HAND DISLOCATION |
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General Information
DEFINITION--Injury to the hand so that adjoining bones are displaced and no longer touch each other. The ulnar nerve is likely to be injured with this dislocation. If the ulnar nerve is involved, surgery is necessary to prevent permanent damage.
BODY PARTS INVOLVED
Hand bones (carpal and metacarpal).
Ligaments that hold the hand bones in the proper position.
Soft tissue surrounding the dislocation site, including periosteum (covering to bone), tendons, blood vessels and connective tissue.
Ulnar nerve.
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SIGNS & SYMPTOMS
Excruciating pain at the time of injury.
Loss of normal hand function.
Severe pain when attempting to move the hand.
Visible deformity if the dislocated bones have locked in the dislocated position. Bones may spontaneously reposition themselves and leave no deformity, but damage is the same.
Tenderness over the dislocation.
Swelling and bruising at the injury site.
Numbness or paralysis below the dislocation from pressure, pinching or cutting of blood vessels or nerves.
CAUSES
Direct blow to the hand or falling on an outstretched hand (most common cause).
End result of a severe hand sprain.
RISK INCREASES WITH
Contact sports.
Previous dislocation or sprain.
Repeated injury to any hand joint.
Arthritis of any type (rheumatoid, gout).
Poor muscle conditioning.
Congenital abnormality, such as shallow or malformed joint surfaces.
HOW TO PREVENTInitial injury usually cannot be prevented. After healing, protect vulnerable hand joints with wrapped elastic bandages, tape wraps, felt or foam-rubber pads or plastic splints.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's treatment. This will include manipulating the joint to reposition the bones.
Surgery (sometimes) to restore the joint to its normal position and repair torn ligaments and tendons. Acute or recurring dislocations may require surgical reconstruction or replacement of the joint. Ulnar-nerve involvement always requires surgery to salvage function in the muscles supplied by the ulnar nerve.
Self-care during rehabilitation.
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the wrist and hand.
POSSIBLE COMPLICATIONS
AT THE TIME OF INJURY:
Shock.
Pressure on or injury to nearby nerves, ligaments, tendons, muscles, blood vessels or connective tissue.
AFTER TREATMENT OR SURGERY:
Excessive internal bleeding around the dislocation site.
Impaired blood supply to the dislocated area.
Death of bone cells due to interruption of the blood supply.
Infection introduced during surgical treatment.
Prolonged healing if activity is resumed too soon.
Recurrent dislocations.
Unstable or arthritic joint following repeated injury.
PROBABLE OUTCOMEAfter the dislocation has been corrected, the joint may require immobilization with a cast or splint for 2 to 8 weeks. Complete healing of injured ligaments requires a minimum of 6 weeks.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AID
Use instructions for R.I.C.E., the first letters of REST,
ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
The doctor will manipulate the dislocated bones in the hand to return them to their normal position. Anesthesia and traction on fingers and countertraction on a flexed elbow are usually necessary to correct this dislocation. Manipulation should be done within 6 hours of injury or many tissues will lose elasticity and become difficult to return to a normal position.
CONTINUING CARE
IF A CAST IS NECESSARY:
See Appendix 2 (Care of Casts).
IF A CAST IS NOT NECESSARY:
Use ice soaks 3 or 4 times a day. Fill a bucket with ice water, and soak the injured area for 20 minutes at a time.
After 24 to 48 hours, apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers or heating pads.
Take whirlpool treatments, if available.
Wrap the hand with an elasticized bandage between treatments.
Massage gently and often to provide comfort and decrease swelling.
MEDICATIONYour doctor may prescribe:
General anesthesia or muscle relaxants to make joint manipulation possible.
Acetaminophen to relieve moderate pain.
Narcotic pain relievers for severe pain.
Stool softeners to prevent constipation due to decreased activity.
Antibiotics to fight infection, if surgery is necessary.
ACTIVITY
IF SURGERY IS NOT NECESSARY:
Resume sports participation after clearance from your doctor.
IF SURGERY IS NECESSARY:
Resume normal activities gradually after surgery. Don't drive until healing is complete.
DIET
Drink only water before manipulation or surgery to correct the dislocation. Solid food in your stomach makes vomiting while under general anesthesia more hazardous.
During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATION
Begin daily rehabilitation exercises when supportive wrapping is no longer needed.
Use ice massage for 10 minutes before and after workouts. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly in a circle over the injured area.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of a dislocated hand. Call immediately if the hand becomes numb, pale or cold after injury. This is an emergency!
Any of the following occurs after treatment:
Swelling above or below the cast.
Blue or gray skin color beyond the cast, particularly under the fingernails.
Loss of feeling in the hand.
Nausea or vomiting.
Constipation.
Any of the following occur after surgery:
Increased pain, swelling or drainage in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
Hand dislocations that you can "pop" back into normal position occur repeatedly.
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