Dislocations

A dislocation occurs when the ligaments supporting a joint are stretched and rupture, allowing the bones in the joint to fall out of line. Dislocations usually result in deformed limbs that are dramatic to look at. They cause considerable pain, due to the soft tissues around the dislocated joint being unpleasantly stretched and can cause problems with blood circulation or nerve supply to the limb. Hence, they should be regarded as an emergency. Nevertheless, a pitfall of providing first aid to deformed and dislocated joints is their appearance can distract the rescuer from the principals of SABCDE and other more serious problems such as a serious neck injury or an obstructed airway can be missed. Consequently, they are sometimes called “distracting” injuries. Do not be distracted!

In Rugby, the more common joints that may dislocate are in the upper limb, with the shoulder joint and the fingers the most common. Ankles can also dislocate if there is a fracture. The same principals of SABCDE and PRICE apply, although the urgency of the situation and distress the player is in mean that protecting and supporting the injured limb becomes more of a priority as they need immediate transfer to the local emergency department.

First time shoulder dislocations are particularly painful and often have an obvious deformity. A player's arms should be supported in whichever position they find most comfortable. This may be simply cradled in the upturned lower border of their Rugby shirt or in a broad arm sling, or simply with themselves holding the arm. Ice can be applied if tolerated, but swift transfer to hospital is needed.

Dislocated fingers will be obviously deformed at the level of the joints and again extremely painful. Players will probably simply hold the wrist to support their own hand whilst being transferred to hospital. Placing them in an elevation sling may provide elevation and help with swelling.

Ankle dislocations are usually combined with a fracture and known as fracture-dislocations. They should simply be supported until an emergency ambulance arrives.

Never attempt to put a dislocated joint back in. To do so requires experience and training and usually an X-ray first to make sure it is what the doctor thinks it is.