`I`m Just Popping Out for a While!

Dislocation/Subluxation Management
Or
‘I’m Just Popping Out for a While!’
Jason Parry
Highly Specialist Physiotherapist
Pain Management and Rehabilitation
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 – abnormal collagen
composition

Ligament and tendon laxity

Joint capsule laxity
Quick Anatomy Lesson
Collagen



The main structural protein of the various
connective tissues in the body
Found in ligaments, tendons and joint
capsules (primarily Type I)
Makes ligaments and tendons strong like
little ‘guy ropes’
Ligaments, Tendons, Capsules
Ehlers-Danlos Syndrome





Heritable disorder of connective tissue (HDCT)
Caused by a defect in the structure,
production or processing of collagen
EDS Type III (Hypermobility Type) – mutation
of Tenascin X protein
Means that the collagen making up ligaments
and tendons are more stretchy (more lax)
Means that joints are potentially less stable –
hence subluxations and dislocations
Other Reasons Too!

Altered muscle tone – fatigue, muscle
patterning, spasm, stress

Impaired proprioception

Repeated overstretching - too many ‘party
tricks’

Traumatic incident
‘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

What about Entonox?
Must be used with caution. Prolonged use can
lead to:
 vitamin B12 deficiency
 Interference with folate metabolism and
DNA synthesis
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

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
What do I DO?
1.
2.
3.
4.
5.
6.
Breathe
Use painkillers
Support the joint
Try heat
Distraction
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
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 A&E 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!