Dislocation/Subluxation Management Or ‘I’m Just Popping Out for a While!’
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<strong>Dislocation</strong>/<strong>Subluxation</strong> <strong>Management</strong><br />
<strong>Or</strong><br />
<strong>‘I<strong>’</strong>m</strong> <strong>Just</strong> <strong>Popping</strong> <strong>Out</strong> <strong>for</strong> a <strong>While</strong>!<strong>’</strong><br />
Jason Parry<br />
Highly Specialist Physiotherapist<br />
Pain <strong>Management</strong> and Rehabilitation
What<strong>’</strong>s the Difference?<br />
<strong>Dislocation</strong><br />
“Displacement of a bone from its natural<br />
position in the joint” (OED)<br />
Where the two bones that <strong>for</strong>m a joint fully<br />
separate from each other.
<strong>Dislocation</strong><br />
Shoulder<br />
Elbow
<strong>Subluxation</strong><br />
Subluxate<br />
‘To partially dislocate<strong>’</strong> (CED)<br />
A partial dislocation of a joint
<strong>Subluxation</strong><br />
Knee<br />
Shoulder
<strong>Dislocation</strong>/<strong>Subluxation</strong><br />
• Can happen in any joint, but some are more<br />
common than others<br />
• Shoulder, knee, thumb, ankles
Why?<br />
• Main reason – abnormal collagen<br />
composition<br />
• Ligament and tendon laxity<br />
• Joint capsule laxity
Quick Anatomy Lesson<br />
Collagen<br />
• The main structural protein of the various<br />
connective tissues in the body<br />
• Found in ligaments, tendons and joint<br />
capsules (primarily Type I)<br />
• Makes ligaments and tendons strong like<br />
little ‘guy ropes<strong>’</strong>
Ligaments, Tendons, Capsules
Ehlers-Danlos Syndrome<br />
• Heritable disorder of connective tissue (HDCT)<br />
• Caused by a defect in the structure,<br />
production or processing of collagen<br />
• Means that the collagen making up ligaments<br />
and tendons are more stretchy (more lax)<br />
• Means that joints are potentially less stable –<br />
hence subluxations and dislocations
Other Reasons Too!<br />
• Altered muscle tone – fatigue, muscle<br />
patterning, spasm, stress<br />
• Impaired proprioception<br />
• Repeated overstretching - too many ‘party<br />
tricks<strong>’</strong><br />
• Traumatic incident
‘Party Trick<strong>’</strong><br />
‘Captain Frodo<strong>’</strong> – moves his body<br />
through a tennis racquet!<br />
‘<strong>Just</strong> hanging around<strong>’</strong><br />
‘The Snake Man<strong>’</strong> entertaining<br />
French soldiers in 1915!
It<strong>’</strong>s <strong>Out</strong>!<br />
• A regular occurrence?<br />
• 1 x week, 1 x day, 1 x hour, 1 x every 5 mins!<br />
• Joint slips back into place on its own<br />
But we still need to see if we can reduce the<br />
frequency <strong>for</strong> the future...
Help – it won<strong>’</strong>t go back in!<br />
Understandable tendency to panic!
Whoa There!
Panic<br />
• More stress<br />
• Muscle spasms – pull the joint out of<br />
place<br />
• More pain<br />
• Less chance of resolving the dislocation
What do I DO?<br />
Breathe!<br />
• Slow, deep, relaxed breaths<br />
• Try using some relaxation techniques
What do I DO?<br />
Use Painkillers<br />
• Appropriate use of analgesia<br />
• What about Entonox?<br />
Must be used with caution. Prolonged use can<br />
lead to:<br />
• vitamin B12 deficiency<br />
• Interference with folate metabolism and<br />
DNA synthesis
What do I DO?<br />
Support the Joint<br />
• Use pillows or a sling<br />
• Find a ‘com<strong>for</strong>table<strong>’</strong> resting position<br />
• Allows the muscles to relax/stop spasming
What do I DO?<br />
Try Heat<br />
• Hot water bottles, wheat bags, warm bath<br />
• Can help to relax muscles
What do I DO?<br />
Distraction<br />
• Listen to music, watch a film, talk to<br />
friends/family, try relaxation CD<br />
• Can be helpful as a short-term pain<br />
relieving strategy<br />
• Can help muscles relax
What do I DO?<br />
Massage<br />
• Sometimes gentle massage will help to relax<br />
the muscles enough to be able to re-locate<br />
the joint
What do I DO?<br />
1. Breathe<br />
2. Use painkillers<br />
3. Support the joint<br />
4. Try heat<br />
5. Distraction<br />
6. Gentle massage
What<strong>’</strong>s the big idea?<br />
Main aims are to:<br />
• Stay calm<br />
• Keep on top of the pain<br />
• Allow the muscles to relax
What if it doesn<strong>’</strong>t go back?<br />
• Don<strong>’</strong>t expect the joint to go straight back in<br />
• Not unusual <strong>for</strong> joints to remain out of place<br />
<strong>for</strong> hours or days
When do I go to hospital/get help?<br />
• If the limb starts to change colour due to a<br />
lack of blood supply<br />
• If your limb goes completely numb<br />
• If you have tried the strategies above and are<br />
really struggling<br />
• Not unusual <strong>for</strong> A&E to relocate joint <strong>for</strong> it to<br />
pop straight out again or when anaesthetic<br />
wears off<br />
• Need to learn to stay calm and self-manage
What about damage?<br />
• Highly unlikely<br />
• Joint laxity allows <strong>for</strong> ligaments and<br />
capsules to stretch<br />
• Mostly distressing and unpleasant as<br />
opposed to damaging
Learning Lessons<br />
• Reflect on the event<br />
• Were you moving in a way that normally<br />
causes the joint to dislocate?<br />
• Did you move without thinking?<br />
• What was your posture like?<br />
• Were you tired or overdoing it?<br />
• Were you stressed about something?
Prevention<br />
• Physiotherapy to learn to control the muscles<br />
and use the right ones<br />
• Rehab to improve proprioception<br />
• Possible use of supports/braces if required<br />
• Try to manage stress and anxieties
Stay Calm<br />
The more you stay calm and manage it yourself,<br />
the easier it should get each time!
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