Dislocations and subluxations
The terms dislocation and subluxation refer to the displacement from their normal position of bones that form a joint. These displacements most often result from injury, causing adjoining bones to no longer align with each other. Apartial or incomplete dislocation is called a subluxation.
In a healthy joint, the bones are held together with tough, fibrous bands called ligaments, attached to each bone. Surrounding the joint is a fibrous saccalled the articular capsule or joint capsule. The ligaments and joint capsule permit movement within a normal range for each joint. In dislocation, one of the bones making up the joint is forced out of its natural alignment by excessive stretching and tearing of the ligaments and capsule. Muscles and tendons surrounding the joint are usually stretched and injured to some degree.
A violent movement at the joint that exceeds normal limits usually causes a joint dislocation. Although dislocations often result from injury, they sometimes occur because of disease affecting the joint structures. 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.
Immediately after the dislocation, the joint almost always swells significantly and feels painful when pressure is applied. If trauma to the joint is violent, small chips of bone can be torn away with the supporting structures. Further dislocations may take place without severe pain because of the slack condition of surrounding muscles and other supporting tissues. A first-time dislocation is treated as a possible fracture. Some infants are born with a hip dislocation, or shallow or abnormally formed joint surfaces that increase possibility of joint dislocation and subluxation.
X rays of the joint and adjacent bones can locate and help determine the extent of dislocated joints. Immediately after the dislocation, application of ice helps 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 realigning of bones following a dislocation is called reduction. This may include simple manipulating of the joint to reposition the bones, or surgical procedures. A general anesthetic or muscle relaxant may be used to relax surrounding muscles in spasm. Acetaminophen or aspirin are sometimes used to control moderate pain, and narcotics may be prescribed for severe pain. Recurring dislocation may require surgical reconstruction or replacement of the joint. It is not recommended to reset a dislocated joint without medical personnel, because a fracturemay be present.
Chiropractic care may 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 mostpotent botanical remedies for this purpose. Homeopathic care with Arnica (Arnica montana) can reduce the trauma to the body. Ligamentand tendon strengthening may be assisted both botanically and homeopathically.
Joint ligaments have poor blood supply and, therefore, heal slowly. This 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 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. 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.
When an individual is involved in strenuous sports or heavy work, joints maybe protected by elastic bandage wraps, tape wraps, knee and shoulder pads, orspecial support stockings. Keeping the muscles surrounding the joint strongwill also help prevent dislocations. Long-term problems may also be preventedby allowing an adequate amount of time for an injured joint to rest and healprior to resuming full activity.
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