Discharge Instructions - Finger Dislocation

As discussed in the Emergency Department prior to discharge, you have been diagnosed with a finger dislocation.  A finger dislocation is when one of the bones in a finger joint is pushed or pulled out of position.  The bone can be forced to the front, back, or side of the joint.  When this happens, the finger bones don't line up correctly.

A finger dislocation usually happens from a sudden injury.  Sometimes, the injury causing the dislocation also causes a broken finger bone.  The medical term for a broken finger bone is a "finger fracture."

A finger dislocation causes pain and swelling around the joint.  People can usually see or feel that their finger bone is out of position.  Because the finger bone is out of position, people have trouble bending or straightening their finger.

Treatment depends on how severe your finger dislocation is and if you also have a finger fracture.

People with a severe dislocation or who also have a finger fracture are usually treated by a specialist called either an Orthopedic or Hand Surgeon.  He or she may need to do surgery to put the bone back in the correct position.

If your finger dislocation is not severe, the doctor can do a procedure to put your bone back in the correct position.  Before he or she does this, you will get a shot to numb your finger or medicine to make you sleepy.

During the procedure, the doctor will gently push or pull your finger back into the correct position.  Then he or she will put a splint on your finger or tape your finger to the finger next to it, called "buddy taping.”  The doctor will usually do another X-ray to check that your bone is in the correct position.  Most people need to wear a splint or use buddy taping for days to weeks, depending on which joint was dislocated.

If your dislocation was reduced (put back in the correct position) in the Emergency Department, you will need to leave the splint in place for 1 week or until follow up with your primary care provider or a hand specialist.  If you were directed to follow up with an Orthopedic or Hand Surgeon, be sure to schedule this appointment and follow up to prevent loss of function in the affected finger.

Return to the Emergency Department for worsening pain, change in color of the finger to blue or pale, numbness or weakness in the affected finger, or any new or concerning symptoms.

MDM - Shoulder Dislocation

[##]-year-old [male/female] with history and exam consistent with [right/left anterior/posterior/inferior] shoulder dislocation.

Initial consideration in this patient included shoulder dislocation, fractures of the humerus, clavicle and scapula, acromioclavicular (AC) injury or separation, rotator cuff injury or tear, biceps tendon rupture, and septic joint among others.

Patient presented with [right/left] pain and evidence of the affected arm in [abduction with ‘squared off’ appearance/adduction with prominence of the posterior shoulder and flattened appearance of the anterior shoulder/full abduction with hand on/behind the head] consistent with likely [anterior/posterior/inferior] glenohumeral joint dislocation.  Patient reported [unknown injury/brief description of injury] that occurred [## minutes/hours] prior to presentation.  Patient [reported/denied] a history of prior shoulder dislocation in the [same/opposite] arm.  Plain films obtained with confirmation of shoulder dislocation [with/without] clear evidence of associated fracture.  We discussed [moderate sedation/intra-articular anesthetic (lidocaine)] to facilitate reduction of shoulder dislocation with the patient who provided [verbal/verbal and written] consent after discussion of risks, benefits, and alternatives.  A complete neurologic and vascular exam of the [right/left] arm was performed prior to attempted reduction and was [noted to be normal/notable for findings consistent with axillary nerve injury].  Successful reduction accomplished with [anterior dislocation: Cunningham technique (physician massages the patient’s biceps muscle as the patient holds the arm adducted and elbow flexed as the patient gradually shrugs shoulder)/Stimson maneuver (patient prone on table with affected limb hanging freely over edge with 10-15 lb weight suspended from wrist for 20-25 minutes)/scapular manipulation (scapula manipulated in counterclockwise direction-stabilized superiorly with medial force applied on the inferior angle)/traction-countertraction technique (gradual, smooth traction applied to the affected arm until patient’s muscled relax or tire sufficiently to release the dislocated humeral head while assistant maintains countertraction to maintain patient in place)/Milch maneuver (patient supine with steady downward traction applied at the elbow combined with slow, gradual external rotation and abduction of the limb)] in the ED.

Repeat plain films obtained after successful reduction of [right/left anterior/posterior/inferior] shoulder dislocation with evidence of normal joint alignment [and evidence of Hill Sachs lesion (impaction fracture of humeral head)/Bankart lesion (detachment of anterior inferior labrum from glenoid)].  A complete neurologic and vascular exam of the [right/left] arm was performed after successful reduction and was [noted to be normal/notable for finding consistent with axillary nerve injury].  Patient was placed in a [sling/shoulder immobilizer] in the ED with discussion of using immobilizer until cleared by Orthopedics.

Prior to discharge, we discussed return precautions, treatment with [NSAIDs/analgesics], and follow up with primary care doctor within one week and Orthopedics within 2-3 weeks for further evaluation, and the patient demonstrated understanding and agreement with this plan.

https://orthoinfo.org/en/diseases--conditions/dislocated-shoulder/

https://orthoinfo.org/en/recovery/rotator-cuff-and-shoulder-conditioning-program/rotator-cuff-pdf/