What Should You Do for a Dislocated or Subluxing Joint?

If a joint completely dislocates (the joint surfaces move completely out of their normal alignment) or subluxes (the joint surfaces partly move out of alignment and may slip back), your immediate priority is to stabilize the area, avoid causing further damage, and determine the level of medical care you need. First, support the joint in the most comfortable position you can find ^[1]. Do not attempt forceful manipulation or repeatedly try to pop the joint back into place yourself ^[2]. If this is a first-time dislocation, happened due to an injury, or is accompanied by “red flag” symptoms like a cold limb or severe pain, you need immediate emergency care ^[3][4].

Immediate First Aid

When a joint slips out of place, the goal is to protect it. It is normal to feel frightened and in pain, but it is important not to rush or force movements.

• Support the joint: Gently rest or splint the joint in the position you found it or the position that is most comfortable. Do not try to forcefully straighten it or move it unnecessarily ^[1]. If applicable, do not bear weight on the affected limb.
• Avoid forceful self-reduction: Do not pull, twist, or forcefully push the joint to try to get it back into place ^[1][2]. Forceful manipulation or repeated attempts to reduce the joint can damage surrounding tissues, aggravate symptoms, and cause further complications, especially in people with hypermobile Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorder (HSD) ^[5].
• Remove tight items: Remove rings, watches, or restrictive clothing near the joint before swelling develops.
• If it goes back in by itself: Even if the joint spontaneously returns to its normal position, a first-time or traumatic dislocation still requires medical assessment because fractures, nerve damage, or blood-vessel injuries may remain ^[3][4].

When to Seek Medical Care

Because joints vary, urgency depends on the specific joint and your symptoms. Some injuries, like posterior collarbone (sternoclavicular) dislocations, can threaten the airway or major blood vessels ^[6][3].

Go to the Emergency Department Immediately

Call emergency services or go directly to the nearest emergency department if you experience:

• Blood flow issues: Unusual paleness, blueness, an absent pulse, or a cold feeling in the limb below the joint ^[4][3].
• Nerve symptoms: Numbness, tingling, new weakness, or an inability to move the fingers or toes below the affected joint ^[7][4].
• Visible deformity or unmanageable pain: If the joint looks noticeably deformed or the pain is severe and intractable ^[3].
• High-risk joints: Suspected dislocations of the hip, knee, spine, or collarbone ^[6].

Seek Same-Day Medical Assessment

Go to an urgent care or same-day clinic (provided they have X-ray capabilities) if:

• First-time or traumatic dislocation: If a joint has never dislocated before, or if it happened during a fall, collision, or other significant trauma ^[1].
• Persistent symptoms: If the joint went back in by itself, but you still have ongoing pain, swelling, weakness, or limited function ^[3].

Follow Your Pre-Approved Plan

Joint subluxations and dislocations are commonly self-reported in hEDS and HSD ^[8]. However, having hypermobility does not mean it is always safe to manage a dislocation at home ^[1]. You should only manage a dislocation at home if you are following a specific, written plan from your clinician or physical therapist for a familiar, recurrent subluxation. This plan should detail what gentle maneuvers (if any) are allowed, what braces to use, and when to seek medical care.

Clinical Management

When you seek medical care, trained clinicians will evaluate the joint to ensure it is managed safely.

• Assessing nerves and blood flow: Before and after treating the dislocation, doctors will check your pulse, sensation, and movement to ensure no nerves or blood vessels are pinched or damaged ^[4].
• Imaging: X-rays are typically used before and after reduction to confirm the joint’s position and check for fractures ^[9]. Depending on the joint and whether there are persistent symptoms, advanced imaging like a CT scan (for complex bone injuries) or MRI (for soft tissues like ligaments) may be needed ^[3].
• Reduction: If the joint remains dislocated and it is appropriate to do so, a trained clinician will safely guide the joint back into its normal anatomical position ^[10].
• Aftercare: After a reduction, watch for worsening pain, swelling, numbness, or color changes, and seek prompt care if these occur ^[4].

Follow-Up and Rehabilitation

Once the acute injury is managed, long-term care focuses on managing symptoms and preventing future joint injuries ^[11].

• Hypermobility-aware physical therapy: A poorly tailored exercise program or overly aggressive physical therapy can aggravate symptoms in people with hEDS/HSD ^[12]. It is crucial to work with a therapist who understands hypermobility and can design a gradual, supervised program ^[13].
• Focus on stability: Rehabilitation should be individualized, focusing on muscle strengthening, proprioception (your body’s ability to sense its position and movement in space), and motor control (the ability to coordinate muscles for stable movement), rather than relying only on passive stretching (stretching done by an external force or therapist without your active muscle use) ^[14][15].
• Realistic expectations: While physical therapy can improve joint function and reduce pain, the goal is functional improvement and stability rather than completely preventing all future subluxations or dislocations ^[16][17].