Joint Subluxation Injury: Symptoms and Treatment

A joint subluxation is a partial dislocation of a joint. It is often the result of acute injury or repetitive motion injury but can also be caused by medical conditions that undermine the integrity of ligaments. The treatment for subluxations may include resetting the joint, pain relief, rehabilitation therapy, and, in severe cases, surgery. 

This article discusses different types of subluxations, what causes a subluxation, joint subluxation symptoms, and how subluxations are treated.

Joint Subluxation Symptoms

As opposed to luxation (the complete dislocation of a joint), subluxations only result in the partial separation of a joint. Some of the common symptoms include:

• Pain and swelling around the joint
• A sensation of joint instability
• Limited mobility or the loss of range of motion
• Loss of feeling or numbness (usually temporary)
• Bruising

When to Seek Emergency Care

If you experience any of the following symptoms, you should see a healthcare provider right away:

• Inability to bear weight on joint
• Inability to move the joint
• Loss of sensation in the area of the joint
• Severe pain
  

Types of Subluxation

Some joints are more likely to be affected by subluxations than others. Some of the more commonly affected joints include those of the spine, shoulder, kneecap, and elbow.

Vertebral Subluxation

A vertebral subluxation can occur from poor posture, repetitive movements, or trauma to the spine, such as a fall or severe blow. The subluxation may involve a ligament rupture with or without injury to the vertebra (spinal bones) itself. This type of injury can compress the spinal cord, resulting in shooting pains, referred pain, or loss of nerve function.

The term subluxation is also commonly and inappropriately used by chiropractors. Subluxations in the chiropractic community frequently do not represent true subluxations since the joints are properly aligned and in continuity with each other, and the supposed "misalignments" are not observed by other health professionals, such as surgeons and radiologists.

Subluxation of the Shoulder

A subluxation of the shoulder means that the ball of your upper arm comes partially out of the socket in your scapula (shoulder blade). Severe injury or trauma is most often the cause of shoulder subluxation.

Sports like swimming, tennis, volleyball, and others that involve repetitive upward motions can loosen the ligaments in the shoulder and make it more likely for subluxation to occur.

Subluxation of the Patella

The patella (kneecaps) fits in a groove at the end of the tibia (thigh bone). A subluxation of the patella occurs when the kneecap moves partially out of that groove. Patellar subluxation is the most common knee problem in children and adolescents.

A joint subluxation of the knee is usually caused by a direct fall on the knee but can also happen if the knee ligaments are loose. Symptoms can vary but may include pain, swelling, feeling the knee "give way," and a misshapen look to the knee.

Elbow Subluxation

Elbow subluxations can occur when someone falls onto their hands. Though elbow luxations are typically very painful, subluxations may not be as obvious. The elbow may move perfectly well, although there may be a dull or sharp pain.

Children under seven can get a type of subluxation called a radial head subluxation (a.k.a. "nursemaid's elbow"). This can happen when the child’s arm is pulled a little too roughly. Because the bones and muscles of younger children are still growing, dislocation can occur quite easily. Although painful, a nursemaid’s elbow can be easily reset by a healthcare provider.

Causes

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

Traumatic causes of joint subluxation include:

• Blunt force injuries: Including motor vehicle accidents, sports injuries, or a severe fall
• Overuse injuries: Including those associated with medial epicondylitis (golfer's elbow) or patellar tendonitis (jumper's knee)
• Joint hyperextension: An injury that occurs when a joint is hyperextended (extended beyond its normal range of motion)

Subluxations can also occur as a result of loose joints. For example, people with generalized joint laxity and Ehlers-Danlos syndrome have joints that are overly flexible. Individuals with these conditions are prone to subluxations, often without any instigating trauma or injury.

Arthritis can also cause joint subluxations. Cartilage damage from osteoarthritis or inflammatory arthritis, such as rheumatoid arthritis or psoriatic arthritis, can lead to joint instability that results in subluxations.

Diagnosis

Joint subluxation is typically diagnosed with a physical exam and imaging studies. Even if a joint injury doesn't appear all that serious but is limiting motion or "feels loose," it is important to make an appointment with your healthcare provider immediately.

During the appointment, your healthcare provider will examine the injured joint to check for any visible damage, such as swelling and bruising. The healthcare provider will ask questions about any incidents or accidents that preceded the injury. You may also be asked to wiggle your fingers or toes to see if there are any ruptured tendons or nerve injuries.

To confirm the diagnosis and direct the appropriate treatment, your healthcare provider will order imaging tests to check if there are ruptures, hematoma (a blood pocket), joint effusion (the accumulation of fluid), or a fracture. Imaging options include:

• X-ray: A plain film radiologic study that can help characterize the dislocation and identify ruptured ligaments or bone fractures
• Computerized tomography (CT): A radiologic study involving composited X-rays that offer a three-dimensional representation of an injured joint
• Magnetic resonance imaging (MRI): An imaging study using powerful magnetic and radio waves that can help identify soft tissue injuries

Healthcare providers will use these same diagnostic tools if you are seen in an emergency room. They will also check for serious injuries, including arterial and nerve damage.

Treatment

After examining the injury, your healthcare provider will likely reset the joint into its proper position using manual manipulation. This may involve turning or pulling the limb.

Once the joint is properly realigned and your healthcare provider has ruled out any complications, the treatment will be focused on reducing inflammation and pain. The standard approach, known by the acronym RICE, involves:

• Rest: You will be instructed to limit activity and avoid putting weight on the affected joint. To improve recovery and ensure stability, the healthcare provider may immobilize the joint with a splint, brace, or cast.
• Ice application: Icing an injury helps dilate blood vessels to reduce pain, inflammation, and swelling. Apply the ice pack for no more than 15 to 20 minutes several times a day, using a cloth barrier to prevent frostbite.
• Compression: Your healthcare provider may suggest an elastic bandage to control swelling, reduce blood flow, and provide structural support to the affected joint.
• Elevation: Placing the joint above the heart can also alleviate pain and inflammation by reducing blood flow and pressure to the joint.

Your healthcare provider may also suggest a nonsteroidal anti-inflammatory drug (NSAID) like Aleve (naproxen), Advil (ibuprofen), or Voltaren (diclofenac) to alleviate swelling and inflammation.

Joint surgery is performed by an orthopedic surgeon who specializes in muscle and skeletal diseases and disorders. It may require open surgery or be performed arthroscopically.

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 will be able to fully recover the function of a joint with simple at-home exercises.

Severe subluxations can cause long-term impairment and instability. If these symptoms persist after treatment, your healthcare provider will likely refer you to a physical therapist to strengthen the muscles and ligaments and maintain or increase the range of motion in the joint. This may involve in-office procedures and at-home exercises and treatments.

A Word From Verywell

Just because a subluxation is "not as bad" as a full dislocation, you shouldn't ignore it and hope that it goes away on its own. Doing so may lead to permanent changes in the joint space (including the development of osteoarthritis) or result in the impairment of blood flow and the onset of tissue necrosis (tissue death) or avascular necrosis (bone death).

In most cases, joint subluxation can be treated conservatively. But, if a severe injury occurs, early treatment almost always results in better outcomes.