My Mum had an Ankle Dislocation - Discussing Shoulder and Ankle Dislocation

I received a call that my mum had dislocated her legs. It was not a funny call to receive since I am not at home. She was immediately rushed to the hospital and was treated. She wanted me to travel down to see her but then it would take me about 9 to 11 hours to move from Abuja to Lagos. I had actually wanted to embark on the journey, but I thought about so many things including the state of security in the north and just thought it was a good idea I stayed back and communicate with her though phone. I wasn't happy I was not able to go down to see her but at knowing that she was fine brought me joy. That said, today I will be writing on dislocation, its causes, diagnosis and treatment. Someone will say, I thought you just reduce dislocations, yes we do, but there are cases where other options are considered.

this is a picture taken by my mum when she left the hospital

A dislocation in simple term is a separation between two bones in a joint. There are several types of dislocation but the most common type is the shoulder dislocation. Dislocation can occur in several joints in the body, just like that of my mum which is in the ankle but let's pick it from one end to another. So let's do shoulder dislocation. A shoulder dislocation occurs when the humerus leaves the shoulder joint. To understand what I mean, the shoulder joint is made of the humerus head which is articulated to the Glenoid fossa of the scapula. This joint is a ball and socket joint which can move 360 degrees. The joint isn't stable as a result of the large size of the humerus head to the glenoid fossa surface, but the glenoid labrum, the ligaments, the biceps tendon, and the rotator cuff muscles stabilizes the joint.

Shoulder dislocation can present in different forms which are Anterior Dislocation, Posterior dislocation, Inferior Dislocation and Superior dislocation which is very rare and always prevented by the coracoacromial arch. While shoulder dislocation is the most common large bone dislocation, anterior dislocation is the most common type of shoulder bone dislocations.

Anterior Dislocation
This dislocation is as a result of the abduction, extension and external rotation of the humerus. This usually happens as a result of a hard fall on an outstretched arm. The dislocation is accompanied by compression fraction of the humerus known as Hill Sachs lesion, and Bankart lesion. Anterior dislocation can be subdivided into four sub types, depending on where the humerus head ends up after the dislocation. These sub types are Subcoracoid (which is the most common), Subglenoid, Subclavicular (rare occurrence), and Intrathoracic (rare cases).

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If the humerus head ends up below the coracoid, it is known as subcoracoid anterior dislocation, when the humerus ends up below the glenoid, it is referred to as subglenoid anterior dislocation, when it ends up below the clavicular, it is referred to as subclavicular anterior shoulder dislocation, and when the head of the humerus goes into the chest, it is referred to as intrathoracic anterior shoulder dislocation. When patients have a dislocation, they present with limb attitudes which should be quickly managed (an attitude refers to the deformity the patient presents with in the limb), so it is important to know that any dislocation is an emergency as it has to be managed immediately. It is important to know that with an anterior dislocation, the patient cannot internally rotate and adduct the limb, and it causes the shoulder contour to be flattened.

Posterior Dislocation
After discussing anterior dislocation, you should be able to identify one when you see it. Straight to posterior dislocation which occurs as a result of the head of the humerus forced posteriorly in internal rotation. It occur in just about 2 to 4 percent of all dislocations and is often caused by an underlying condition such as from a Generalized Tonic Clonic Seizures, or cases of electrocution or in cases of electro convulsive therapy, and in cases of a fall when the arms are outstreched but this isn't always common. Posterior dislocation occurs often Bilaterally causing reversed Hill Sachs lesions, Reversed Bankart lesions, Subscapularis muscle often injured. Since the arm is held in internal rotation and adducted, it cannot perform external rotation. While anterior dislocation is often associated with loss of contour, with posterior dislocation it isn't often associated with loss of contour but it is possible.

Image From Wikimedia
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Inferior Dislocation
Unlike the Posterior and the Anterior dislocation, Inferior dislocation is rare type of dislocation also known as luxatio erecta. With this dislocation, the arm is in dislocated in an upward hyperabduction where patient usually have their hands on their head. This dislocation is associated with complications such as neurovascular injury in cases of axillary nerve injury, and brachial plexux injury. This dislocation can lead to the injury of soft tissues such as rotator cuff, and ligaments. This said, superior shoulder dislocation which is a rare type of dislocation is said to associated with the rupture of the deltoid

Ankle Dislocation
Back to the type of dislocation my mum had. Just as the name implies, it is a dislocation of the bones of the ankle joint. While the shoulder is a ball and socket joint, the ankle is a hinge joint composed of three bones which connects the lower leg to the foot. These bones are the tibia (shin bone), the fibula, and and the Talus which is the lower part of the ankle joint. When there is a dislocation, there is a dis-joining of the tibia and the talus, which can cause a damage to the bones, the tendons, ligaments and nerve in the area. It is very surprising that my mum could dislocate her ankle just because she wanted to come down the stairs because ankle dislocations are very rare but since she slipped while coming down the stairs there is a possibility of a force on the ankle causing it to dislocate. Ankle dislocation could be superior, posterior or anterior with the most common type being the posterior which was what my mum was diagnosed of. It is as a result of the thalus shifting backwards into the tibia. With anterior, the thalus is pushed forwards, while superior is caused when the thalus is pushed upwards between the fibula and the tibia.

Patients who have dislocations often present with severe pain in the area of the dislocation, this pain often looks like the limb is held by just a muscle. patients will present with numbness, swelling, inability to use the dislocated limb and joint, deformity of the dislocated region, and tingling in cases where nerves are damaged. When a patient has dislocation, diagnosis is made clinically based on the appearance of the dislocation, evaluation of pulse and sensation to verify vessels and nerve damage, Imaging test including x-rays, MRI, and CT-Scan can be used to identify the bone and the location of the dislocated bone. Treatment is dependent on the diagnosis, and if there are no complications. In the case of ankle dislocation, treatment can include cold and heat therapy, braces, cast which was what was done for my mum. Also patients would be giving medications such as muscle relaxants, opioids, NSAIDs. In severe cases, surgery can be done on the patient. In the case of shoulder dislocation, a closed reduction is done to reposition the bone to its normal position. Using slings to stabilize the joint, physiotherapy, and in cases where the dislocation happens regularly, then surgery is needed to get the joint stabilized.

Thanks a lot for reading my post, I hope you had a good time reading.

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