2. GROUP MEMBERS
• PATIENCE KAMTSWATSWA
• LINERT FALIA
• TAMALA BANDA
• MERVIS CHIKALIPO
• COSMAS MWALE
3. BROAD OBJECTIVE
• By the end of this presentation student nurses should
acquire knowledge on dislocation/subluxation and also skills
in management of this condition
4. SPECIFIC OBJECTIVES
By the end of this presentation student nurses should be able
to :
Describe dislocation and subluxation
Describe the burden and incidence of the condition
Explain factors influencing the condition
5. Explain the causes and factors influencing dislocation and
subluxation
Explain the pathophysiology of dislocation and subluxation
List the clinical manifestations
Explain how the condition is diagnosed
6. Explain NANDA nursing diagnosis and management
Explain the medical and surgical management with
scientific rationales
Explain the patients education
Explain the complications of the condition
7. REVIEW OF ANATOMY OF JOINTS
• Joint is the part of the body where two or more bones meet to allow
movement. e.g.
hinge joint e.g. elbow and knee
ball and socket e.g. shoulder and hip
pivot e.g. neck wrist and elbow
gliding e.g. ankle and wrist
9. DISCRIPTION OF DISLOCATION/
SUBLUXATION
DISLOCATION
• A dislocation occurs when the bones of a joint are
completely separated, causing the joint to lose its normal
aliganment and function.
SUBLUXATION
• A subluxation, also known as a partial dislocation, occurs
when the bones of a joint are only partially separated,
causing the joint to be misaligned but still partially
functional.
11. INCIDENCE/BURDEN OF DISLOCATION AND
SUBLUXATION
• In the united states , the incidence of dislocation is 23.9 per
100,000 persons in a year and approximately 85 to 98% of the
dislocation are shoulder dislocation.
• Dislocations tend to occur more often in males than in females
• In males, the peak age of the incidence is 10-30 years and in
females it is of over 50 years
12. • In Malawi incidence of dislocation is 43.4% males and 28.9% are
females
• The peak age groups is above 5 years of age to 30 years
• All the cases reported are associated with sports games, falls from
bicycles , motorcycle operators and fall from slippery grounds e.g.
bathrooms .
13. FACTORS INFLUENCING DISLOCATION AND
SUBLUXATION
TRAUMA
• Sudden, forceful blows or injuries.
JOINT INSTABILITY
• Weak or lax ligaments, muscles, or tendons
MUSCLE IMBALANCES
• Weak or overactive muscles, disrupting joint stability.
POOR JOINT ALIGNMENT
• Abnormal joint positioning or biomechanics
14. GENETIC PREDISPOSITION
• Family history of joint problems or connective tissue disorders
OBESITY
• Excess weight, putting additional stress on joints
NEUROMUSCULAR CONDITIONS
• Condition like cerebral palsy, Parkinson’s disease, or muscular
dystrophy
AGE
• Older adults, with age related joint wear and tear
15. ETIOLOGY OF DISLOCATION/SUBLUXATION
The causes can be categorized into:
1. TRAUMATIC CAUSES
• Sudden impact or blow to the joint
• Falls
• Sports injuries
• Direct blows to the joint
16. 2. NON TRAUMATIC CAUSES
• Weakened muscles or ligaments
• Poor joint mechanics or alignment
• Neurological conditions
• Inflammatory conditions
• Tumors
• Infections
17. PATHOPHYSIOLOGY
The pathophysiology of dislocation involves a complex interplay of
factors that lead to the disruption of normal joint anatomy and function.
It begins with a traumatic or non traumatic event that applies excessive
force to the joint, causing the bones to move out of their normal
position.
As the bones displace, the surrounding ligaments, tendons, and muscles
are stretched or torn, leading to joint instability. The joint capsule,
which provides additional support, may also be damaged. This results in
a loss of joint congruence, allowing the bones to move abnormally.
18. The nervous system responds to the injury by transmitting pain signals,
leading to muscle spasms and further joint instability. Inflammation and
swelling ensue, causing increased pain and limited mobility.
In some cases, the dislocation may be accompanied by fractures, nerve
damage, or blood vessel injury, compounding the severity of the
condition . If left untreated, dislocation can lead to chronic joint
instability, arthritis, and long term disability.
19. Nerve palsy
Avascular necrosis (tissue death due to anoxia and diminished blood
supply
Joint structures, blood supply and nerves are distorted and severely
stressed
Dislocation of the joint
Outstretching of the ligamets on the joint
Trauma(e.g fall in sports)
20. CLINICAL MANIFESTATIONS OF
DISLOCATION/SUBLUXATION
Pain
- sudden, severe, or chronic pain in the affected joint or surrounding area
Deformity
-visible abnormal alignment or positioning of the joint
Swelling
- the joints may became swollen and inflamed due to disruption
(trauma) of the surrounding tissues
Limited range of motion
- reduced range of motion or stiffness in the joint
21. Muscle spasm
- painful muscle contractions around the joint
Weakness
- reduced strength or function in the affected limb
23. INDIVIDUALS AS HIGHER RISK OF
DISLOCATION/SUBLUXATION
• Athletes
• Older adults
• Obese individuals
• Those with muscle imbalances or weakness
• People with neurological condition
• Those with poor joint mechanics or alignment
• Individuals with a history of previous dislocations
24. HOW DISLOCATION/SUBLUXATION IS
DIAGNOSED
• History taking
• Physical Examination
• X-Ray
- This is to determine the extent and shifting of the involved structures
• C T scans
• Neurological examination
• magnetic resonance imaging (MRI)
- Magnetic resonance imaging (MRI) can help the doctor to assess
damage to the soft tissue structures around a dislocated joint.
25. NANDA NURSING DIAGNOSIS AND NURSING
MANAGEMENTG
Acute pain related to trauma, inflammation and muscle spasms
evidenced by patient’s report of pain
Goal
To relieve pain
Management: apply ice parks to alleviate the pain and reduce
inflammation
Position the patient in comfortable position depending on the
dislocated/subluxated joint
26. Impaired physical mobility related to displaced joint evidenced by
limited range of motion
GOAL- To improve physical mobility
Management: provide crutches or walkers to assist patient in movement
-Collaborate with physical therapy for addition intervention in to help the
patient in rehabilitation
27. Risk for infection related to open wound or surgical intervention
evidenced by redness, swelling
GOAL- To control and eradicate infection
Management: monitor the site of dislocation for signs of dislocation
such as redness, swelling and drainage
Insure proper wound care e.g. cleaning and dressing changes
28. Anxiety related to displaced joints evidenced by patient asking many
questions
GOAL – To alley anxiety
Management: explain the condition and treatment plan to patient in simple terms
to alley anxiety
Encourage the patient to express his/her fears and concerns relating to condition to
alley anxiety
29. MEDICAL MANAGEMENT
• Administer prescribed analgesics e.g morphine iv 2.5- 5 mg every
3-4 hours as needed
• Administer diazepam oral dose 2-10 mg , for 3-4 times a day as
needed
• Administer dexamethasone iv 4-8 mg daily, depending on the severity
of inflammation
• Administer cefazolin iv dose 1-2 g every 8 hours
30. SURGICAL MANAGEMENT
• Ligament repair
- The surgeon may repair the torn ligaments or use a graft to
reconstruct the ligaments.
• Joint capsule repair
- The surgeon repairs the joint capsule to prevent future dislocation
• Arthroscopy
• Nerve or blood vessel repair
• Bankart repair( for shoulder dislocation)
31. CASTING AND SPLINTING
• These are hard wraps used to support and protect injured bones,
ligaments, tendons and other tissues
• How long you wear the splint or sling depends on the nature and
location of your dislocation.
33. COMPLICATIONS
• Muscle strains
• Ligaments and tendons damage
• Nerve damage
• Damage to blood vessels
• Bone fractures
• Recurrent dislocation
• Long term disability
• Chronic pain
34. PATIENT TEACHINGS
• Explain to the patient how dislocation occur and ways of preventing it
• Teach the patient about the signs and symptoms of dislocation
• Teach the management of dislocation
• Teach about pain management
• Teach about immobilization techniques
• Teach about rehabilitation exercises
35. CONCLUSION
• Dislocation is the total displacement of the joints while subluxation just
partial displacement of the joints.
• Mainly the patients with dislocation present with pain, swollen, loss of
balance and deformity.
• On management the aim is to relieve pain, stable body part, maintain vital
signs within normal range and exhibit no evidence of complications
36. REFERENCE
Ignatavicius, D. D., & Woekman, M. L.(2021). Medical surgical nursing
:concepts for interprofessional collaborative care(10th
ed).Elsevier
Timby, B.& Smith, N .(2017). Introductory medical surgical nursin.
(12th
ed ). Wolters Kluwer
Linton, A.(2015).Inroduction medical surgical nursing.(6th
ed ). Elsevie
Ignatavious, W. R. (2018). Medical surgical nursing.(9th
ed ) Elsevie
