National Athletic Trainers' Association Position Statement: Immediate Management of Appendicular Joint Dislocations

This statement addresses one of the harder calls in sports medicine: when an athletic trainer may put a dislocated joint back in place on site, and when the joint should be splinted and the patient sent for reduction in a hospital.

It starts with legal footing. Athletic trainers and their supervising physicians should check state law and employer policies first; where on-site reduction is allowed, it needs written standing orders from the physician naming which joints and techniques are covered, documented competence, and consent from the patient (or a parent for minors).

Before any attempt, the athletic trainer should take a history and complete a full musculoskeletal and nerve-and-blood-supply check, and repeat the nerve and circulation check after each attempt. Reduction should not be attempted if a fracture is suspected or if the patient may still have open growth plates. Every reduced joint should be immobilized and the patient referred for x-rays. Joint-by-joint guidance covers the shoulder, hip, knee, kneecap, elbow, fingers and other joints.