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Dislocation/Subluxation Management

Or

‘I’m Just Popping Out for a While!’

Jason Parry

Highly Specialist Physiotherapist

Pain Management and Rehabilitation


What’s the Difference?

Dislocation

“Displacement of a bone from its natural

position in the joint” (OED)

Where the two bones that form a joint fully

separate from each other.


Dislocation

Shoulder

Elbow


Subluxation

Subluxate

‘To partially dislocate’ (CED)

A partial dislocation of a joint


Subluxation

Knee

Shoulder


Dislocation/Subluxation

• Can happen in any joint, but some are more

common than others

• Shoulder, knee, thumb, ankles


Why?

• Main reason – abnormal collagen

composition

• Ligament and tendon laxity

• Joint capsule laxity


Quick Anatomy Lesson

Collagen

• The main structural protein of the various

connective tissues in the body

• Found in ligaments, tendons and joint

capsules (primarily Type I)

• Makes ligaments and tendons strong like

little ‘guy ropes’


Ligaments, Tendons, Capsules


Ehlers-Danlos Syndrome

• Heritable disorder of connective tissue (HDCT)

• Caused by a defect in the structure,

production or processing of collagen

• EDS Type III (Hypermobility Type) – mutation

of Tenascin X protein

• Means that the collagen making up ligaments

and tendons are more stretchy (more lax)

• Means that joints are potentially less stable –

hence subluxations and dislocations


Other Reasons Too!

• Altered muscle tone – fatigue, muscle

patterning, spasm, stress

• Impaired proprioception

• Repeated overstretching - too many ‘party

tricks’

• Traumatic incident


‘Party Trick’

‘Captain Frodo’ – moves his body

through a tennis racquet!

‘Just hanging around’

‘The Snake Man’ entertaining

French soldiers in 1915!


It’s Out!

• A regular occurrence?

• 1 x week, 1 x day, 1 x hour, 1 x every 5 mins!

• Joint slips back into place on its own

But we still need to see if we can reduce the

frequency for the future...


Help – it won’t go back in!

Understandable tendency to panic!


Whoa There!


Panic

• More stress

• Muscle spasms – pull the joint out of

place

• More pain

• Less chance of resolving the dislocation


What do I DO?

Breathe!

• Slow, deep, relaxed breaths

• Try using some relaxation techniques


What do I DO?

Use Painkillers

• Appropriate use of analgesia

• What about Entonox?

Must be used with caution. Prolonged use can

lead to:

• vitamin B12 deficiency

• Interference with folate metabolism and

DNA synthesis


What do I DO?

Support the Joint

• Use pillows or a sling

• Find a ‘comfortable’ resting position

• Allows the muscles to relax/stop spasming


What do I DO?

Try Heat

• Hot water bottles, wheat bags, warm bath

• Can help to relax muscles


What do I DO?

Distraction

• Listen to music, watch a film, talk to

friends/family, try relaxation CD

• Can be helpful as a short-term pain

relieving strategy

• Can help muscles relax


What do I DO?

Massage

• Sometimes gentle massage will help to relax

the muscles enough to be able to re-locate

the joint


What do I DO?

1. Breathe

2. Use painkillers

3. Support the joint

4. Try heat

5. Distraction

6. Gentle massage


What’s the big idea?

Main aims are to:

• Stay calm

• Keep on top of the pain

• Allow the muscles to relax


What if it doesn’t go back?

• Don’t expect the joint to go straight back in

• Not unusual for joints to remain out of place

for hours or days


When do I go to hospital/get help?

• If the limb starts to change colour due to a

lack of blood supply

• If your limb goes completely numb

• If you have tried the strategies above and are

really struggling

• Not unusual for A&E to relocate joint for it to

pop straight out again or when anaesthetic

wears off

• Need to learn to stay calm and self-manage


What about damage?

• Highly unlikely

• Joint laxity allows for ligaments and

capsules to stretch

• Mostly distressing and unpleasant as

opposed to damaging


Learning Lessons

• Reflect on the event

• Were you moving in a way that normally

causes the joint to dislocate?

• Did you move without thinking?

• What was your posture like?

• Were you tired or overdoing it?

• Were you stressed about something?


Prevention

• Physiotherapy to learn to control the muscles

and use the right ones

• Rehab to improve proprioception

• Possible use of supports/braces if required

• Try to manage stress and anxieties


Stay Calm

The more you stay calm and manage it yourself,

the easier it should get each time!

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