SUBLUXATION

A Brief Introduction

In a bid to comprehend the extent of this term, one should first discuss and understand the movable joints in the body. Fully movable joints include synovial joints. A synovial joint refers to the area where two bones articulate, or when two bones meet each other to form a movable joint. Synovial joints contain structures that allow the joint to move while reducing friction and stress. These include lubricated articular cartilage, synovial fluid (which acts as the lubricant for these joints), and a joint space that prevents the bones from rubbing on each other.

Synovial joints include the most frequently injured joints in the body and may suffer from certain ailments such as dislocations, sprains, arthritis, and subluxations. 

Types

Joint Subluxation

A subluxation of a joint involves a situation where a connecting bone partially pulls out of the joint. In contrast to a luxation, which refers to a complete separation of the joints, a subluxation often returns to its original position/location without additional help from a health professional. 

A typical example of a joint subluxation includes nursemaid’s elbow, which refers to subluxation of the radial head from the annular ligament. Other joints susceptible to subluxations include the kneecaps, joints of the spine, shoulder, ribs, wrists, fingers, ankles, and the hips affected by hip dysplasia. A health professional can observe spinal subluxation with the aid of X-rays. Spinal subluxations can sometimes pinch on spinal nerve roots, leading to symptoms in the areas supplied by those roots. In the spine, such a displacement may occur due to falls, accidents, fracture, spondylolisthesis, rheumatoid arthritis, severe osteoarthritis, and other forms of trauma.

Dental subluxation

Subluxation of the tooth refers to a dental traumatic injury in which the tooth experiences increased mobility but still remains in the mandible or maxilla. Dental subluxation holds a position as one of the most common dental traumatic disorders. This type of subluxation includes a non-dental-urgency condition, meaning it unlikely results in significant morbidity if not seen within 24 hours by a dentist, and usually treated conservatively. This entails good oral hygiene with 0.12% chlorhexidine gluconate mouthwash, a soft and cold diet, and avoidance of smoking for several days. In painful situations, a temporary splinting of the injured tooth may provide relief of the pain. 

Subluxation of the lens

Subluxation of the lens, also known as ectopia lentis, refers to a displacement or malpositioning of the lens within the eye. Subluxated lenses usually occur in individuals who have experienced ocular trauma and those with certain systemic disorders, such as Ehlers-Danlos syndrome, Marfan syndrome, Loeys-Dietz syndrome and homocystinuria. Some subluxated lenses may require removal, such as lenses that float freely or those that no longer possess the typical transparent quality, forming cataracts. 

Symptoms

Different types of subluxations often present different symptoms, with only a few sharing similar features. These symptoms include:

• Pain and swelling around the joint
• A sensation of joint instability
• Loss of the range of motion
• Numbness
• Tenderness to percussion
• Decreased vision (subluxation of the lens)
• Marked astigmatism (subluxation of the lens)

Causes

Subluxations often occur as a result of trauma to a joint. However, predisposing factors may occur to increase the risk of subluxation, such as older age or participation in contact sports.

Traumatic causes include:

• Blunt force injuries such as sports injuries or a severe fall
• Joint hyperextension
• Overuse injuries

Other causes include joint laxity (which occurs in individuals with certain disorders such as Ehlers-Danlos syndrome).

Treatment

After examining the injury, the healthcare provider may likely reset the joint into its original position using manual manipulation. This may involve turning or pulling the limb. Upon realignment of the joint, the healthcare provider may rule out complications and strictly focus on treatment to reduce inflammation and pain. The standard approach, known by the acronym RICE, involves:

RICE Therapy:

1. Rest: Rest the affected knee to reduce inflammation and pain.
2. Ice: Apply ice to the knee for 15-20 minutes every 2-3 hours to reduce swelling.
3. Compression: Use a compression bandage to support the knee and reduce swelling.
4. Elevation: Elevate the leg when possible to help reduce swelling.

The healthcare provider may also recommend NSAIDs such as ibuprofen, advil and diclofenac to relieve the pain.

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