Dislocated arm in children: types, causes, prevention

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February 11, 2021

Author of the article: Bogatov Viktor Borisovich

Highest qualification category. Doctor of Medical Sciences, Professor of the Department of Traumatology and Orthopedics, First Moscow Medical University. I.M. Sechenov.

Experience: 21 years

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As a result of exposure to mechanical damage, a child may experience a disruption in the joints of the hand. This pathology is called a dislocated arm. If you consult a doctor in a timely manner, a dislocated arm in a child does not threaten a critical condition, which cannot be said about old dislocations. If 2-3 weeks have passed from the moment of injury to contacting a specialist, then the treatment will be complex and protracted, and surgical intervention is possible.

Classification parameters for this condition.

By origin:

traumatic;
pathological;
congenital.

Depending on the location, the dislocation may be:

child's wrists;
elbow joint;
shoulder joint;
child's finger;
forearms.

By volume of damage:

partial4
full.

By difficulty:

closed;
open – accompanied by damage to the skin.

Causes of arm dislocation in children

The main risk group is active children, who often experience falls and injuries. An additional seasonal factor that increases the risk of injury is winter ice, when a fall can happen even to a calmly walking child or adult. Experts consider regular participation in certain sports, heavy lifting and strong impacts as risk factors.

Trauma is not the only cause of a dislocated arm in a child, but congenital causes and pathological destructive processes are still much less common.

First aid to the victim

Every person should be able to provide assistance to a patient whose arm has been dislocated. The first thing to do is apply a cold compress to the area where the upper limb is injured (this can be a heating pad with ice or cold water) and give a painkiller from the analgesic class.

You should not adjust the arm yourself, as this can cause even more harm to the patient. It is advisable to fix the person’s injured arm in a forced position. To do this, you can use any available means (board, rags, etc.). In this situation, the victim should be taken to the nearest medical facility.

Symptoms of a dislocated arm in children

How to detect a dislocated arm in a child? It is not always possible for adults without special medical education to immediately accurately determine the type of injury in a child - a dislocation, a severe bruise, or even a fracture. Symptoms of a dislocated arm in a child are similar to the signs of a fracture and at the same time can also resemble a reaction to a severe bruise, so timely contact with a specialist becomes especially important.

The main signs of a dislocated arm in a child:

unnatural hand position and low mobility or complete immobility;
presence of hematoma and slight swelling;
severe pain that sharply intensifies when you try to move your arm, hand, or fingers;
rapid or, conversely, slow pulse.

A hematoma usually does not form immediately; it appears later, sometimes after several hours. The formation of severe swelling and severe hematoma is most often observed if there is additional spraining of the ligaments, rupture of articular tissues and capsules.

Classification of dislocations

Upper limb dislocations are classified as follows:

By origin: Arm dislocations occur:
habitual traumatic;
congenital;
pathological.
By volume: Dislocations of the upper extremities are:
partial.
By location: Arm dislocations can be:
dislocation of the elbow joint;
forearm dislocation;
dislocation of the hand;
dislocated finger.
By type of injury: Dislocations of the upper extremities are:
closed.
By duration: Arm dislocations occur:
stale (3 to 4 weeks have passed since the injury to the upper limb);
old (more than 30 days have passed since the dislocation occurred).

When to see a doctor

Only a doctor can accurately determine the type and severity of damage. Therefore, if a child receives an injury and the symptoms described above appear, it is necessary to immediately consult a traumatologist.

When a patient comes in, the doctor conducts a diagnosis. The initial stage of diagnosis is visual inspection and palpation. During palpation, the traumatologist determines the degree of hand mobility and skin sensitivity, and measures the pulse. This method also makes it possible to identify changes in the shape of the composition and the location of the articular endings. The next stage is hardware research. Most often this is an x-ray. With its help, you can identify damage to internal tissues that was caused by a dislocation.

Diagnostics

A patient who has sustained a hand injury must be urgently taken to a medical facility, where specialists will diagnose and provide emergency care. The doctor at the trauma center will carefully examine the injured arm, perform palpation, and interview the patient. While palpating the damaged area, the specialist determines not only the sensitivity of the skin, but also the motor function of the upper limb. Careful palpation will reveal any abnormalities in the neurovascular bundle, as well as check the rhythm of the artery pulsating.

After a personal examination, the patient will be sent for an x-ray, thanks to which it will be possible to determine whether, in addition to the dislocation, there are any other injuries (fracture, bone crack, etc.) of the upper limb. Typically, x-rays are taken in two or three projections, and the results are stored in a medical institution (they must be given to patients upon request).

If, during diagnostic measures, serious injuries to the limbs were identified, the patient is sent to the surgical department, where he will undergo emergency surgery. Sometimes there are cases when patients were diagnosed with dislocation of the same joint more than 3 times. This category of patients requires surgical treatment, after which they will be assigned a disability group. The male half of the population with such a diagnosis will automatically be exempt from the obligation to serve in the Army.

When diagnosing a traumatic dislocation, a specialist during palpation determines how much the shape of the joint has changed. It is equally important to identify whether retraction has occurred at the locations of the articular endings. During palpation, the traumatologist may feel springy resistance in the damaged area.

With traumatic dislocation of the upper limbs, patients may experience:

tear or complete rupture of tendons;
extensive capsule rupture;
compression of nerves;
rupture of blood vessels, etc.

Treatment of a dislocated arm in children

If a child has severe pain, then in the absence of contraindications, anesthesia is performed. Local anesthesia is also required to perform joint reduction. Anesthesia helps the muscles relax, which makes the doctor's job easier. The reduction process itself proceeds slowly and smoothly, without jerks or sudden movements. Only a specialist can perform joint realignment. Parents' attempts to straighten the arm themselves can cause additional harm.

Depending on the severity of the lesion, a plaster splint may be placed on the arm, which the child will have to wear for one to several weeks. The splint keeps the arm in the correct position and reduces pain. After removing the splint, restorative therapy is prescribed, which includes a set of measures - massage, gymnastics, physiotherapeutic procedures. Rehabilitation procedures are aimed at restoring mobility to the arm, restoring blood circulation and strengthening joint tissue.

If the treatment was not timely and attempts were made to self-medicate, then serious risks to the child’s health arise. Old dislocations are often treated surgically.

One of the methods of treating long-standing severe cases involves the installation of Kirschner wires. The entire procedure includes the following steps:

to stretch the wrist joint, a distraction device is applied;
open reduction of joints is performed using the surgical method;
removal of the distraction device;
joint fixation using Kirschner wires;
long-term restorative physiotherapy.

Complications that threaten untimely or incomplete treatment of a dislocated arm in a child:

the risk of re-injury increases;
unreduced dislocation can cause rupture of tendons, ligaments, muscle tissue, and blood vessels;
Pathologies and joint damage may develop in adulthood.

In order for the treatment to be effective, so that the dislocation does not make itself felt in the future, it is very important that the patient follows all the doctor’s instructions. Otherwise, therapy may be delayed and may not give the desired result.

Shoulder dislocation - reduction. Exercise therapy for dislocation

Even if the victim is sure that he has a dislocated shoulder, you should not try to straighten it, as this can damage blood vessels and nerves. Survivalists identify three dislocations that can be repaired on your own if the journey to a medical facility is more than two hours away - these are dislocations of the patella, fingers and toes, and a dislocated shoulder. And although the shoulder is included in this number, it is better to seek medical help, since you need to know the techniques for reducing such dislocations and have sufficient experience for this. In addition, you need to be sure that the dislocation is not complicated by a fracture.

Self-help for sprains.

pain relief (take an analgesic tablet);
immobilization of the joint using a soft scarf that limits the movement of the hand;
applying a cold compress to the sprain site;
contacting a traumatology specialist;
Before visiting a traumatologist, you should not eat or drink, since in order to reduce serious dislocations it is sometimes necessary to use general anesthesia.

Reduction of dislocation.

Reduction of a fresh dislocation occurs in the order of primary care. The reduction method is chosen by the doctor after examination and the necessary examination. If the dislocation is habitual, then with each subsequent time it will be easier to reset. But in any case, you shouldn’t do it yourself, since self-medication and self-reduction can lead to disability!

How is the reduction procedure performed? First, anesthesia is given. Anesthesia can be local or general.

After the anesthesia has taken effect, the doctor reduces the dislocation. There are several dozen methods for reducing a dislocation. The technology chosen will depend on the severity of the injury, the timing of the dislocation, the age of the patient, and the experience and qualifications of the doctor. Usually they combine methods. When corrected, the patient will hear a characteristic click - that is, the head of the bone has taken its anatomical position.

In some cases, it is necessary to resort to surgical intervention. The traumatologist installs the head of the humerus in a physiological position during arthrotomy using pins, tendon suturing or plastic surgery, strengthens the articulation capsule and at the same time eliminates tissue trapped between the articular surfaces.

Immobilize the joint if necessary.

After reduction, another x-ray must be taken to confirm whether the head of the bone is fixed in the correct place. After this, bone immobilization is necessary. Immobilization can last up to 25-30 days. A shorter period is in elderly and weakened patients, since prolonged immobilization can provoke muscle atrophy. Sometimes the doctor recommends applying a scarf bandage or Deso bandage. In young people, the fixation is more rigid (a cast may be applied) and the immobilization period is one month. The pain usually goes away after reduction within a few hours, and disappears completely after 24-48 hours.

How is rehabilitation after reduction?

Professional massage and physiotherapy, physical therapy can do a lot to restore joint function. The rehabilitation period begins from the moment of immobilization and continues until all movements are completely normalized.

Diet.

There are numerous recommendations regarding diet to help the body recover from bone injuries. But all authors agree that nutrition should be complete and balanced, aimed at strengthening bone tissue, ligaments and joints. The diet must include the following products:

milk, cottage cheese;
fatty fish, cod liver;
buckwheat, lentils, beans;
rosehip decoction;
wholemeal bread;
seaweed

The products must contain the required amount of vitamins and microelements, which are important for restoring the elasticity of the ligaments. During this period, much attention is paid to culinary processing - steaming, boiling and baking. You need to eat raw fruits and vegetables in large quantities.

Physiotherapy.

Physical therapy stimulates circulation, relieves swelling, helps remove clotted blood from the site of hemorrhage, and prevents the formation of contractures (fibrous tissue that connects body organs that would normally be separated). Physiotherapy is used for all types of dislocation, but it cannot be used for massive hemorrhages in the joint.

At the European Center for Orthopedics and Pain Therapy, modern physiotherapy equipment is at your service. The Center's doctors use innovative technologies that have proven their effectiveness in the best clinics in the world.

autoplasmotherapy stimulates the outflow of venous blood and lymph from the pathological area;
shock wave therapy, ultrasound and laser stimulate regeneration and eliminate local damage;
ozone therapy restores sensitivity and trophism of tissues;
manual muscle testing method – helps to find problem areas, collect reliable information and select the optimal treatment

Medicinal electrophoresis, low-frequency magnetic therapy, paraffin and ozokerite applications, myoelectric stimulation are excellent helpers for a faster recovery.

Exercise therapy.

Physical therapy is indicated at all stages of recovery. An experienced exercise therapy specialist will be able to prevent subsequent bone deformations, atrophy of adjacent muscles, loss of ligament flexibility and restore full range of motion in the shoulder. The doctor selects a specific set of exercises, taking into account the peculiarities of the process. As a rule, exercise therapy for dislocation consists of 3 stages.

Shoulder dislocation - exercises

A. The first stage is general tonic, it occurs during the period of immobilization. The goal is to prevent muscle atrophy, improving tissue trophism, and maintain motor activity in the shoulder. Exercise therapy is prescribed immediately if the patient’s condition allows and the pain has disappeared. The doctor asks you to clench and unclench your fingers into a fist and take turns, and then bend and straighten your wrist, not only of the sore hand, but also of the healthy one.

B. The second stage begins after removing the fixer. The main goal of this stage is to accelerate metabolic processes and create a strong “muscle corset” for the shoulder. First, the exercises take place under facilitating conditions, then with self-help. Muscle tension alternates with relaxation. Swing exercises are excluded.

The first exercise therapy classes should be supervised by a methodologist. If the rehabilitation process goes well, then after 14 days the patient can make careful movements of the shoulder, and after a month the range of motion increases. During exercise therapy, you can remove the fixing bandage.

B. The third stage is the period of completion of recovery. Work continues on the formation of a muscular shoulder corset, residual effects completely disappear, all functions of the shoulder should be restored. The complex will include exercises with rotation, abduction, adduction, and weights. After 3-4 weeks, the full range of rotation of the shoulder in a healthy state will be used.

All exercises are performed not only with the injured hand, but also with the healthy one.

After a month and a half, you can lift weights with your shoulder adjusted, starting with a small weight. Weight should be increased gradually. Exercises performed in water give excellent results.

Attention! At all stages of the rehabilitation period, painful sensations should be avoided!

Massage

Massage improves the outflow of lymph from the affected area, reduces swelling, helps remove clotted blood from hemorrhage sites, and prevents the development of contractures. The massage usually starts with the healthy hand. What happens on one side of the body, through the mechanisms of the nervous system, affects what happens on the other. Then the massage continues with light rubbing and tapping with the palm of the hand near the site of the dislocation. Stretching, flexion and extension begin to be used only after the doctor’s recommendations.

Rehabilitation will be most effective if the victim follows all the doctor’s recommendations. During the first 3 months, the functionality of the affected shoulder is restored, and its complete rehabilitation ends on average after 6 months. These terms are arbitrary and depend on the person’s physical fitness, age, degree of dislocation and his caution. Under no circumstances should you remove the bandage yourself, since the recovery processes will not have time to complete and the condition may turn into a habitual dislocation, which will be more difficult to get rid of.

In addition to the usual dislocation, with inadequate treatment and careless attitude to the injury, the patient may encounter complications such as

decreased range of motion of the shoulder;
changes in the structure of cartilage and the formation of arthrosis with all the negative consequences;
damage to peripheral nerves with symptoms of paresthesia;
repeated dislocation even in the absence of any load on the shoulder;
atrophy of the muscles surrounding the joint

Remember that after 3 weeks the dislocation will be considered old and can only be cured with surgery!

At the European Center for Orthopedics and Pain Therapy, highly qualified orthopedic surgeons will diagnose and propose the optimal way to reduce (treat) a dislocation with a subsequent rehabilitation scheme.

Prevention of arm dislocation in children

Parents need to have a preventive conversation with their child and try to explain to the child that excessive activity can lead to injury and painful consequences.

For children who engage in contact sports, care should be taken to purchase appropriate protective equipment (elbow pads, knee pads). It is also recommended to choose sports that promote the development and strengthening of the musculoskeletal system.

An important preventive method is a proper balanced diet, including foods that provide the growing body with nutrients, vitamins and microelements necessary for the normal development of the musculoskeletal system.

First aid

First of all, it is necessary to determine what type of injury the dislocation is; the treatment of a dislocation of the hand and the speed of further recovery depend on this stage. The sequence of actions is as follows:

Determination of the severity of pain symptoms;
Comparison of joints on both hands to visually determine displacement;
Assessment of localization of edema. In case of a fracture, it is located in the area of the bone, and in case of dislocation - in the area of the joint;
Assessment of the ability to move fingers and the presence of sensitivity in the fingers and the hand itself;
Using a splint and fabric to fix the damaged area relative to the body;
Apply a cold compress and urgently visit a traumatologist.

How to make an appointment with a pediatric traumatologist

Our clinic employs qualified doctors who have extensive experience in diagnosing and treating dislocations. Experts will tell you how to significantly reduce risks and protect your child from injury. Modern equipment for diagnosing and treating various types of injuries is available to patients. To make an appointment with a specialist, you can use any convenient method:

by phone;
on the clinic website by filling out a special online form.

Also on the website you can find out the cost of the services provided, see a list of available equipment, and choose which doctor you want to undergo treatment with. Contact us, we will always help you and your children!

About the symptoms of shoulder dislocation

If this problem happens, and it always happens at the wrong time, the person will feel a sharp pain. The fact is that at this moment the joint capsule ruptures/tears. Nerve endings located inside signal this. In addition to this part, tendons and muscle fibers are also affected.

Interesting fact! According to medical observations, a person who has been injured for the first time feels pain most acutely. Repeated dislocations may be completely asymptomatic.

When a shoulder joint is dislocated, a person cannot move his arm. In this case, all attempts to move the hand will return it to its place. Doctors call this feature “springy resistance syndrome.” In addition, what other signs make it possible to recognize the presence of complexity.

Among the obvious symptoms is a visual deformation of the shoulders: they look asymmetrical. A protrusion is visible on the dislocated shoulder.
Swelling appears around the shoulder.
The hand may become numb, the arm may feel tingling and turn blue.

Now we need to verify the presence of injury at the medical level.

Joint instability

The use of Kirschner wires is important when dislocation occurs again immediately after reduction. After inserting the needles, the wound is sutured in layers, and the joint is fixed for a month or a month and a half. If we are talking about transscaphoid-perilunar dislocation, the period increases to 4 months. It is permissible to use distraction devices in the following situations:

Late visit to a traumatologist;
No compressive symptoms;
Closed reduction is not possible.

If the median nerve is compressed in the carpal tunnel, the dislocation must be reduced through surgery or the risk of nerve degeneration increases.

Features of treatment

Pain relief is the first stage of treatment for a dislocated arm, since acute pain is the first thing that will bother the patient. It is advisable to do general anesthesia for severe damage. Since damaged segments must be reduced after anesthesia, the analgesic must be potent.

Reduction can begin only after complete muscle relaxation.

After reduction, a plaster cast must be used. It will not be possible to remove it for 3-4 weeks.

Fresh hand dislocations

For fresh wrist dislocation, anesthesia is used. The reduction is carried out by a surgeon and an assistant, since only two people can correct the hand. An assistant is needed to keep the shoulder immobilized, while the surgeon stretches the wrist joint by stretching along the axis of the forearm. One hand of the specialist should pull one finger of the hand, and the other hand should pull the others.

To correct a dorsal dislocation, the surgeon must apply pressure to the bulging area at the wrist joint using his or her thumbs. Next, fixation at an angle of 40 degrees relative to the neutral position of 90 degrees is relevant. The area from the elbow to the metacarpophalangeal joint is fixed. At the final stage, a control x-ray is performed.

After a couple of weeks, the hand must be removed from the specified position and fixed again with a plaster splint for 2 weeks.

Rehabilitation

A rehabilitation course is a mandatory measure to restore the functionality of the arm after removing the cast. The recovery stage consists of the following techniques:

Therapeutic exercises and a set of physiotherapeutic procedures recommended by a specialist;
Magnetic therapy, mud treatment and hydrotherapy;
Massage;
Mechanotherapy – physiotherapeutic procedures using exercise machines.