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Joint dislocation
Other namesLatin: luxatio
A traumatic dislocation of the tibiotarsal joint of the ankle with distal fibular fracture. Open arrow marks the tibia and the closed arrow marks the talus.
SpecialtyOrthopedic surgery Edit this on Wikidata

A joint dislocation, also called luxation, occurs when there is an abnormal separation in the joint, where two or more bones meet.[1] A partial dislocation is referred to as a subluxation. Dislocations are commonly caused by sudden trauma to the joint like during a car accident or fall. A joint dislocation can damage the surrounding ligaments, tendons, muscles, and nerves.[2] Dislocations can occur in any major joint (shoulder, knees, hips) or minor joint (toes, fingers). The most common joint dislocation is a shoulder dislocation.[1]

The treatment for joint dislocation is usually by closed reduction, that is, skilled manipulation to return the bones to their normal position. Only trained medical professionals should perform reductions since the manipulation can cause injury to the surrounding soft tissue, nerves, or vascular structures.[3]

Signs and symptoms

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The following symptoms are common with any type of dislocation.[1]

  • Intense pain[4]
  • Joint instability[4]
  • Deformity of the joint area[4]
  • Reduced muscle strength[4]
  • Bruising or redness of the joint area[4]
  • Difficulty moving joint[4]
  • Stiffness[4]

Complications

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Joint dislocations can have associated injuries to surrounding tissues and structures, including muscle strains, ligament and tendon injuries, neurovascular injuries, and fractures.[5][6][7][8] Depending on the location of the dislocation, there are different complications to consider.

In the shoulder, vessel and nerve injuries are rare, but can cause many impairments and requires a longer recovery process.[5] Knee dislocations are rare, but can be complicated by injuries to arteries and nerves, leading to limb-threatening complications.[6] Degenerative changes following injury to the wrist are common, with many developing arthritis.[7] Persistent nerve pain years after the initial trauma is not uncommon.[7] Most finger dislocations occur in the middle of the finger (PIP) and are complicated by ligamentous injury (volar plate).[8] Since most dislocations involving the joint near the fingertip (DIP joint) are due to trauma, there is often an associated fracture or tissue injury.[8] Hip dislocations are at risk for osteonecrosis of the femoral head, femoral head fractures, the development of osteoarthritis, and sciatic nerve injury.[9][10] Given the strength of ligaments in the foot and ankle, ankle dislocation-fractures can occur.[11]

Causes

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Joint dislocations are caused by trauma to the joint or when an individual falls on a specific joint.[4] Great and sudden force applied, by either a blow or fall, to the joint can cause the bones in the joint to be displaced or dislocated from their normal position.[12] With each dislocation, the ligaments keeping the bones fixed in the correct position can be damaged or loosened, making it easier for the joint to be dislocated in the future.[12]

Risk factors

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A variety of risk factors can predispose individuals to joint dislocation.[12] They can vary depending on location of the joint. Genetic factors and underlying medical conditions can further increase risk.[13] Genetic conditions, such as hypermobility syndrome and Ehlers-Danlos syndrome put individuals at increased risk for dislocations.[13] Hypermobility syndrome is an inherited disorder that affects the ligaments around joints.[14] The loosened or stretched ligaments in the joint provide less stability and allow for the joint to dislocate more easily.[14] Dislocation can also occur because of conditions such as rheumatoid arthritis.[15] In Rheumatoid arthritis the production of synovial fluid decreases, gradually causing pain, swollen joints, and stiffness.[15] A forceful push causes friction and can dislocate the joint.[15] Notably, joint instability in the neck is a potential complication of rheumatoid arthritis.[15]

Participation in sports, being male, variations in the shape of the joint, being older, and joint hypermobility in males are risk factors associated with an increased risk of first time dislocation.[16] Risk factors for recurrent dislocation include participation in sports, being a young male, a history of a previous dislocation with an associated injury, and any history of previous dislocation.[16]

Diagnosis

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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, as injury to these structures may occur during the injury or during the reduction process.[3] Imaging studies are frequently obtained to assist with diagnosis and to determine the extent of injury.

Radiograph of right fifth finger dislocation

Imaging Types

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X-ray, usually a minimum of 2-views

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  • 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.[17]
  • 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 AC joint separations.[18]

Ultrasound

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  • 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.[19][20] Ultrasound may also have utility in diagnosing AC joint dislocations.[21]
  • In infants <6 months of age with suspected 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.[22]

Cross-sectional imaging (CT or MRI)

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  • 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 .[23] CT angiogram may be used if vascular injury is suspected.[23] 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

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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.[23] 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.[23] Joint dislocations are named based on the distal component in relation to the proximal one.[24]

Prevention

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Preventing joint dislocations can be difficult since most are caused by an unexpected injury. If participating in activities such as contact sports, where there is a risk for dislocation, wearing appropriate protective equipment can be helpful. Similarly, avoiding positions that place the joint in a vulnerable position can reduce the risk of experiencing a dislocation. Strengthening the muscles surrounding joints can effectively reduce the risk of a joint dislocation and recurrent dislocations.[4]

Treatment

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Non-operative

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Reduction/Repositioning

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X-rays are taken to confirm the diagnosis and detect any associated fractures. A dislocation is easily seen on an X-ray.[25] 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.[26] A dislocated joint should be reduced into its normal position only by a trained medical professional. Trying to reduce a joint without any training could worsen the injury.[27]

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.[28] 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.[3] After a dislocation, injured joints are usually held in place by a splint (for straight joints like fingers and toes) or a bandage (for complex joints like shoulders).

Immobilization

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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.[3] There is no significant difference in healing or long-term joint mobility between simple shoulder dislocations treated conservatively versus surgically.[29] Shorter immobilization periods are encouraged, with the goal of return to increased range-of-motion activities as soon as possible.[30][31] Shorter immobilization periods is linked to increased ranges of motion in some joints.[31]

Rehabilitation

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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.[32] Take the shoulder for example. The most common treatment method for a dislocation of the shoulder joint is exercise based management.[33] 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.[34]

Operative

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Surgery is often considered in extensive injuries or after failure of conservative management with strengthening exercises.[4] 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 arthroscopic surgery.[25]

Prognosis

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Prognosis varies depending on the location and extent of the dislocation. The prognosis of a shoulder dislocation is dependent on various factors including age, strength, connective tissue health and severity of the injury causing the dislocation.[23] There is a good prognosis in simple elbow dislocations in younger people. Older people report more pain and stiffness on average.[23] Wrist dislocations are often difficult to manage due to the difficulty in healing the small bones in the wrist.[23] Finger displacement towards the back of the hand is often irreducible due to associated injuries, while finger displacement towards the palm of the hand is more readily reducible.[23] Overall, recovering from a joint dislocation can range from a few weeks to months, depending on the severity of the injury.[4]

Epidemiology

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Each joint in the body can be dislocated, however, there are common sites where most dislocations occur. The most common dislocated parts of the body are discussed as follows:

  • Dislocated shoulder
    • Anterior shoulder dislocation is the most common type of shoulder dislocation, accounting for at least 90% of shoulder dislocations.[5][35] Anterior shoulder dislocations have a recurrence rate around 39%, with younger age at initial dislocation, male sex, and joint hyperlaxity being risk factors for increased recurrence.[36]
    • The incidence rate of anterior shoulder dislocations is roughly 23.1 to 23.9 per 100,000 person-years.[36][37] Young males have a higher incidence rate, roughly four times that of the overall population.[36]
    • Recurrent anterior shoulder dislocations have a higher rate of labrum tears (Bankart lesion) and humerus fractures/dents (Hill-Sachs lesion) compared to initial dislocations.[38]
    • Shoulder dislocations account for 45% of all dislocation visits to the emergency room.[5]
  • Elbow
    • The incidence rate of elbow dislocations is 5 to 6 per 100,000 persons per year.[23][37][39]
    • Posterior dislocations are the most common type of elbow dislocations, comprising 90% of all elbow dislocations.[40]
  • Wrist
    • Overall, injuries to the small bones and ligaments in the wrist are uncommon.[7]
    • Lunate dislocations are the most common.[7]
  • Finger
    • Interphalangeal (IP) or metacarpophalangeal (MCP) joint dislocations[41]
      • In the United States, men are most likely to sustain a finger dislocation with an incidence rate of 17.8 per 100,000 person-years.[42] Women have an incidence rate of 4.65 per 100,000 person-years.[42] The average age group that sustain a finger dislocation are between 15 and 19 years old.[42]
      • The most common dislocations are in the proximal interphalangeal (PIP) joints.[8]
  • Hip
    • Posterior and anterior hip dislocation
      • Anterior dislocations are less common than posterior dislocations. 10% of all dislocations are anterior and this is broken down into superior and inferior types.[43] Superior dislocations account for 10% of all anterior dislocations, and inferior dislocations account for 90%.[43] 16-40 year old males are more likely to receive dislocations due to a car accident.[43]
      • When an individual receives a hip dislocation, there is an incidence rate of 95% that they will receive an injury to another part of their body as well.[43]
      • 46–84% of hip dislocations occur secondary to traffic accidents, the remaining percentage is due based on falls, industrial accidents or sporting injury.[36]
  • Knee
    • The majority of knee dislocations (64.5%) are caused by trauma to the knee, with more than half caused by car and motorcycle accidents.[44]
    • The incidence rate of initial patellar dislocations is roughly 32.8 per 100,000 person years.[37]
    • Nearly 41% of knee dislocations have an associated fracture, with the majority of these fractures in one of the legs.[44]
    • Nerve injury occurs in about 15.3% of knee dislocations, while major artery injury occurs in 7.8% of knee dislocations.[44]
    • More than half (53.5%) of knee dislocations have an associated torn meniscus.[44]
    • Quadriceps tendon rupture occurs up to 13.1% of the time, and patellar tendon rupture occurs 6.8% of the time.[44]
  • Foot and Ankle
    • A lisfranc injury is a dislocation or fracture-dislocation injury at the tarsometatarsal joints.
    • A subtalar dislocation, or talocalcaneonavicular dislocation, is a simultaneous dislocation of the talar joints at the talocalcaneal and talonavicular levels.[45][46]
    • Subtalar dislocations without associated fractures represent about 1% of all traumatic injuries of the foot. They represent 1-2% of all dislocations and are caused by high energy trauma.[47]
    • A total talar dislocation has high rates of complications but is rare.[48][49]
    • Ankle sprains primarily occur as a result of tearing the ATFL (anterior talofibular ligament) in the talocrural joint. The ATFL tears most easily when the foot is in plantarflexion and inversion. Weakening of the ligaments can put the ankle at risk for dislocation.[50]
    • An ankle dislocation without fracture is rare, due to the strength of ligaments surrounding the ankle.[51]
[edit]
  • Dislocation of the left index finger
    Dislocation of the left index finger
  • Radiograph of right fifth phalanx bone dislocation
    Radiograph of right fifth phalanx bone dislocation
  • Radiograph of left index finger dislocation
    Radiograph of left index finger dislocation
  • Depiction of reduction of a dislocated spine, ca. 1300
    Depiction of reduction of a dislocated spine, ca. 1300
  • Dislocation of the carpo-metacarpal joint.
    Dislocation of the carpo-metacarpal joint.
  • Radiograph of right fifth phalanx dislocation resulting from bicycle accident
    Radiograph of right fifth phalanx dislocation resulting from bicycle accident
  • Right fifth phalanx dislocation resulting from bicycle accident
    Right fifth phalanx dislocation resulting from bicycle accident
  • Shoulder dislocation before (left) and after (right) being reduced
    Shoulder dislocation before (left) and after (right) being reduced
  • X-ray of ventral dislocation of the radial head. There is calcification of annular ligament, which can be seen as early as 2 weeks after injury.[52]
    X-ray of ventral dislocation of the radial head. There is calcification of annular ligament, which can be seen as early as 2 weeks after injury.[52]
  • X-ray of left elbow posterior joint dislocation without fracture
    X-ray of left elbow posterior joint dislocation without fracture

See also

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References

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[edit]
Revisions and contributorsEdit on WikipediaRead on Wikipedia

Joint dislocation

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

Definition and Anatomy

Definition

A joint dislocation, also known as luxation, is the complete separation of the articular surfaces at a where two or more bones meet, resulting in the displacement of the bones from their normal anatomical positions. This injury disrupts the normal alignment and function of the , often requiring prompt medical intervention to restore stability. The concept of joint dislocation has historical roots in ancient medicine, with the term first described in the works of , who provided detailed observations on the clinical signs and management of dislocations around the 5th century BCE. Joint dislocation must be differentiated from related conditions such as , which involves only partial separation of the joint surfaces without complete loss of contact between the bones. 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 specifically refers to the full derangement of the joint's articulating components. 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 , while complex dislocations are characterized by the presence of one or more fractures involving the bones of the .

Joint Anatomy Relevant to Dislocation

Synovial joints, the most common type in the , consist of articular surfaces covered by , a capsule enclosing the cavity, and an inner that secretes lubricating . The capsule, reinforced by ligaments, provides containment and passive restraint to motion, while additional structures like the labrum—a fibrocartilaginous rim deepening the articular socket—enhance stability in certain joints, such as the in the that extends the to better accommodate the humeral head. Muscles and tendons surrounding the contribute to its dynamic support, compressing the articular surfaces during movement. Joint stability arises from a combination of static and dynamic stabilizers. Static stabilizers include the , ligaments, and bony architecture, which passively limit excessive or by providing tensile resistance. 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. Vulnerable synovial joints include ball-and-socket types like the (glenohumeral joint), where the rounded humeral head articulates with the shallow of the , allowing extensive motion but inherent instability, and the , where the femoral head fits into the deeper of the for greater inherent congruence. In contrast, hinge joints such as the (humeroulnar articulation) and (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. The degree of joint congruence—the closeness of fit between articular surfaces—and socket depth significantly influence resistance to by promoting a compressive mechanism that resists translational forces. Shallower, less congruent joints like the rely more on soft tissues for stability, whereas deeper, more congruent ones like the offer greater bony resistance to displacement.

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 to the joint axis; indirect forces, involving leverage or 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 , with the humeral head in the , for instance, more prone to anterior displacement due to its shallow . In the pathophysiological sequence, initial force application stretches the 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 from posterior humeral head impact against the glenoid rim. Ligamentous tears, such as the anterior inferior glenohumeral ligament in anterior dislocations, occur sequentially under tension, with associated soft tissue damage like labral avulsions contributing to instability. For the , valgus or varus forces in extension initiate disruption, progressing to posterior dislocation via posterolateral rotatory instability, with the lateral collateral ligament complex typically failing first through avulsion from the lateral epicondyle. Force vectors play a critical role in determining the injury pattern, with axial loading compressing the along its long axis, rotational twisting stabilizers beyond their yield point, and hyperabduction or hyperextension leveraging the into extreme positions. In the , anterior dislocation often results from hyperextension s exceeding 30 degrees, rupturing the posterior capsule and in sequence, while varus or valgus vectors in the or drive lateral or medial shifts. These mechanisms highlight the interplay of magnitude, direction, and velocity of s in overcoming static constraints like ligaments and dynamic ones like muscle tension.

Associated Soft Tissue Damage

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

Clinical Presentation

Signs and Symptoms

Joint dislocations typically present with acute, severe 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 involvement. 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 dislocations. Limited is nearly universal, leading to functional impairment where the patient cannot bear weight or use the limb effectively. Physical examination reveals tenderness to palpation over the , and in some cases, 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 line, confirming the displacement of articular surfaces. Patients may report numbness, tingling, or if nearby are stretched or compressed. The clinical history usually includes a sudden onset linked to high-impact trauma, such as a fall, , or , with the patient able to describe the mechanism of injury, like a direct blow or twisting force. 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 preventing any weight-bearing. In contrast, finger dislocations may manifest as obvious shortening or overlap of the digit, with localized swelling and limiting grip or extension.

Immediate Complications

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

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 , 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, 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 or can lead to or dislocations from hyperextension or axial loading, as seen in high-impact landings or collisions. Accidental traumas, such as collisions, represent a major cause of joint dislocations, particularly in high-energy scenarios. The " injury" in frontal car crashes often results in posterior knee dislocations due to the being driven backward against the . Falls from height, another common accident, can cause 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 or may experience or 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. In EDS, joint dislocations can occur with minimal trauma or even spontaneously, complicating management and increasing the likelihood of early-onset arthritis. 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. Demographic factors also influence susceptibility; although overall shoulder dislocation incidence is higher in males, females exhibit greater , which contributes to a higher predisposition to certain types such as multidirectional instability (MDI), often linked to overhead activities. This laxity contributes to a higher of atraumatic or low-energy dislocations in women, though traumatic events can exacerbate the risk. Age-related changes further compound vulnerability; for instance, in older adults weakens the acetabular bone structure, increasing the likelihood of dislocations during falls by facilitating acetabular rim fractures or posterior disruptions. 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 and congruence. 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. 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. Congenital conditions like developmental dysplasia of the hip (DDH) structurally predispose to dislocation by creating a shallow that fails to adequately contain the , with untreated cases risking progressive and early .

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. 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. 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. 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. 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. 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. 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. Special tests help assess joint stability and guide . 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. In knee dislocations, the —drawing the tibia anteriorly with the knee flexed at 20–30 degrees—evaluates integrity, while varus and valgus stress tests at 0° and 30° flexion assess medial and lateral collateral ligaments to detect multidirectional laxity. These maneuvers aid in differentiating dislocation from or by checking for abnormal translation or end-point stability, though they should be performed cautiously to avoid exacerbating . Symptoms such as severe and loss of function, as noted in clinical presentation, direct the focus of these exams.

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. This approach is particularly effective in common sites like the and , where AP and scapular Y views can delineate anterior or posterior humeral head displacement relative to the glenoid. 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 congruity. CT is especially indicated when plain films are inconclusive, such as in posterior dislocations or fracture-dislocations, where it can reveal fractures or that alter . In dislocations, given the high risk of injury (up to 40%), vascular imaging such as CT angiography or conventional is often indicated, even if distal pulses are palpable, to detect intimal flaps or occlusion. Magnetic resonance imaging (MRI) excels in delineating accompanying dislocations, including labral tears, capsular disruptions, and ligamentous injuries that are not visible on or CT. In dislocations, for instance, MRI can quantify glenoid bone loss or identify Bankart lesions, providing critical insights into instability mechanisms. MR arthrography enhances sensitivity for intra-articular by distending the . Ultrasound is a valuable adjunct, particularly in pediatric populations, for its non-ionizing nature and ability to perform dynamic assessments of reduction and stability. It is commonly employed for neonatal or infant hip dislocations to evaluate position and acetabular morphology without . systems derived from facilitate standardized 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. For acromioclavicular dislocations, the Rockwood uses radiographic displacement metrics to grade injury from type I ( ) to type VI (severe inferior displacement), based on coracoclavicular integrity. Recent advancements in 3D CT reconstruction have improved diagnostic precision and preoperative planning for complex dislocations, offering volumetric models that enhance pattern visualization over traditional 2D . A 2025 systematic review of 3D for complex limb s reported a 32% increase in diagnostic accuracy using 3D CT techniques compared to 2D ; 56% of included studies utilized CT scans.

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 . These methods prioritize closed reduction to restore alignment, followed by immobilization and structured rehabilitation to promote and stability while minimizing complications such as or recurrent instability. Such conservative strategies are particularly suitable for simple traumatic dislocations in joints like the , , and , where prompt intervention can achieve favorable outcomes without operative intervention. Initial reduction involves closed techniques performed under or general to relax muscles and alleviate pain, ensuring atraumatic realignment. For anterior 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 for counterforce. In dislocations, typically posterior, reduction employs in-line traction with the patient supine, combined with external rotation and adduction of the to maneuver the back into the . For dislocations, a similar traction-countertraction approach is used, with the arm extended and gentle longitudinal pull applied while an assistant stabilizes the . Post-reduction , such as X-rays or CT scans, confirms proper joint congruence before proceeding to immobilization. Following successful reduction, immobilization stabilizes the to allow and prevent re-dislocation, with the duration and type varying by 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. reductions often require 6 to 8 weeks of non- or toe-touch weight-bearing using crutches, sometimes with a brace to maintain position. Splints or casts are used for smaller joints like the , typically for 1 to 3 weeks, to protect against early motion-induced instability. During this phase, pain control with ice, elevation, and nonsteroidal anti-inflammatory drugs supports comfort and reduces swelling. Rehabilitation begins after the initial immobilization period, emphasizing gradual restoration of and strength to enhance joint stability. Early passive motion exercises, guided by , are introduced to prevent adhesions, progressing to active-assisted and then active strengthening focused on surrounding musculature—such as rotator cuff exercises for the . For the , therapy includes protected progression and gluteal strengthening to improve and function. Protocols typically span 6 to 12 weeks, with emphasis on proprioceptive training to mitigate future injury risk in active individuals. If significant instability or associated injuries emerge during follow-up, surgical evaluation may be warranted.

Surgical Interventions

Surgical interventions are indicated for joint dislocations that cannot be managed conservatively, particularly irreducible cases where closed reduction fails due to interposition or mechanical blockade. Associated fractures, such as fracture-dislocations of the or , necessitate to achieve stable alignment and prevent . Neurovascular injuries, including vascular compromise in posterior dislocations or entrapment in cases, require urgent operative exploration and repair to restore and function. Recurrent dislocations, often seen in the after initial conservative management, warrant surgical stabilization to address underlying instability from labral tears or capsular laxity. 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. Capsulorrhaphy tightens the joint capsule to restore stability, particularly in chronic shoulder instability. 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. For acromioclavicular (AC) joint dislocations, coracoclavicular ligament reconstruction with autografts or synthetic ligaments provides robust stabilization in high-grade injuries. Arthroscopic advances have transformed surgical , enabling minimally invasive repairs through small portals with high-definition visualization, which reduces postoperative and scarring compared to open techniques. A 2025 review highlights improved outcomes in stabilizations using arthroscopic methods, allowing return to light activities within 1-6 weeks with reduced and enhanced function due to avoidance of large incisions. Arthroscopically assisted AC joint stabilizations have increased in prevalence, rising from 19.6% in 2013 to 37.5% in 2023, demonstrating equivalent to open methods with lower complication profiles. Postoperative care typically involves immobilization with slings or braces for 4-6 weeks to protect repairs, followed by progressive physical therapy. 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. 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. 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.

Prevention

Injury Prevention Strategies

Protective equipment plays a crucial role in mitigating the risk of dislocations during sports and high-impact activities. Helmets, pads, and braces absorb and distribute forces that could otherwise displace , particularly in contact sports like rugby and football. For instance, specialized braces, such as the S2 Shoulder Stabilizer, enhance glenohumeral stability during overhead or tackling movements, reducing anterior dislocation risk in athletes. The quality of such gear, including proper fitting, has been shown to improve overall safety by preventing traumatic impacts from reaching vulnerable structures. Training programs emphasizing balance and exercises are effective for building stability in at-risk populations, such as athletes or individuals with mild . These programs typically include activities like single-leg balance on unstable surfaces, drills, or closed-chain exercises that improve neuromuscular feedback and joint position sense, thereby decreasing the likelihood of dislocations in the , , or ankle. Consistent at moderate intensity further refines proprioceptive acuity, allowing better control during dynamic movements. 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. Occupational , including adjustable workstations and tools designed for neutral wrist and elbow positions, minimize repetitive strain that can culminate in elbow or wrist joint trauma. These adaptations, often guided by professional assessments, promote safer movement patterns across daily environments. Public health initiatives from organizations like the (WHO) advocate for broad trauma prevention in high-risk activities through and . WHO guidelines emphasize community-level interventions, such as promoting safety standards in and workplaces, to curb injury incidence from falls, collisions, and overexertion—common precursors to joint dislocations. These strategies include awareness campaigns on equipment use and in vulnerable groups, fostering a preventive culture that targets modifiable environmental and behavioral factors.

Post-Injury Preventive Measures

Following an initial joint dislocation, particularly in the , 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. Strengthening protocols form a of secondary prevention, emphasizing exercises to enhance dynamic stability around the affected . For 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 and prevent . Activity modification involves consciously avoiding positions that predispose the to redislocation, allowing tissues to heal while maintaining function. In the , this includes steering clear of extreme abduction combined with external rotation, a common mechanism for anterior , through adjustments in daily tasks or sport-specific techniques. Such modifications, integrated into rehabilitation, help patients gradually resume activities without compromising joint integrity. For athletes returning to , functional bracing provides external support to limit risky motions during the transition phase. These braces, often custom-fitted to restrict excessive abduction or , 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. Ongoing monitoring through regular follow-up appointments is essential to detect early signs of , such as apprehension during movement or subtle laxity. Clinicians assess progress via physical exams and, if indicated, 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 sections.

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. 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. The absence of associated fractures or soft tissue injuries also facilitates quicker return to function, as simple dislocations require less extensive intervention. 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 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 or . Recovery outcomes vary by joint type, with smaller joints like those in the fingers generally yielding better short-term results due to simpler and lower complication rates; for instance, stable proximal interphalangeal 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 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 , while dislocations may require 3 to 6 months for complete restoration, influenced by the extent of capsulolabral damage.

Long-Term Prognosis

The long-term prognosis following dislocation varies by joint type, patient age, and treatment approach, with and dislocations serving as common examples of potential chronic sequelae. In the , untreated anterior dislocations in young adults under 20 years old carry recurrence rates of 80-90%, often leading to persistent over years or decades. Surgical interventions, such as arthroscopic , significantly lower these rates to 9.6-23% at long-term follow-up, thereby mitigating the cycle of repeated episodes that exacerbate joint damage. Degenerative changes represent a major long-term concern, particularly post-traumatic (PTOA), which develops due to 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. In the , recurrent 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. These changes typically manifest 10-25 years post-injury, contributing to stiffness and pain that may necessitate joint replacement in severe instances. Functional impacts often include chronic instability, reduced , and diminished athletic or occupational performance, with untreated cases leading to ongoing pain and potential . For instance, persistent shoulder subluxation can limit overhead activities and cause , while hip involvement may impair and weight-bearing, affecting over decades. 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.

Epidemiology

Incidence Rates

Shoulder dislocations represent the most common type, accounting for about 50% of all major dislocations reported in settings. This predominance is attributed to the 's inherent , making it particularly susceptible to traumatic forces. The incidence of dislocations is approximately 23.9 to 25.2 per 100,000 person-years, with global estimates from the indicating a crude incidence of 75.54 per 100,000 in 2019. In contrast, other joints exhibit lower frequencies. Joint-specific incidence rates highlight distinct patterns of occurrence. Hip dislocations are rare, comprising approximately 2-5% of all joint dislocation cases. They are often associated with high-energy trauma and significant morbidity, including risks of and concomitant injuries. Elbow dislocations represent 10-20% of dislocations, with an estimated incidence of 5 to 6 cases per 100,000 person-years, often resulting from falls or sports-related impacts. These rates underscore the relative rarity of lower limb dislocations compared to 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 , 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. 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. These variations briefly intersect with demographic factors like age and sex, which are explored in greater detail elsewhere.

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 dislocations in adolescents and athletes. For instance, dislocations peak in the 15-20 age group among males involved in contact sports. In contrast, elderly individuals over 65 years face elevated risk for dislocations, often resulting from low-energy falls, where even a simple fall from standing height can cause displacement in geriatric s due to reduced and integrity. Overall incidence of dislocations shows a secondary rise in older age groups following a decline after young adulthood. 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 and dislocations. For dislocations, males account for about 72-87% of cases, with peak incidence in men aged 20-29 years. Conversely, females show increased susceptibility to atraumatic dislocations, such as multidirectional , attributed to greater , which is more prevalent in women. This laxity contributes to higher rates of non-traumatic presentations in female athletes and those with generalized hypermobility. Geographic and ethnic variations influence dislocation patterns, with higher incidences in regions or cultures emphasizing contact sports, such as or rugby, leading to elevated rates among athletes in those areas. Ethnic differences include higher finger dislocation rates among Black individuals compared to other groups. Congenital predispositions, like those associated with disorders, may vary by ethnicity, though data on specific joint dislocations remain limited. National estimates, such as in , report overall lower incidence rates (0.22 per 1,000) compared to Western populations, potentially reflecting differences in activity levels and trauma exposure. Special populations highlight further disparities. In , nursemaid's elbow (radial head ) 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. Athletes, particularly in high school and collegiate sports, experience shoulder dislocations at rates substantially higher than the general , with incidences up to several times greater due to repetitive overhead or contact activities. In comparison, the general sees lower overall rates, estimated at 23.9-26.9 per 100,000 person-years for shoulder dislocations.

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