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!