence resistance to dislocation by promoting a compressive mechanism that resists translational forces.^[28] Shallower, less congruent joints like the shoulder rely more on soft tissues for stability, whereas deeper, more congruent ones like the hip offer greater bony resistance to displacement.^[29]

Pathophysiology

Mechanisms of Injury

Joint dislocation arises from biomechanical forces that exceed the structural integrity of the joint's stabilizing elements, resulting in the complete separation of articular surfaces. These forces can be categorized into direct trauma, where impact is applied perpendicular to the joint axis; indirect forces, involving leverage or torque transmitted through adjacent structures; and high-energy impacts that combine multiple vectors to disrupt stability. The direction of dislocation—such as anterior, posterior, or lateral—depends on the orientation of the applied force relative to the joint's anatomy, with the humeral head in the shoulder, for instance, more prone to anterior displacement due to its shallow glenoid fossa.^[5]^[30] In the pathophysiological sequence, initial force application stretches the joint capsule and ligaments, leading to plastic deformation or rupture when thresholds are surpassed. This is followed by loss of articular congruity, allowing bone ends to impinge or subluxate, potentially causing fractures like Hill-Sachs lesions in the shoulder from posterior humeral head impact against the glenoid rim. Ligamentous tears, such as the anterior inferior glenohumeral ligament in anterior shoulder dislocations, occur sequentially under tension, with associated soft tissue damage like labral avulsions contributing to instability. For the elbow, valgus or varus forces in extension initiate medial collateral ligament disruption, progressing to posterior olecranon dislocation via posterolateral rotatory instability, with the lateral collateral ligament complex typically failing first through avulsion from the lateral epicondyle.^[30]^[5]^[31] Force vectors play a critical role in determining the injury pattern, with axial loading compressing the joint along its long axis, rotational torque twisting stabilizers beyond their yield point, and hyperabduction or hyperextension leveraging the joint into extreme positions. In the knee, anterior dislocation often results from hyperextension forces exceeding 30 degrees, rupturing the posterior capsule and posterior cruciate ligament in sequence, while varus or valgus vectors in the elbow or knee drive lateral or medial shifts. These mechanisms highlight the interplay of magnitude, direction, and velocity of forces in overcoming static constraints like ligaments and dynamic ones like muscle tension.^[32]^[31]^[5]

Associated Soft Tissue Damage

Joint dislocations frequently involve concurrent injuries to surrounding soft tissues, such as ligaments, muscles, tendons, nerves, and blood vessels, due to the disruptive forces that cause the joint displacement. These injuries can significantly complicate management and contribute to immediate risks like instability or compromised circulation. For instance, in anterior shoulder dislocations, associated soft tissue damage occurs in up to 40% of cases, including labral tears and neurovascular involvement.^[5] Ligamentous tears are among the most common associated injuries, often leading to joint instability if not addressed. A classic example is the Bankart lesion, an anteroinferior glenoid labral tear, which affects approximately 59% of first-time anterior shoulder dislocations and disrupts the primary stabilizer of the glenohumeral joint.^[33] In elbow dislocations, the lateral collateral ligament complex typically fails first through avulsion from the lateral epicondyle. Knee dislocations commonly feature multiligamentous disruption, often involving the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL), which can result in profound knee instability.^[34] Muscle and tendon avulsions further exacerbate soft tissue damage and functional impairment. In the shoulder, humeral avulsion of the glenohumeral ligament (HAGL) lesions tear the inferior glenohumeral ligament from its humeral attachment, contributing to anteroinferior instability and seen in a subset of traumatic dislocations.^[35] Rotator cuff tears accompany up to 40% of anterior shoulder dislocations, particularly in older patients, leading to impaired shoulder mechanics.^[5] Knee dislocations may involve patellar tendon ruptures or periarticular muscle avulsions, adding to the overall soft tissue compromise.^[34] Neurovascular injuries represent a critical subset of associated damage, with potential for immediate pathophysiological consequences like ischemia or neurological deficits. The axillary nerve is compromised in over 40% of shoulder dislocations, often through stretch during humeral head displacement, resulting in deltoid weakness and sensory loss over the lateral shoulder if unresolved.^[5] In elbow dislocations, ulnar nerve stretch injuries occur due to traction, while brachial artery damage, though infrequent (0.3-1.7% incidence), can cause arterial occlusion and limb ischemia from intimal tears or thrombosis.^[36] Knee dislocations carry a 5-15% risk of popliteal artery injury and over 20% incidence of peroneal nerve damage, where vascular compromise may lead to tissue necrosis and amputation if ischemia persists beyond 6-8 hours.^[34] These soft tissue injuries collectively heighten the risk of recurrent instability from ligamentous laxity and ischemic events from vascular disruption, underscoring the need for thorough assessment to mitigate acute and subacute morbidity.^[5]

Clinical Presentation

Signs and Symptoms

Joint dislocations typically present with acute, severe pain at the affected site, often described as intense and exacerbated by any attempt to move the joint. This pain arises immediately following the injury and may radiate to surrounding areas due to associated muscle spasms or soft tissue involvement.^[10]^[14] Swelling and bruising are common early signs, resulting from hemorrhage and inflammatory response in the periarticular tissues. The affected joint often appears deformed, with visible asymmetry or an unnatural positioning of the limb, such as a squared-off contour in shoulder dislocations. Limited range of motion is nearly universal, leading to functional impairment where the patient cannot bear weight or use the limb effectively.^[10]^[14]^[37] Physical examination reveals tenderness to palpation over the joint, and in some cases, crepitus may be elicited during gentle movement if there is concurrent soft tissue or bony disruption. A palpable abnormality, such as a step-off or abnormal prominence, can often be detected at the joint line, confirming the displacement of articular surfaces. Patients may report numbness, tingling, or paresthesia if nearby nerves are stretched or compressed.^[14]^[10] The clinical history usually includes a sudden onset linked to high-impact trauma, such as a fall, sports injury, or motor vehicle accident, with the patient able to describe the mechanism of injury, like a direct blow or twisting force.^[10]^[14] Variations in presentation occur depending on the joint involved. For example, in hip dislocations, the leg often appears shortened and internally or externally rotated, with severe pain preventing any weight-bearing. In contrast, finger dislocations may manifest as obvious shortening or overlap of the digit, with localized swelling and pain limiting grip or extension.^[8]^[38]

Immediate Complications

Joint dislocations can precipitate immediate vascular complications, most notably arterial occlusion that compromises blood flow and leads to ischemia. In knee dislocations, the popliteal artery is particularly vulnerable, with injury rates ranging from 18% to 40% depending on the mechanism and energy of trauma.^[39] Such injuries often result from intimal tears, thrombosis, or transection, necessitating urgent vascular assessment and intervention to restore perfusion and avert limb-threatening ischemia.^[34] Prompt recognition is critical, as delays beyond 6-8 hours of ischemia can cause irreversible tissue damage or necessitate amputation.^[40] Neurological complications arise from direct nerve stretch, compression, or laceration during the dislocation event. In elbow dislocations, the ulnar nerve is the most commonly injured due to its proximity to the medial structures, with overall nerve injury rates up to 20% (ulnar comprising ~70% of cases).^[19]^[41] Similarly, wrist dislocations, such as perilunate injuries, can entrap or stretch the median nerve, leading to acute sensory and motor deficits in the hand.^[42] High-energy dislocations overall carry a 10-40% risk of peroneal or other nerve involvement, particularly in the knee, where common peroneal nerve palsy manifests as foot drop and sensory loss.^[43] These injuries demand immediate neurovascular examination post-reduction to mitigate permanent deficits.^[44] Additional immediate complications include compartment syndrome, hemarthrosis, and associated fractures. Compartment syndrome, often secondary to vascular injury or swelling in knee dislocations, elevates intracompartmental pressures, risking muscle necrosis if not decompressed emergently via fasciotomy.^[45] Hemarthrosis, the accumulation of blood within the joint capsule, frequently accompanies dislocations with capsular tears or fractures, causing acute swelling and pain that may obscure underlying damage.^[46] Associated fractures, such as avulsion or condylar types in elbow or knee dislocations, occur in up to 50% of cases and exacerbate instability while increasing the likelihood of neurovascular compromise.^[47] In high-energy scenarios, neurovascular injury rates approach 10-20%, underscoring the need for rapid multidisciplinary intervention to preserve limb function.^[43]

Causes and Risk Factors

Traumatic Causes

Traumatic causes of joint dislocation typically arise from sudden, forceful external impacts or movements that exceed the joint's normal range of motion, often exploiting underlying joint laxity. These events can be broadly categorized by the nature of the activity or incident involved, with high-energy traumas delivering greater force and low-energy ones relying on repetitive or convulsive actions. In sports-related incidents, joint dislocations frequently occur due to direct blows or extreme positioning during play. For instance, shoulder dislocations are common in contact sports like rugby, where tackles or falls onto an outstretched arm apply anterior force to the glenohumeral joint. Similarly, falls during skiing or gymnastics can lead to elbow or wrist dislocations from hyperextension or axial loading, as seen in high-impact landings or collisions. Accidental traumas, such as motor vehicle collisions, represent a major cause of joint dislocations, particularly in high-energy scenarios. The "dashboard injury" in frontal car crashes often results in posterior knee dislocations due to the tibia being driven backward against the femur. Falls from height, another common accident, can cause hip or ankle dislocations through vertical compressive forces upon impact. Occupational hazards in manual labor contribute to dislocations via acute overload on repetitively stressed joints. Workers in construction or manufacturing may experience shoulder or finger dislocations from sudden heavy lifting or machinery entanglement, where cumulative strain culminates in a traumatic event. Distinctions between high-energy and low-energy traumas highlight varying mechanisms, though both can precipitate dislocations. High-energy examples include blasts or severe falls, leading to multi-joint involvement, while low-energy events like grand mal seizures can cause bilateral shoulder dislocations from uncontrolled muscle contractions.

Predisposing Factors

Joint hyperlaxity is a key anatomical predisposing factor for joint dislocation, characterized by excessive elasticity in ligaments and connective tissues that reduces joint stability. Conditions such as Ehlers-Danlos syndrome (EDS), a group of heritable connective tissue disorders, significantly elevate the risk due to inherently fragile and hypermobile joints, leading to frequent subluxations or dislocations, particularly in the shoulders, elbows, and knees.^[48]^[49] In EDS, joint dislocations can occur with minimal trauma or even spontaneously, complicating management and increasing the likelihood of early-onset arthritis.^[50] Similarly, structural variations like a shallow glenoid fossa in the shoulder joint diminish the articulating surface area for the humeral head, promoting instability and recurrent anterior dislocations by allowing greater translation of the joint surfaces.^[5]^[51] Demographic factors also influence susceptibility; although overall shoulder dislocation incidence is higher in males, females exhibit greater ligamentous laxity, which contributes to a higher predisposition to certain types such as multidirectional instability (MDI), often linked to overhead activities.^[52] This laxity contributes to a higher prevalence of atraumatic or low-energy dislocations in women, though traumatic events can exacerbate the risk. Age-related changes further compound vulnerability; for instance, osteoporosis in older adults weakens the acetabular bone structure, increasing the likelihood of hip dislocations during falls by facilitating acetabular rim fractures or posterior wall disruptions.^[53]^[54] A history of prior joint dislocation markedly heightens the risk of recurrence, often by 50-90% in younger patients due to residual capsuloligamentous laxity, labral damage, or bony defects that impair healing and joint congruence.^[55] In shoulders, for example, individuals under 20 years old face recurrence rates of 72-100% after initial conservative management, while those aged 20-30 years experience 70-82%, underscoring the impact of incomplete tissue repair on future stability.^[55] Iatrogenic and congenital factors represent additional predispositions; post-surgical instability, such as after total hip arthroplasty (THA) or shoulder stabilization procedures, can lead to dislocations if implant positioning, soft tissue balancing, or neuromuscular control is suboptimal, with revision surgeries carrying up to a 28% dislocation rate.^[56]^[57] Congenital conditions like developmental dysplasia of the hip (DDH) structurally predispose to dislocation by creating a shallow acetabulum that fails to adequately contain the femoral head, with untreated cases risking progressive subluxation and early osteoarthritis.^[58]^[59]

Diagnosis

Clinical Evaluation

The clinical evaluation of joint dislocation begins with a thorough history to identify potential risk factors and the circumstances surrounding the injury. Patients typically report a traumatic mechanism, such as a fall, direct impact, or hyperextension, which displaces the articular surfaces beyond their normal range.^[60] The onset of severe pain is usually immediate and acute, often accompanied by a sensation of the joint "popping out," particularly in dislocations of the shoulder or elbow.^[61] Inquiry into prior dislocations is essential, as recurrent episodes increase suspicion for underlying instability, with patients who have experienced previous events being more prone to redislocation.^[61] Comorbidities, such as ligamentous laxity, obesity, or connective tissue disorders, should also be assessed, as they predispose individuals to injury, especially in low-energy scenarios like sports participation.^[34] Physical examination follows, prioritizing a systematic approach to confirm suspicion of dislocation while assessing for associated injuries. Inspection reveals obvious deformity, such as an abducted and externally rotated arm in anterior shoulder dislocation or a shortened forearm in posterior elbow dislocation, along with swelling, ecchymosis, or open wounds.^[61]^[62] Palpation identifies tenderness over the joint, crepitus indicating possible fracture, or abnormal prominence of the dislocated bone, such as the humeral head anteriorly in the shoulder.^[60] A comprehensive neurovascular assessment is critical, evaluating distal pulses, capillary refill, sensation, and motor function to detect compromise, which occurs in up to 40% of shoulder dislocations due to axillary nerve involvement and over 20% of knee dislocations affecting the peroneal nerve.^[5]^[34] Special tests help assess joint stability and guide differential diagnosis. For suspected shoulder dislocation, the apprehension test involves abducting and externally rotating the arm while applying anterior pressure; a positive response of patient discomfort or resistance indicates instability.^[63] In knee dislocations, the Lachman test—drawing the tibia anteriorly with the knee flexed at 20–30 degrees—evaluates anterior cruciate ligament integrity, while varus and valgus stress tests at 0° and 30° flexion assess medial and lateral collateral ligaments to detect multidirectional laxity.^[34] These maneuvers aid in differentiating dislocation from fracture or sprain by checking for abnormal translation or end-point stability, though they should be performed cautiously to avoid exacerbating injury.^[60] Symptoms such as severe pain and loss of function, as noted in clinical presentation, direct the focus of these exams.^[60]

Diagnostic Imaging

Plain radiography serves as the initial and primary imaging modality for suspected joint dislocations, providing essential confirmation of articular displacement and screening for associated fractures. Standard protocols recommend obtaining at least two orthogonal views, such as anteroposterior (AP) and lateral projections, to accurately assess the direction and degree of dislocation while minimizing the risk of missing subtle bony injuries.^[64] This approach is particularly effective in common sites like the shoulder and elbow, where AP and scapular Y views can delineate anterior or posterior humeral head displacement relative to the glenoid.^[65] For cases involving complex anatomy, subtle dislocations, or intra-articular fractures, computed tomography (CT) offers superior multiplanar reconstruction and bone detail, enabling precise evaluation of fragment alignment and joint congruity.^[66] CT is especially indicated when plain films are inconclusive, such as in posterior hip dislocations or elbow fracture-dislocations, where it can reveal occult fractures or entrapment that alter management.^[67] In knee dislocations, given the high risk of popliteal artery injury (up to 40%), vascular imaging such as CT angiography or conventional angiography is often indicated, even if distal pulses are palpable, to detect intimal flaps or occlusion.^[34] Magnetic resonance imaging (MRI) excels in delineating soft tissue pathology accompanying dislocations, including labral tears, capsular disruptions, and ligamentous injuries that are not visible on radiography or CT.^[66] In shoulder dislocations, for instance, MRI can quantify glenoid bone loss or identify Bankart lesions, providing critical insights into instability mechanisms.^[67] MR arthrography enhances sensitivity for intra-articular pathology by distending the joint capsule.^[68] Ultrasound is a valuable adjunct, particularly in pediatric populations, for its non-ionizing nature and ability to perform dynamic assessments of joint reduction and stability.^[69] It is commonly employed for neonatal or infant hip dislocations to evaluate femoral head position and acetabular morphology without radiation exposure.^[70] Classification systems derived from imaging facilitate standardized diagnosis and prognostic assessment. In shoulder fracture-dislocations, the Neer classification delineates injury severity by the number of displaced segments (humeral head, shaft, greater and lesser tuberosities), with distinctions between anterior and posterior patterns guiding reduction strategies.^[71] For acromioclavicular joint dislocations, the Rockwood classification uses radiographic displacement metrics to grade injury from type I (ligament sprain) to type VI (severe inferior displacement), based on coracoclavicular ligament integrity.^[72] Recent advancements in 3D CT reconstruction have improved diagnostic precision and preoperative planning for complex dislocations, offering volumetric models that enhance fracture pattern visualization over traditional 2D imaging. A 2025 systematic review of 3D imaging for complex limb fractures reported a 32% increase in diagnostic accuracy using 3D CT techniques compared to 2D imaging; 56% of included studies utilized CT scans.^[73]

Management

Non-Surgical Approaches

Non-surgical approaches to joint dislocation management are indicated for uncomplicated cases where the joint can be successfully reduced without evidence of associated fractures, soft tissue interposition, or neurovascular compromise, as determined by initial clinical assessment and imaging.^[74] These methods prioritize closed reduction to restore joint alignment, followed by immobilization and structured rehabilitation to promote healing and stability while minimizing complications such as stiffness or recurrent instability.^[37] Such conservative strategies are particularly suitable for simple traumatic dislocations in joints like the shoulder, hip, and elbow, where prompt intervention can achieve favorable outcomes without operative intervention.^[75] Initial reduction involves closed techniques performed under sedation or general anesthesia to relax muscles and alleviate pain, ensuring atraumatic realignment. For anterior shoulder dislocations, common methods include the Stimson technique, where the patient is positioned prone with the arm hanging freely over the edge of a table while gentle traction is applied, or the traction-countertraction method using a sheet around the torso for counterforce.^[76] In hip dislocations, typically posterior, reduction employs in-line traction with the patient supine, combined with external rotation and adduction of the hip to maneuver the femoral head back into the acetabulum.^[8] For elbow dislocations, a similar traction-countertraction approach is used, with the arm extended and gentle longitudinal pull applied while an assistant stabilizes the humerus.^[77] Post-reduction imaging, such as X-rays or CT scans, confirms proper joint congruence before proceeding to immobilization.^[8] Following successful reduction, immobilization stabilizes the joint to allow soft tissue healing and prevent re-dislocation, with the duration and type varying by joint and patient factors. Shoulder dislocations are commonly managed with a sling in internal rotation for 2 to 3 weeks, though some protocols extend to 3 to 6 weeks for younger patients to reduce recurrence risk.^[37] Hip reductions often require 6 to 8 weeks of non-weight-bearing or toe-touch weight-bearing using crutches, sometimes with a brace to maintain position.^[8] Splints or casts are used for smaller joints like the elbow, typically for 1 to 3 weeks, to protect against early motion-induced instability.^[75] During this phase, pain control with ice, elevation, and nonsteroidal anti-inflammatory drugs supports comfort and reduces swelling.^[37] Rehabilitation begins after the initial immobilization period, emphasizing gradual restoration of range of motion and strength to enhance joint stability. Early passive motion exercises, guided by physical therapy, are introduced to prevent adhesions, progressing to active-assisted and then active strengthening focused on surrounding musculature—such as rotator cuff exercises for the shoulder.^[37] For the hip, therapy includes protected weight-bearing progression and gluteal strengthening to improve gait and function.^[8] Protocols typically span 6 to 12 weeks, with emphasis on proprioceptive training to mitigate future injury risk in active individuals.^[78] If significant instability or associated injuries emerge during follow-up, surgical evaluation may be warranted.^[79]

Surgical Interventions

Surgical interventions are indicated for joint dislocations that cannot be managed conservatively, particularly irreducible cases where closed reduction fails due to soft tissue interposition or mechanical blockade.^[80] Associated fractures, such as fracture-dislocations of the shoulder or elbow, necessitate surgery to achieve stable alignment and prevent avascular necrosis.^[81] Neurovascular injuries, including vascular compromise in posterior hip dislocations or nerve entrapment in elbow cases, require urgent operative exploration and repair to restore perfusion and function.^[82] Recurrent dislocations, often seen in the shoulder after initial conservative management, warrant surgical stabilization to address underlying instability from labral tears or capsular laxity.^[6] Common procedures include open reduction, which involves direct visualization to relocate the joint and address entrapped structures, followed by internal fixation if fractures are present.^[83] Capsulorrhaphy tightens the joint capsule to restore stability, particularly in chronic shoulder instability.^[84] Ligament reconstruction techniques, such as the Bankart repair for anterior shoulder dislocations, reattach the detached anteroinferior labrum to the glenoid rim using sutures or anchors, often performed arthroscopically to minimize tissue disruption.^[85] For acromioclavicular (AC) joint dislocations, coracoclavicular ligament reconstruction with autografts or synthetic ligaments provides robust stabilization in high-grade injuries.^[86] Arthroscopic advances have transformed surgical management, enabling minimally invasive repairs through small portals with high-definition visualization, which reduces postoperative pain and scarring compared to open techniques.^[87] A 2025 review highlights improved outcomes in shoulder girdle stabilizations using arthroscopic methods, allowing return to light activities within 1-6 weeks with reduced pain and enhanced function due to avoidance of large incisions.^[88] Arthroscopically assisted AC joint stabilizations have increased in prevalence, rising from 19.6% in 2013 to 37.5% in 2023, demonstrating equivalent efficacy to open methods with lower complication profiles.^[89] Postoperative care typically involves immobilization with slings or braces for 4-6 weeks to protect repairs, followed by progressive physical therapy.^[90] Hardware such as bioabsorbable screws, suture anchors, or locking plates is commonly used for fixation, providing biomechanical stability while allowing eventual resorption in some cases to avoid secondary removal.^[91] Infection risks remain low at 1-2% in clean elective procedures, managed through prophylactic antibiotics and sterile techniques, though higher in open trauma cases with contamination.^[92] Initial closed reduction attempts precede surgery in reducible dislocations but are referenced here only to underscore the transition to operative care when they prove insufficient.^[80]

Prevention

Injury Prevention Strategies

Protective equipment plays a crucial role in mitigating the risk of joint dislocations during sports and high-impact activities. Helmets, shoulder pads, and knee braces absorb and distribute forces that could otherwise displace joints, particularly in contact sports like rugby and football. For instance, specialized shoulder braces, such as the S2 Shoulder Stabilizer, enhance glenohumeral joint stability during overhead or tackling movements, reducing anterior dislocation risk in athletes.^[93] The quality of such gear, including proper fitting, has been shown to improve overall safety by preventing traumatic impacts from reaching vulnerable joint structures.^[94]^[10] Training programs emphasizing balance and proprioception exercises are effective for building joint stability in at-risk populations, such as athletes or individuals with mild ligamentous laxity. These programs typically include activities like single-leg balance on unstable surfaces, wobble board drills, or closed-chain exercises that improve neuromuscular feedback and joint position sense, thereby decreasing the likelihood of dislocations in the shoulder, knee, or ankle.^[95] Consistent strength training at moderate intensity further refines proprioceptive acuity, allowing better control during dynamic movements.^[96] Such targeted regimens, when integrated into routine fitness, address inherent vulnerabilities without requiring advanced equipment. Environmental modifications are vital for preventing falls and occupational hazards that precipitate joint dislocations, especially among the elderly and workers in manual labor roles. In homes, installing grab bars near bathtubs, removing loose rugs, and ensuring adequate lighting reduce tripping risks that commonly lead to hip or shoulder displacements.^[97] Occupational ergonomics, including adjustable workstations and tools designed for neutral wrist and elbow positions, minimize repetitive strain that can culminate in elbow or wrist joint trauma.^[98] These adaptations, often guided by professional assessments, promote safer movement patterns across daily environments.^[99]^[100] Public health initiatives from organizations like the World Health Organization (WHO) advocate for broad trauma prevention in high-risk activities through education and policy. WHO guidelines emphasize community-level interventions, such as promoting safety standards in sports and workplaces, to curb injury incidence from falls, collisions, and overexertion—common precursors to joint dislocations.^[101] These strategies include awareness campaigns on equipment use and risk assessment in vulnerable groups, fostering a preventive culture that targets modifiable environmental and behavioral factors.^[102]

Post-Injury Preventive Measures

Following an initial joint dislocation, particularly in the shoulder, preventive measures focus on reducing the risk of recurrence through targeted rehabilitation and behavioral adjustments. Without such interventions, recurrence rates can range from 50% to over 90% in younger patients or those engaging in high-demand activities, depending on factors like age and sport involvement.^[103]^[55]^[104] Strengthening protocols form a cornerstone of secondary prevention, emphasizing exercises to enhance dynamic stability around the affected joint. For shoulder dislocations, rotator cuff strengthening—such as side-lying external rotation, prone horizontal abduction, and internal/external rotation with resistance bands—is typically prescribed, progressing from isometric holds to dynamic loads over several months. These protocols often span 6 to 12 weeks initially for basic muscle activation and mobility, extending to 6-12 months of supervised or home-based maintenance to rebuild proprioception and prevent instability.^[105]^[106]^[103] Activity modification involves consciously avoiding positions that predispose the joint to redislocation, allowing tissues to heal while maintaining function. In the shoulder, this includes steering clear of extreme abduction combined with external rotation, a common mechanism for anterior instability, through adjustments in daily tasks or sport-specific techniques. Such modifications, integrated into rehabilitation, help patients gradually resume activities without compromising joint integrity.^[107]^[108] For athletes returning to sport, functional bracing provides external support to limit risky motions during the transition phase. These braces, often custom-fitted to restrict excessive abduction or rotation, have been shown in some studies to facilitate earlier and safer return to play, though evidence on their impact on long-term recurrence varies. Bracing is typically used for 4-6 weeks post-rehabilitation or as needed during high-risk activities.^[93]^[109] Ongoing monitoring through regular follow-up appointments is essential to detect early signs of instability, such as apprehension during movement or subtle laxity. Clinicians assess progress via physical exams and, if indicated, imaging to guide adjustments in protocols; this proactive approach can mitigate the 20-50% recurrence risk observed in non-compliant or unmonitored cases. For individuals at high risk of recurrence despite conservative measures, surgical options like stabilization procedures may be considered, as detailed in relevant management sections.^[37]^[110]

Prognosis and Outcomes

Recovery Factors

Several factors influence the short-term recovery success following joint dislocation, including patient demographics, injury characteristics, and treatment timing. Prompt reduction of the dislocation, ideally within 6 hours for high-risk joints like the hip, significantly improves outcomes by minimizing complications such as avascular necrosis.^[111] Younger age is associated with faster healing due to better tissue regeneration and compliance with rehabilitation, whereas older patients may experience prolonged recovery owing to reduced physiological resilience.^[112] The absence of associated fractures or soft tissue injuries also facilitates quicker return to function, as simple dislocations require less extensive intervention.^[113] Conversely, delayed treatment beyond the optimal window exacerbates damage to surrounding structures, leading to poorer short-term results. High-energy trauma, such as that from motor vehicle accidents, often involves concomitant ligamentous or neurovascular injuries, complicating recovery and extending immobilization periods. Poor patient compliance with prescribed rehabilitation protocols can hinder progress, resulting in persistent stiffness or weakness.^[10]^[114] Recovery outcomes vary by joint type, with smaller joints like those in the fingers generally yielding better short-term results due to simpler anatomy and lower complication rates; for instance, stable proximal interphalangeal joint dislocations often achieve full function within 3 to 6 weeks after reduction and buddy taping. In contrast, larger weight-bearing joints such as the hip carry a higher risk of avascular necrosis if reduction is delayed, potentially delaying functional recovery for several months. The elbow typically returns to full motion in 4 to 6 weeks with initial immobilization followed by therapy, while shoulder dislocations may require 3 to 6 months for complete restoration, influenced by the extent of capsulolabral damage.^[38]^[111]^[19]^[115]

Long-Term Prognosis

The long-term prognosis following joint dislocation varies by joint type, patient age, and treatment approach, with shoulder and hip dislocations serving as common examples of potential chronic sequelae. In the shoulder, untreated anterior dislocations in young adults under 20 years old carry recurrence rates of 80-90%, often leading to persistent instability over years or decades.^[116] Surgical interventions, such as arthroscopic Bankart repair, significantly lower these rates to 9.6-23% at long-term follow-up, thereby mitigating the cycle of repeated episodes that exacerbate joint damage.^[117] Degenerative changes represent a major long-term concern, particularly post-traumatic osteoarthritis (PTOA), which develops due to cartilage erosion and altered joint mechanics. For hip dislocations, PTOA incidence reaches up to 19% in affected individuals, with higher rates (up to 88% in complicated cases) linked to associated fractures or delays in reduction.^[118]^[119] In the shoulder, recurrent instability correlates with glenohumeral osteoarthritis, influenced by factors like bone loss and multiple dislocations, with studies reporting an incidence of 20-56% in cases of recurrent instability, depending on follow-up and severity.^[120]^[121] These changes typically manifest 10-25 years post-injury, contributing to stiffness and pain that may necessitate joint replacement in severe instances.^[122] Functional impacts often include chronic instability, reduced range of motion, and diminished athletic or occupational performance, with untreated cases leading to ongoing pain and potential disability. For instance, persistent shoulder subluxation can limit overhead activities and cause muscle atrophy, while hip involvement may impair gait and weight-bearing, affecting quality of life over decades.^[123]^[124] Recent studies emphasize improved prognoses with early arthroscopic intervention. This approach, supported by 2025 analyses, highlights a potential 15-20% relative decrease in long-term degenerative complications through timely repair.^[125]

Epidemiology

Incidence Rates

Shoulder dislocations represent the most common type, accounting for about 50% of all major joint dislocations reported in emergency settings.^[126]^[127] This predominance is attributed to the shoulder's inherent instability, making it particularly susceptible to traumatic forces. The incidence of shoulder dislocations is approximately 23.9 to 25.2 per 100,000 person-years, with global estimates from the Global Burden of Disease study indicating a crude incidence of 75.54 per 100,000 in 2019.^[126]^[127]^[128] In contrast, other joints exhibit lower frequencies.^[129] Joint-specific incidence rates highlight distinct patterns of occurrence. Hip dislocations are rare, comprising approximately 2-5% of all joint dislocation cases.^[130]^[131] They are often associated with high-energy trauma and significant morbidity, including risks of avascular necrosis and concomitant injuries.^[118] Elbow dislocations represent 10-20% of upper limb dislocations, with an estimated incidence of 5 to 6 cases per 100,000 person-years, often resulting from falls or sports-related impacts.^[41]^[132] These rates underscore the relative rarity of lower limb dislocations compared to upper limb ones in non-traumatic contexts. Trends indicate a rising incidence of joint dislocations in sports participation, particularly in contact activities where repetitive high-impact forces increase vulnerability. For instance, in American football, shoulder dislocations contribute significantly to injury profiles, with studies reporting elevated risks during games compared to practices, though exact annual player-level risks vary by position and level of play.^[133]^[127] Globally, incidence rates are higher in trauma-heavy regions such as low- and middle-income countries, where road traffic accidents and interpersonal violence drive elevated frequencies, often exceeding 75 per 100,000 for shoulder dislocations alone in some estimates.^[134] These variations briefly intersect with demographic factors like age and sex, which are explored in greater detail elsewhere.^[128]

Demographic Variations

Joint dislocations exhibit distinct patterns across demographic groups, with incidence and presentation varying significantly by age, sex, and population characteristics. In terms of age, the highest rates occur among young adults aged 15-30 years, primarily due to sports-related trauma, such as shoulder dislocations in adolescents and college athletes.^[135] For instance, shoulder dislocations peak in the 15-20 age group among males involved in contact sports.^[136] In contrast, elderly individuals over 65 years face elevated risk for hip dislocations, often resulting from low-energy falls, where even a simple fall from standing height can cause displacement in geriatric hips due to reduced bone density and ligament integrity.^[137] Overall incidence of hip dislocations shows a secondary rise in older age groups following a decline after young adulthood.^[138] Sex differences are pronounced, with males experiencing higher rates of traumatic dislocations at a ratio of approximately 2:1 compared to females, particularly in sports and high-impact injuries like shoulder and hip dislocations.^[139] For shoulder dislocations, males account for about 72-87% of cases, with peak incidence in men aged 20-29 years.^[140] Conversely, females show increased susceptibility to atraumatic dislocations, such as multidirectional shoulder instability, attributed to greater ligamentous laxity, which is more prevalent in women.^[141] This laxity contributes to higher rates of non-traumatic presentations in female athletes and those with generalized hypermobility.^[52] Geographic and ethnic variations influence dislocation patterns, with higher incidences in regions or cultures emphasizing contact sports, such as American football or rugby, leading to elevated rates among athletes in those areas.^[142] Ethnic differences include higher finger dislocation rates among Black individuals compared to other groups.^[143] Congenital predispositions, like those associated with connective tissue disorders, may vary by ethnicity, though data on specific joint dislocations remain limited. National estimates, such as in China, report overall lower incidence rates (0.22 per 1,000) compared to Western populations, potentially reflecting differences in activity levels and trauma exposure.^[144] Special populations highlight further disparities. In pediatrics, nursemaid's elbow (radial head subluxation) is prevalent in toddlers aged 1-4 years, accounting for over 20% of upper arm injuries in young children and often resulting from pulling on the arm.^[145] Athletes, particularly in high school and collegiate sports, experience shoulder dislocations at rates substantially higher than the general population, with incidences up to several times greater due to repetitive overhead or contact activities.^[146] In comparison, the general population sees lower overall rates, estimated at 23.9-26.9 per 100,000 person-years for shoulder dislocations.^[127]

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[116]
Hip Dislocation Management in the ED - Medscape Reference
Oct 21, 2025 · Posttraumatic arthritis is the most frequent long-term complication following hip dislocation. It occurs in up to 19% of affected individuals ...Missing: post- | Show results with:post-
[117]
Coxarthrosis After Traumatic Hip Dislocation in the Adult
Aug 9, 2025 · Sixteen percent of patients with uncomplicated hip dislocations have posttraumatic arthritis develop. Incidences as high as 88% are reported ...
[118]
Post-traumatic osteoarthritis | Radiology Reference Article
Apr 19, 2020 · Post-traumatic OA is common, accounting for ~12% of all OA and can account for ~50% of ankle OA, ~15% of shoulder OA, ~10% knee OA and ~2% of hip OA.
[119]
A review of Risk Factors for Post-traumatic hip and knee ...
Nov 2, 2022 · After thirteen years, OA risk is around 22%, and it achieves 50% after 25 years of follow up, depending on whether patients had a recurrent ...
[120]
What Happens if Shoulder Instability Is Left Untreated
May 24, 2024 · If shoulder instability is not addressed, the condition can eventually worsen, leading to more frequent dislocations, increased pain, and potential long-term ...
[121]
Long Term Outcomes of Arthroscopic Shoulder Instability Surgery
Anterior first time shoulder dislocation has significant short and long term effects on the shoulder joint. It can lead to anterior instability, loss of ...<|control11|><|separator|>
[122]
Glenohumeral Osteoarthritis: Disease Burden, Current ... - NIH
May 19, 2025 · Early intervention with arthroscopic stabilization in patients who sustained a first-time shoulder dislocation before age 25 has been shown ...
[123]
Management of First-Time Anterior Shoulder Dislocation—A ...
Feb 17, 2025 · Early ABR of first-time anterior shoulder dislocations consistently demonstrated decreased subsequent rates of cumulative instability events, ...
[124]
Shoulder Dislocation in Emergency Medicine - Medscape Reference
Jan 28, 2025 · Shoulder dislocations constitute up to 50% of all major joint dislocations. Anterior dislocations occur in as many as 97% of cases. Anterior ...Background · Epidemiology · United States Statistics
[125]
Epidemiology of Shoulder Dislocation Treated at Emergency ...
Mar 12, 2024 · The overall incidence of shoulder dislocations was 25.2 per 100,000 person-years, with a decreasing trend in dislocations from the peak ...
[126]
Epidemiology of Joint Dislocations and Ligamentous/Tendinous ...
Fractures were the most frequent injuries (43.4%) followed by soft tissue injuries (21.1%), lacerations (12.8%), ligamentous/tendinous injuries (11%), and ...
[127]
Epidemiology of Hip Dislocations in the United States From 1990 to ...
Jun 28, 2025 · ... incidence rate of hip dislocations over the 29 years. Nationally ... incidence rate of all four regions, with a rate of 50.14 per 100,000.
[128]
Incidence of elbow dislocations in the United States population
Feb 1, 2012 · The estimated incidence of elbow dislocations in the U.S. population is 5.21 per 100000 person-years, with use of a national database.
[129]
Epidemiology of Shoulder Instability in the National Football League
May 4, 2021 · 355 players sustained 403 missed-time shoulder instability injuries. Most injuries occurred during games (65%) via a contact mechanism (85%).
[130]
Global, regional, and national burden of shoulder dislocation 1990 ...
May 9, 2025 · Countries with higher economic levels have significantly lower shoulder dislocation incidence rates than the global average, possibly due to ...
[131]
Exploring temporal trends and burden of traumatic shoulder ...
Feb 28, 2024 · In 2019, the global crude incidence rate of traumatic shoulder dislocation was 75.54 (95% UI 56.20–103.04) per 100,000 persons for both genders, ...
[132]
Epidemiology of shoulder dislocations presenting to United States ...
The national annual incidence rate of glenohumeral dislocations throughout the study period was approximately 23.92 per 100000 persons.
[133]
Shoulder dislocations among high school–aged and college ... - NIH
From 2015 to 2019, the total incidence of athletic-related shoulder dislocations slightly decreased from 41.34 to 36.3 per 100,000 persons. On a per year basis, ...
[134]
Chapter 86. Hip Joint Dislocation Reduction
Less impressive mechanisms may result in hip dislocations in the young and the elderly. A simple fall from standing may dislocate a geriatric hip.
[135]
A comprehensive study of hip dislocation: global health burden from ...
The global incidence number of hip dislocation escalated from 2,052,924 (95% UI: 1,388,083 to 2,841,632) in 1990 to 2,429,935 (95% UI: 1,634,456 to 3,549,251) ...Missing: osteoarthritis | Show results with:osteoarthritis
[136]
Shoulder Dislocation Incidence and Risk Factors—Rural vs. Urban ...
In this study, the incidence rates of shoulder joint dislocation were 25.97/100,000 person-years in the rural subgroup, and 25.62/100,000 person-years in the ...Missing: globally | Show results with:globally
[137]
Racial/ethnic differences in emergency care for joint dislocation in ...
Black patients presenting to the ED with joint dislocations received lower quality of care in some, but not all, areas compared with white patients.Missing: geographic | Show results with:geographic
[138]
[PDF] Sex-specific Considerations for Shoulder Instability and Adhesive ...
May 19, 2022 · Females are much more likely to experience atraumatic shoulder instability than their male counterparts, likely due to higher rates of ...
[139]
Shoulder dislocations among high school–aged and college-aged ...
Aug 16, 2021 · Overall, the most common sports involved in traumatic shoulder dislocation were basketball (24.1%), football (21%), soccer (7.1%), baseball (7.1 ...
[140]
The Epidemiology of Finger Dislocations Presenting for Emergency ...
Most dislocations occurred in the 15- to 19-year age group (38.6 dislocations per 100 000 person-years). Among racial groups, blacks (16.8) were affected more ...
[141]
National incidence of joint dislocation in China - PubMed Central - NIH
Aug 18, 2022 · The incidence rates of joint dislocations were estimated to be 0.22‰ (0.16‰, 0.27‰) in China, 0.27‰ (0.20‰, 0.34‰) in male participants, and ...Missing: variations | Show results with:variations
[142]
Epidemiology of Nursemaid's Elbow - PMC - NIH
Nursemaid's elbow, also known as radial head subluxation, is a common pediatric condition that typically occurs in children between 1 and 4 years of age.
[143]
Epidemiology of Shoulder Dislocations in High School and ... - NIH
May 30, 2017 · Shoulder dislocations in high school and college athletes occur more frequently than in the general population and result in substantial ...