Dislocation – Subluxation

Joint stability depends not only upon ligaments and muscles, but also on the bony architecture of the joint. Dislocation (a complete disruption of the joint) and subluxation (a partial dislocation followed by relocation) can damage the ligaments, nerves, joint surfaces (cartilage), as well as the bones that make up the joint. The most common dislocations and subluxations in sport occur to the shoulder, elbow, fingers, and knee (kneecap). In the shoulder, falling on an outstretched arm (arm/shoulder slipped out) can cause either condition.

Signs and Symptoms

• Pain is usually severe, even upon the slightest of movement.
• Swelling and significant hemorrhaging occurs around the joint.
• Deformity. A visible deformity is usually present, although this may not be the case with a subluxation. The athlete, however, will usually report that the joint "went out of place".

On-Site Management

P.R.I.C.E. PROTECT the dislocated/sublocated joint (i.e. splint) from further injury. REST the area to promote healing. ICE is definitely indicated, however, COMPRESSION may elicit more pain, so this may have to be avoided. ELEVATION also maybe difficult as it would require movement to accomplish.

Immobilize the Joint. Usually the athlete will support the affected limb in the position of most comfort. Try to support this position in any way possible and transport the athlete to a medical facility.

Medical Referral-Do NOT Attempt to Relocate. Regardless of the temptation to help an athlete, never attempt to relocate a dislocation. Physician referral is mandatory. Subluxations must also be examined by a physician as bone and ligament damage is almost always associated with these injuries.

Rehabilitation. After your physicial has cleared you to rehab see a physiotherapist. Activities will include active range of motion exercises and strengthening the rotator cuff and postural muscles.

Return to Activity. The athlete should not return to activity until they receive their physician's OK. The athlete should use some form of protective taping, strapping or bracing upon return.

Prevention

• Vulnerable fingers (for example) can be taped prior to practice and competitions.
• Proper strengthening of muscles surrounding the joints (i.e. shoulder girdle) will help prevent shoulder subluxations/dislocations.

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