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

Abstract

Objective To provide certified athletic trainers (ATs) with recommendations and guidelines for the immediate management of patients with joint dislocations. Background One of the primary responsibilities of ATs is to provide immediate injury care for active individuals. Although ATs are confronted with managing patients who have many kinds of injuries, the onsite management of a joint dislocation presents challenges in evaluation and immediate treatment. The critical concern in managing a dislocation is deciding when a joint can be reduced onsite and when the patient should be splinted and transported for reduction to be performed in the hospital or medical setting. Factors that influence the decision-making process include the following: whether the AT possesses a documented protocol that is supported by his or her supervising physician(s), employer documents, and respective state regulations; the AT's qualifications and experience; the dislocated joint; whether the dislocation is first time or recurrent; the patient's age and general health; and whether associated injuries are present. Recommendations These guidelines are intended to provide considerations for the initial care of specific joint dislocations. They are not intended to represent the standard of care and should not be interpreted as a standard of care for therapeutic or legal discussion.

Closed-Reduction Techniques for Glenohumeral-, Patellofemoral-, and Interphalangeal-Joint Dislocations

“…2,3 Certified athletic trainers (ATs) should be prepared to evaluate a joint dislocation; assess whether the patient is a candidate for an on-site reduction; and, if appropriate and permitted by their state statutes, rules, and regulations, perform a closed technique to reduce the dislocated joint. 4 Historically, performing closed-reduction techniques has been controversial, with some prominent athletic training texts stating that closed reductions were outside the scope of practice of ATs and, thus, should be attempted only by physicians. 5 The 2019 National Athletic Trainers' Association (NATA) position statement on the immediate management of appendicular joint dislocations 4 clarified that joint reductions are within ATs' scope of practice and provided ATs with multiple relevant clinical and legal recommendations and guidelines.…”

“…4 Historically, performing closed-reduction techniques has been controversial, with some prominent athletic training texts stating that closed reductions were outside the scope of practice of ATs and, thus, should be attempted only by physicians. 5 The 2019 National Athletic Trainers' Association (NATA) position statement on the immediate management of appendicular joint dislocations 4 clarified that joint reductions are within ATs' scope of practice and provided ATs with multiple relevant clinical and legal recommendations and guidelines. Especially important among the legal recommendations was that, whereas joint reductions may be part of the nationally recommended scope of practice, ATs should consult their state statutes, rules, and regulations.…”

“…They should also verify if joint reductions are covered by their malpractice insurance. 4 Only ATs with verifiable education, training, and competency should perform reduction techniques for joint dislocations. 4 However, limited discipline-specific resources exist for ATs to pursue further education and training.…”

“…4 Only ATs with verifiable education, training, and competency should perform reduction techniques for joint dislocations. 4 However, limited discipline-specific resources exist for ATs to pursue further education and training. Starting in 2020, the Commission on Accreditation of Athletic Training Education standards include joint reductions in the curriculum 6 ; however, the addition of this skill to entry-level education does not address updating currently certified clinicians.…”

“…1 These are not only the most frequently dislocated joints but also the joints most often deemed appropriate for on-the-field management. 3,4 Relative to other dislocated joints, these 3 are considered lower risk (ie, lower probability of complications, poor patient outcomes, and legal action) and straightforward to reduce, 6 so they provide a good starting point for ATs to develop reduction skills. We evaluated the evidence supporting the recommendations for each reduction technique using the Strength of Recommendation (SOR) Taxonomy, with ratings of A (consistent, good-quality, patient-oriented evidence), B (inconsistent or limited-quality patient-oriented evidence), and C (evidence based on consensus, usual practice, opinion, or disease-oriented evidence).…”