Dislocation/Subluxation Management
Or
‘I’m Just Popping Out for a While!’
Jason Parry Extended Scope Practitioner Clinical Specialist Physiotherapist Hypermobility
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 – connective tissue
§ Support, bind together.
§ Framework for the body (ligaments, tendons)
§ Ligaments and tendons act like little ‘guy ropes’ Ligaments, Tendons, Capsules Quick Anatomy Lesson Collagen
§ The main structural protein of the various connective tissues in the body
§ Alteration in collagen causes the connective tissues to be more lax (stretchy)
§ Means that the collagen making up ligaments and tendons are more stretchy (more lax)
§ Joint capsule laxity
§ Means that joints are potentially less stable – hence subluxations and dislocations
Other Reasons Too!
§ Altered muscle tone – fatigue, muscle patterning, spasm, stress
§ Impaired proprioception
§ Traumatic incident
§ Repeated overstretching - too many ‘party tricks’ ‘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
§ Only take the dosage indicated by your prescriber. Never take more than the suggested dose 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/MP3
§ 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 The 6 Key Principles of Management
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
§ Once it’s out, it’s out – it’s not going out even more! 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 ER 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!