{"id":1471,"date":"2024-03-12T16:54:18","date_gmt":"2024-03-12T20:54:18","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/?post_type=chapter&p=1471"},"modified":"2025-10-17T19:31:06","modified_gmt":"2025-10-17T23:31:06","slug":"dislocations-subluxations-and-frozen-shoulder","status":"web-only","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/chapter\/dislocations-subluxations-and-frozen-shoulder\/","title":{"raw":"Dislocations, Subluxations, and Frozen Shoulder","rendered":"Dislocations, Subluxations, and Frozen Shoulder"},"content":{"raw":"

Dislocations and Subluxations<\/strong><\/h3>\r\nJoint dislocations<\/strong> involve the loss of contact between one or more bones in a joint.\u00a0 Dislocations often are caused by accidents during sports, falls, workplace mishaps, or other forms of trauma (e.g., car crashes).\r\n\r\nJoint subluxations<\/strong> involve the partial loss of contact between one or more bones in a joint.\u00a0 Subluxations (unlike dislocations) often return to their normal position on their own.\r\n\r\nJoints that are susceptible to both dislocation and subluxation are the shoulders, hips, elbows, wrists, fingers, ribs, and kneecaps.\r\n\r\n \r\n\r\nExamples of Joint Dislocations<\/span>:<\/strong>\r\n\r\nShoulder (glenohumeral) dislocations<\/strong> are the most common type of dislocation in adults, which is thought to be due to its high degree of mobility and therefore reduced stability in comparison with other joints.\u00a0 Shoulder dislocations typically occur as a result of traumatic injury, though loose capsular ligaments and previous shoulder dislocations can be predisposing factors.\u00a0 Shoulder dislocations usually involve the head of the humerus being thrust out of the glenoid socket in an anterior and inferior direction.\u00a0 The scapula provides posterior support and the glenohumeral joint is more vulnerable on its anterior side.\u00a0 That being said, although rare, dislocation can occur posteriorly as well.\u00a0 Other dislocations involving the scapula can occur (e.g., involving the acromioclavicular joint) though these are not typically called shoulder dislocations.\r\n\r\nElbow dislocations<\/strong> are the most common dislocation in children, and second most common in adults.\u00a0 The elbow is a more stable joint than the shoulder with more limited range of motion.\u00a0 The elbow is a biaxial hinge joint and the shoulder is triaxial ball joint.\u00a0 The bony olecranon hook of the ulna helps to keep the humerus in place, and also means considerable force is required to dislocate the elbow, frequently fracturing the ulna in the process, especially in an adult.\u00a0 In children the hook of the ulna is less formed, leading to easier dislocations particularly when pulling or swinging a child by their arms (when in an extended arm position).\u00a0 Sports (e.g., football and wrestling) account for approximately 10-50% of elbow dislocations.\r\n

Risk Factors - Dislocations<\/strong><\/h3>\r\nSports as well as falls are risk factors for shoulder and elbow dislocations.\u00a0 Hyperlaxity of joints as well as the shape of bone ends and cerebral palsy at times can predispose to shoulder dislocations.\r\n

Signs and Symptoms - Shoulder Dislocations<\/strong><\/h3>\r\nShoulder Dislocations:<\/strong>\u00a0 Signs and symptoms include the feeling of the joint popping out, as well as the tearing of ligaments, tendons, and\/or articular capsule.\u00a0 Inflammation, characterized by intense pain, swelling, redness, and warmth, as well as bruising, and reduced muscular strength are common.\u00a0 The pain or numbness which can radiate down the limb results from sensory neurons in the articular capsule and nearby structures being stretched.\r\n\r\nShoulder dislocations often have the appearance of deformed joints and can also be palpated.\u00a0 Dislocations will also be noted to exhibit poor range of motion.\r\n\r\nAt times, a patient can report having very loose joints (hyperlaxity) and they are able to roll their shoulder back into position without assistance.\r\n\r\nThe most common complication of shoulder dislocation is recurrences, though rotator cuff muscle tears and nerve or vascular damage can also occur which can lead to loss of range of motion, reduced strength and sensory deficits.\u00a0 Additionally, dislocations may occur at the same time as bone fractures.\u00a0 Dislocations and associated trauma are predisposing risk factors for the development of compartment syndrome and myositis ossificans.\r\n

Diagnostic Tools - Dislocations<\/strong><\/h3>\r\nPhysical examination coupled with imaging (e.g., x-rays) are often used, before and after reduction of the joint (putting the joint back in place).\u00a0 MRI can be helpful in assessing ligament, tendon, and capsular damage.\u00a0 With shoulder dislocations, the tearing of ligaments and rotator cuff tendons frequently occurs which will result in muscle weakness (which will also be noted in strength tests).\r\n

Treatment - Dislocations<\/strong><\/h3>\r\nDepending on the injury, reduction of the joint may be done while the patient is conscious, or while sedated.\u00a0 \u00a0Typically, neurovascular examinations are performed before and after reduction to ensure that nerve and blood vessel injury is assessed and prevented if possible.\u00a0 Analgesics and NSAIDs are often used to reduce pain and inflammation in the initial days following the dislocation event.\r\n\r\nShoulder Dislocations - treatment strategies<\/span>:<\/strong>\r\n\r\nWith shoulder dislocations, after reduction, immobilization of the joint with a sling for 1-3 weeks is usually recommended.\u00a0 Minor tears of ligaments and tendons of the rotator cuff muscles may heal on their own however surgery using arthroscopy may be performed to repair tears.\r\n\r\nOnce healing has progressed, physical therapy is an important phase of rehabilitation in restoring, both strength and flexibility of the surrounding soft tissues (ligaments, tendons, muscles) as well as ensuring range of motion (ROM) is restored.\u00a0 Scar tissue that has formed will start to shorten and stretching exercises are required to ensure ROM is not compromised - which can result in adhesive capsulitis also known as \"frozen shoulder\".\r\n\r\nRamping up to more vigorous rehabilitative therapy is advantageous in regaining rotator cuff strength as well as maintaining ROM.\u00a0 Swimming is often recommended.\r\n\r\n \r\n

Dislocations and Subluxations Summary:<\/strong><\/span><\/h1>\r\n
\r\n

Key Take Aways - Specific Learning Objectives Study Guide<\/strong><\/p>\r\n\r\n<\/header>\r\n

\r\n
\r\n
\r\n
\r\n

Joints - Dislocation & Subluxation:<\/strong><\/h2>\r\n
    \r\n \t
  • Dislocation:<\/strong>\r\n
      \r\n \t
    • Bones in a joint bones in joint lose contact with each other due to tearing of surrounding tissue (e.g. joint capsule, ligament(s), and or muscles\/tendons)<\/li>\r\n \t
    • Most common in shoulder, elbow, wrist, finger, hip, and knee<\/li>\r\n \t
    • Shoulder most susceptible due to its high mobility<\/li>\r\n \t
    • Can occur due to joint disease or previous damage<\/li>\r\n \t
    • Can damage surrounding ligaments, muscles, nerves, and blood vessels<\/li>\r\n \t
    • Risk Factors:<\/strong> joint diseases (e.g., rheumatic arthritis)<\/li>\r\n \t
    • Symptoms:<\/strong> pain, tenderness, swelling, possible anesthesia or paralysis<\/li>\r\n \t
    • Diagnosis:<\/strong> imaging (X-ray, MRI, arthroscope)<\/li>\r\n \t
    • Treatment:<\/strong> reduction, analgesics, anti-inflammatories, PRICE (protection, rest, ice, compression, elevation), possible surgical repair<\/li>\r\n \t
    • Rehabilitation:<\/strong> physiotherapy to regain function and range of motion<\/li>\r\n \t
    • Complications<\/strong> include:\r\n
        \r\n \t
      • Adhesive capsulitis (e.g., Frozen Shoulder) in which scarring and adhesions forming in connective tissue surrounding the glenohumeral joint - causing stiffness and loss of range of motion.<\/li>\r\n \t
      • Prevent this from occurring by following prescribed stretching and exercise regime.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t
      • Subluxation:<\/strong>\r\n
          \r\n \t
        • Partial loss of contact between one or more bones in a joint<\/li>\r\n \t
        • Less severe than dislocation, often self-resolves<\/li>\r\n \t
        • Similar signs and symptoms: pain, stiffness<\/li>\r\n \t
        • Can also lead to frozen shoulder (adhesive capsulitis) if not properly rehabilitated<\/li>\r\n \t
        • Importance of physiotherapy to prevent loss of range of motion and muscle atrophy<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t
        • Frozen Shoulder:<\/strong>\r\n
            \r\n \t
          • Also known as adhesive capsulitis<\/li>\r\n \t
          • Excessive scarring reduces range of motion long-term<\/li>\r\n \t
          • Importance of following doctor and physiotherapist guidance for recovery and rehabilitation.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n \r\n\r\n \r\n\r\n ","rendered":"

            Dislocations and Subluxations<\/strong><\/h3>\n

            Joint dislocations<\/strong> involve the loss of contact between one or more bones in a joint.\u00a0 Dislocations often are caused by accidents during sports, falls, workplace mishaps, or other forms of trauma (e.g., car crashes).<\/p>\n

            Joint subluxations<\/strong> involve the partial loss of contact between one or more bones in a joint.\u00a0 Subluxations (unlike dislocations) often return to their normal position on their own.<\/p>\n

            Joints that are susceptible to both dislocation and subluxation are the shoulders, hips, elbows, wrists, fingers, ribs, and kneecaps.<\/p>\n

             <\/p>\n

            Examples of Joint Dislocations<\/span>:<\/strong><\/p>\n

            Shoulder (glenohumeral) dislocations<\/strong> are the most common type of dislocation in adults, which is thought to be due to its high degree of mobility and therefore reduced stability in comparison with other joints.\u00a0 Shoulder dislocations typically occur as a result of traumatic injury, though loose capsular ligaments and previous shoulder dislocations can be predisposing factors.\u00a0 Shoulder dislocations usually involve the head of the humerus being thrust out of the glenoid socket in an anterior and inferior direction.\u00a0 The scapula provides posterior support and the glenohumeral joint is more vulnerable on its anterior side.\u00a0 That being said, although rare, dislocation can occur posteriorly as well.\u00a0 Other dislocations involving the scapula can occur (e.g., involving the acromioclavicular joint) though these are not typically called shoulder dislocations.<\/p>\n

            Elbow dislocations<\/strong> are the most common dislocation in children, and second most common in adults.\u00a0 The elbow is a more stable joint than the shoulder with more limited range of motion.\u00a0 The elbow is a biaxial hinge joint and the shoulder is triaxial ball joint.\u00a0 The bony olecranon hook of the ulna helps to keep the humerus in place, and also means considerable force is required to dislocate the elbow, frequently fracturing the ulna in the process, especially in an adult.\u00a0 In children the hook of the ulna is less formed, leading to easier dislocations particularly when pulling or swinging a child by their arms (when in an extended arm position).\u00a0 Sports (e.g., football and wrestling) account for approximately 10-50% of elbow dislocations.<\/p>\n

            Risk Factors – Dislocations<\/strong><\/h3>\n

            Sports as well as falls are risk factors for shoulder and elbow dislocations.\u00a0 Hyperlaxity of joints as well as the shape of bone ends and cerebral palsy at times can predispose to shoulder dislocations.<\/p>\n

            Signs and Symptoms – Shoulder Dislocations<\/strong><\/h3>\n

            Shoulder Dislocations:<\/strong>\u00a0 Signs and symptoms include the feeling of the joint popping out, as well as the tearing of ligaments, tendons, and\/or articular capsule.\u00a0 Inflammation, characterized by intense pain, swelling, redness, and warmth, as well as bruising, and reduced muscular strength are common.\u00a0 The pain or numbness which can radiate down the limb results from sensory neurons in the articular capsule and nearby structures being stretched.<\/p>\n

            Shoulder dislocations often have the appearance of deformed joints and can also be palpated.\u00a0 Dislocations will also be noted to exhibit poor range of motion.<\/p>\n

            At times, a patient can report having very loose joints (hyperlaxity) and they are able to roll their shoulder back into position without assistance.<\/p>\n

            The most common complication of shoulder dislocation is recurrences, though rotator cuff muscle tears and nerve or vascular damage can also occur which can lead to loss of range of motion, reduced strength and sensory deficits.\u00a0 Additionally, dislocations may occur at the same time as bone fractures.\u00a0 Dislocations and associated trauma are predisposing risk factors for the development of compartment syndrome and myositis ossificans.<\/p>\n

            Diagnostic Tools – Dislocations<\/strong><\/h3>\n

            Physical examination coupled with imaging (e.g., x-rays) are often used, before and after reduction of the joint (putting the joint back in place).\u00a0 MRI can be helpful in assessing ligament, tendon, and capsular damage.\u00a0 With shoulder dislocations, the tearing of ligaments and rotator cuff tendons frequently occurs which will result in muscle weakness (which will also be noted in strength tests).<\/p>\n

            Treatment – Dislocations<\/strong><\/h3>\n

            Depending on the injury, reduction of the joint may be done while the patient is conscious, or while sedated.\u00a0 \u00a0Typically, neurovascular examinations are performed before and after reduction to ensure that nerve and blood vessel injury is assessed and prevented if possible.\u00a0 Analgesics and NSAIDs are often used to reduce pain and inflammation in the initial days following the dislocation event.<\/p>\n

            Shoulder Dislocations – treatment strategies<\/span>:<\/strong><\/p>\n

            With shoulder dislocations, after reduction, immobilization of the joint with a sling for 1-3 weeks is usually recommended.\u00a0 Minor tears of ligaments and tendons of the rotator cuff muscles may heal on their own however surgery using arthroscopy may be performed to repair tears.<\/p>\n

            Once healing has progressed, physical therapy is an important phase of rehabilitation in restoring, both strength and flexibility of the surrounding soft tissues (ligaments, tendons, muscles) as well as ensuring range of motion (ROM) is restored.\u00a0 Scar tissue that has formed will start to shorten and stretching exercises are required to ensure ROM is not compromised – which can result in adhesive capsulitis also known as “frozen shoulder”.<\/p>\n

            Ramping up to more vigorous rehabilitative therapy is advantageous in regaining rotator cuff strength as well as maintaining ROM.\u00a0 Swimming is often recommended.<\/p>\n

             <\/p>\n

            Dislocations and Subluxations Summary:<\/strong><\/span><\/h1>\n
            \n
            \n

            Key Take Aways – Specific Learning Objectives Study Guide<\/strong><\/p>\n<\/header>\n

            \n
            \n
            \n
            \n

            Joints – Dislocation & Subluxation:<\/strong><\/h2>\n
              \n
            • Dislocation:<\/strong>\n
                \n
              • Bones in a joint bones in joint lose contact with each other due to tearing of surrounding tissue (e.g. joint capsule, ligament(s), and or muscles\/tendons)<\/li>\n
              • Most common in shoulder, elbow, wrist, finger, hip, and knee<\/li>\n
              • Shoulder most susceptible due to its high mobility<\/li>\n
              • Can occur due to joint disease or previous damage<\/li>\n
              • Can damage surrounding ligaments, muscles, nerves, and blood vessels<\/li>\n
              • Risk Factors:<\/strong> joint diseases (e.g., rheumatic arthritis)<\/li>\n
              • Symptoms:<\/strong> pain, tenderness, swelling, possible anesthesia or paralysis<\/li>\n
              • Diagnosis:<\/strong> imaging (X-ray, MRI, arthroscope)<\/li>\n
              • Treatment:<\/strong> reduction, analgesics, anti-inflammatories, PRICE (protection, rest, ice, compression, elevation), possible surgical repair<\/li>\n
              • Rehabilitation:<\/strong> physiotherapy to regain function and range of motion<\/li>\n
              • Complications<\/strong> include:\n
                  \n
                • Adhesive capsulitis (e.g., Frozen Shoulder) in which scarring and adhesions forming in connective tissue surrounding the glenohumeral joint – causing stiffness and loss of range of motion.<\/li>\n
                • Prevent this from occurring by following prescribed stretching and exercise regime.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n
                • Subluxation:<\/strong>\n
                    \n
                  • Partial loss of contact between one or more bones in a joint<\/li>\n
                  • Less severe than dislocation, often self-resolves<\/li>\n
                  • Similar signs and symptoms: pain, stiffness<\/li>\n
                  • Can also lead to frozen shoulder (adhesive capsulitis) if not properly rehabilitated<\/li>\n
                  • Importance of physiotherapy to prevent loss of range of motion and muscle atrophy<\/li>\n<\/ul>\n<\/li>\n
                  • Frozen Shoulder:<\/strong>\n
                      \n
                    • Also known as adhesive capsulitis<\/li>\n
                    • Excessive scarring reduces range of motion long-term<\/li>\n
                    • Importance of following doctor and physiotherapist guidance for recovery and rehabilitation.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

                       <\/p>\n

                       <\/p>\n

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