Joint subluxation is a partial dislocation of a joint. It is often the result of acute or repetitive motion trauma, but it can also be caused by medical conditions that compromise the integrity of the ligaments. Treatment for subluxation may include joint repair, pain relief, rehabilitation therapy, and, in severe cases, surgery.
Unlike dislocation (complete dislocation of the joint), subluxation produces only a partial separation of the joint. Some of the common symptoms include:
- Pain and swelling around the joint.
- Feeling of joint instability.
- Limited mobility or loss of range of motion .
- Loss of sensation or numbness (usually temporary)
If the joint injury is severe, call 911 or go to the nearest emergency room. Signs of an emergency include severe pain, loss of sensation, or the inability to move or load a joint .
Types of subluxation
Some joints are more susceptible to subluxation than others. Some of the most commonly affected joints include the spinal, shoulder, patella, and elbow joints.
Subluxation of the vertebrae.
Subluxation of the vertebrae can occur when the spine is injured, for example, by a fall or a strong impact. Subluxation can involve a tear in the ligament , with or without damage to the vertebra itself (the bones of the spine). This type of injury can compress the spinal cord and cause shooting pains, reflected pain , or loss of nerve function .
Chiropractors also use the term subluxation to describe any displacement of the vertebrae that requires correction. Chiropractors often use spinal manipulation to correctly position the joints in the spine .
A shoulder subluxation means that the shoulder pad partially protrudes from the socket of the scapula . The most common cause of shoulder subluxation is serious injury or trauma.
Sports such as swimming, tennis, volleyball, and others that involve repetitive upward movements can weaken the shoulder ligaments and increase the likelihood of subluxation .
With a shoulder subluxation, the shoulder may appear to loosen or slide out of the glenoid socket. Pain and loss of movement are common and often serious.
The patella (kneecap) fits into a groove at the end of the tibia (femur). Patellar subluxation occurs when the patella partially protrudes from this groove. Patellar subluxation is the most common knee problem in children and adolescents .
Patellar subluxation is usually caused by a direct fall on the knee, but it can also occur if the knee ligaments are weakened. Symptoms vary, but can include pain, swelling, a feeling that the knee is giving way, and a deformed knee .
An elbow subluxation can occur when someone falls onto their hands. Although a dislocated elbow is usually very painful, the subluxation may not be so obvious. The elbow can move perfectly, although there may be a dull or sharp pain.
Children under the age of seven can develop a type of subluxation called radial head subluxation (also known as babysitter's elbow). This can happen if the child's arm is pulled too roughly. Because bones and muscles are still growing in young children, dislocation can occur quite easily. Despite the pain, a doctor can easily repair a babysitter's elbow.
Subluxations are most often caused by trauma to the joint. There may be predisposing factors that increase the risk of subluxation, such as old age or contact sports.
Traumatic causes of joint subluxation include:
- Blunt force injury : including car accidents, sports injuries, or violent falls.
- Overuse injuries : including those associated with medial epicondylitis (golfer's elbow) or patellar tendonitis (jumper's knee).
- Joint hyperextension: Injury that occurs when a joint is stretched too far (outside of its normal range of motion ) .
Subluxation can also occur as a result of loosening of the joints. For example, in people with generalized joint laxity and Ehlers-Danlos syndrome, the joints are too flexible. People with these conditions are prone to subluxation, often without injury or trauma .
During pregnancy, the overproduction of certain hormones can also weaken the ligaments, causing the joints to become hypermobile and risk dislocation .
Joint subluxation is usually diagnosed by physical exam and imaging tests. Even if the joint injury does not appear to be that serious but restricts movement or 'appears relaxed', it is important to schedule an appointment with your doctor right away.
During your appointment, your healthcare provider will examine the injured joint for visible injuries, such as swelling and bruising. The healthcare provider will ask questions about the type of incident that preceded the injury, if any. You may also be asked to wiggle your fingers or toes to check for tendon tears or nerve damage.
To confirm the diagnosis and treat it accordingly, your healthcare provider will order images to detect tears, a hematoma (a bag of blood), a joint effusion (fluid collection), or a fracture . Display options include:
- X- ray – A simple x-ray examination that can help characterize the dislocation and identify a ligament tear or bone fracture.
- Computed tomography (CT) scan : An x-ray scan that includes compound x-rays that provides a three-dimensional image of the damaged joint.
- Magnetic Resonance Imaging (MRI) : An imaging test that uses powerful magnetic and radio waves that can help identify soft tissue damage.
Healthcare professionals will use these same diagnostic tools if you are in the emergency room. They will also look for serious injuries, including damage to your arteries and nerves.
After examining the injury, your healthcare provider will most likely return the joint to the correct position through manual manipulation. This can include twisting or stretching the limb.
Once the joint is properly aligned and any complications have been ruled out by your healthcare provider, treatment will focus on reducing inflammation and pain. The standard approach, known as RICE , includes:
- Rest – You will be asked to limit activity and avoid stress on the affected joint. To improve recovery and provide stability, the doctor may immobilize the joint with a splint, brace, or cast.
- Apply ice : Ice the injury helps to dilate the blood vessels to reduce pain, inflammation, and swelling. Apply an ice pack for no more than 15 to 20 minutes several times a day using a fabric barrier to prevent freezing.
- Compression – Your healthcare professional may recommend an elastic bandage to relieve swelling, reduce blood flow, and provide structural support to the affected joint.
- Height – Placing the joint over the heart can also relieve pain and inflammation by reducing blood flow and pressure on the joint.
Your healthcare provider may also recommend non-steroidal anti-inflammatory drugs (NSAIDs) such as Aleve (naproxen) , Advil (ibuprofen) , or Voltaren (diclofenac) to help reduce swelling and inflammation.
Recovery and rehabilitation
Once the acute inflammation has subsided, your healthcare provider may suggest a long-term treatment plan. In most cases, subluxations are one-time events and you should be able to fully restore joint function with simple home exercises.
Severe subluxations can cause long-term deterioration and instability. If these symptoms persist after treatment, your healthcare provider will likely refer you to a physical therapist to strengthen your muscles and ligaments and maintain or increase the range of motion in the joint. This may include in-office procedures, as well as exercise and home treatment.
Get the word of drug information
Just because a subluxation is "not as bad" as a complete dislocation, one should not ignore it and hope it will go away on its own. This can lead to irreversible changes in the joint space (including the development of osteoarthritis ) or lead to impaired blood flow and tissue necrosis (tissue death) or avascular necrosis (bone death) .
In most cases, joint subluxation is treated conservatively. But if a serious injury occurs, early treatment almost always leads to better results.