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Definition In medicine, the terms dislocation and subluxation refer to the displacement of bones that form a joint. These conditions affecting the joint most often result from trauma that causes adjoining bones to no longer align with each other. A partial or incomplete dislocation is called a subluxation. Description In a healthy joint, the bones are normally held together with tough, fibrous bands called ligaments. These ligaments are attached to each bone along with a fibrous sac surrounding the joint called the articular capsule or joint capsule. The ligaments and joint capsule are relatively strong and nonelastic but permit movement within normal limits for each particular joint. In the event of a dislocation, one of the bones making up the joint is forced out of its natural alignment from excessive stretching and tearing of the joint ligaments and capsule. Muscles and tendons surrounding the joint are usually stretched and injured to some degree. Causes and symptoms A violent movement at the joint that exceeds normal limits usually causes a joint dislocation. Although dislocations often result from trauma, they sometimes occur as a result of disease affecting the joint structures. In the process of the dislocation, there is tearing of the ligaments and the articular capsule, which are vital structures for connecting the bone. Following a dislocation, the bones affected are often immobile and the affected limb may be locked in an abnormal position; fractures are also a concern with severe dislocations. Important factors in recognizing a dislocation or subluxation include a history of experiencing a fall or receiving a blow in a particular joint followed by the sudden onset of loss of function to the involved limb. Immediately after the dislocation, the joint almost always swells significantly and feels painful when pressure is applied (point tenderness). If trauma to the joint causing the dislocation or subluxation is violent in nature, small chips of bone can be torn away with the supporting structures. Chronic recurrent dislocations may take place without severe pain because of the somewhat slack condition of the surrounding muscles and other supporting tissues. A first-time dislocation is considered and treated as a possible fracture. Risk factors that can increase susceptibility of joint dislocation and subluxation are shallow or abnormally formed joint surfaces present at birth (congenital) and/or other diseases of ligaments and tissue around a joint. Some infants are born with a hip dislocation. Both sexes and all ages are affected. Diagnosis A thorough medical history and physical exam by a physician is the first step in the correct diagnosis of dislocations and subluxations. X rays of the joint and adjacent bones can locate and help determine the extent of dislocated joints Treatment Immediately after the dislocation, the application of ice is helpful to control swelling and decrease pain. If the patient needs to be transported, it is important to prevent the joint from moving (immobilization). At times, a cast or splint may be used to immobilize the joint and ensure proper alignment and healing. The treatment of realigning bones following a dislocation is called reduction. This may include simple maneuvers that manipulate the joint to reposition the bones or surgical procedures to restore the joint to its normal position. A general anesthesia or muscle relaxant may be used to help make joint reduction possible by relaxing surrounding muscles in spasm. Acetaminophen or aspirin are sometimes used to control moderate pain, and narcotics may be prescribed by the physician if the pain is severe. Recurring dislocation may require surgical reconstruction or replacement of the joint. It is not recommended to attempt to reset a dislocated joint outside of a medical environment with experienced medical personnel, because a fracture may be present. Alternative treatment Chiropractic care has been shown to be effective for joint subluxation and dislocation, especially in the spine. Swelling can be addressed using botanical therapies. Bromelain, a pineapple enzyme, and tumeric (Curcuma longa) are the most potent botanical remedies for this purpose. Acute homeopathic care with arnica (Arnica montana) can reduce the trauma to the body. Ligament and tendon strengthening can be assisted both botanically and homeopathically. Prognosis Joint ligaments have poor blood supply and, therefore, heal slowly. This healing process continues long after the symptoms of the dislocation injury have diminished. Once a joint has been either subluxated or completely dislocated, the connective tissue binding or holding it in correct alignment is stretched to such an extent that the joint becomes extremely vulnerable to repeated dislocations. However, this chance of recurrent dislocation and subluxation will decrease if a proper rehabilitation program is implemented to strengthen surrounding muscles of the joint. Most joint dislocations are curable with prompt treatment. After the dislocation has been corrected, the joint may require immobilization with a cast or sling for two to eight weeks. Prevention When an individual is involved in strenuous sports or heavy work, involved joints may be protected by elastic bandage wraps, tape wraps, knee and shoulder pads, or special support stockings. Keeping the muscles surrounding the joint strong will also help prevent dislocations. Long-term problems may also be prevented by allowing an adequate amount of time for an injured joint to rest and heal prior to resuming full activity. - Articular capsule
- An envelope of tissue that surrounds a free moving joint, composed of an external layer of white fibrous tissue and an external synovial membrane that secretes a lubricant into the joint.
For Your Information Books - Arnheim, Daniel D. Modern Principals of Athletic Training. St. Louis: Times Mirror/Mosby College Publishing Co., 1989.
- Magee, David J. Orthopedic Physical Assessment. Philidelphia: W. B. Saunders Co., 1992.
- Scully, Rosemary M., and Marylou R. Barnes. Physical Therapy. Philadelphia: J. B. Lippincott Co., 1989.
Periodicals- Gorden, Everett J. "Fractures and Dislocations: An Overview." Trauma 37, no. 5 (Feb. 1996): 5-36.
Other- Griffith, H. Winter. "Dislocations or Subluxation." ThriveOnline. 1998. 25 Mar. 1998 http://thriveonline.oxygen.com
Source: Gale Encyclopedia of Medicine, Published December, 2002 by the Gale Group
The Essay Author is Jeffrey P. Larson RPT.
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