Managing dislocations and subluxations

Joint dislocations and subluxations can commonly occur in patients diagnosed with hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD). Such events can be very distressing and so it can be very helpful to learn how to manage and cope when this happens. A good place to begin is understanding what the difference is between a dislocation and a subluxation.

A dislocation is defined as “Displacement of a bone from its natural position in the joint”. This is where the two bones that form a joint fully separate from each other. A subluxation, is basically defined as “a partial dislocation”. It can be no less painful than a full dislocation, but the two bones that form the joint are still partially in contact with each other.

These events can happen in almost any joint, but some are more common than others are. They may not be completely eliminated, however with patience, effort, trust or time you can start to manage these events more effectively.

What should I do when it happens?

Try not to panic, stop for a second and breathe normally. Panic causes more stress and more muscle spasms. Stress and muscle spasms cause more pain, which means there is less chance of resolving the dislocation. We understand how difficult this situation is, however learning to manage the panic and anxiety will help you to manage the situation more effectively.

We do not recommend you go to A&E. A&E may not be able to offer you an appropriate management solution for this situation. You will most likely be given pain relief and have your joint (sometimes forcibly) relocated. There is a high chance of your joint then pulling itself back out of place, as your muscles are still spasming. On occasion, your joint may also be put in a plaster cast to hold it in place. We would not recommend this as your joint would be trying to pull itself out of position underneath the cast.

What should I do if my joint comes out?

Six Key Principles of Management

Here are the six key principles that will help you to better manage this situation. The main aims are to stay calm, keep on top of the pain, and allow the muscles to relax. It takes lots of practice and patience, but it can be done.

1. Breathe

Use slow deep, relaxed breaths. Try using some relaxation techniques, there are lots of different ones out there. As painful as it is, and as difficult as it may sound, you need to start to try to take control of this situation. Learning how to breathe through it will greatly help you.

2. Use painkillers

Take some appropriate painkillers (analgesia) if you have some. You should only ever take analgesia according to the dosage indicated by your prescriber. Never take more than the suggested dose. You might feel like it may not be enough at the time, but if it can take some of the edge off, then this is a great start. Please do not ever overdose.

3. Support the joint

You need to try to make yourself as comfortable as possible (We understand that this is not easy).

Use pillows or a sling if you have one. Find a comfortable resting position as much as possible. This allows the muscles to relax and stop spasming.

4. Try heat

Hot water bottles, wheat bags and a warm bath can all help to relax spasming and overactive muscles.

5. Distraction

• Try to take your focus away from the pain and the situation.
• Listen to music.
• Watch a film if you can.
• Talk to friends/family.
• Try a relaxation CD/MP3.

These short-term pain-relieving techniques can help muscles to relax.

6. Gentle massage

Sometimes gentle massage around the joint can help relax the muscles enough to be able to gently relocate the joint or for the joint to just slip back into place by itself.

What if it doesn’t go back?

Your joint may not go straight back in. It is not unusual for joints to remain out of place for hours or even days. However, try not to panic, as the joint will not dislocate any further.

Is it dangerous? Am I damaging my joint if it comes out?

This is highly unlikely. Your joint laxity (the natural extra looseness and stretchiness of the joint) allows for your ligaments and capsules (the soft-tissue structures that surround the joint and help to hold it in position) to stretch. It is mostly just distressing as opposed to damaging.

When should you go to hospital or 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 strategies 1-6 above, have waited a reasonable amount of time and are still desperately struggling.

It is not unusual for A&E to relocate your joint only for it to pop straight out again or when the anaesthetic wears off. Therefore, staying calm will help you to self-manage your condition.

Reflect and learn lessons!

• One of the most valuable things you can do after a subluxation/dislocation is to 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?

It is so valuable to reflect on these types of questions to look for triggers as to why the event may have happened. It may have been none of these reasons, but if it was, then you can learn to avoid repeating them in the future.

Finally, prevention is better than cure! It is obviously better if we can prevent these situations occurring in the first place instead of having to deal with them. The following can help to reduce the frequency of such occurrences:

• Physiotherapy to learn to control the muscles around joints and to use the right ones.
• Rehab to improve proprioception.
• Possible use of supports/braces if required.
• Managing stress and anxiety.

The most important thing is for you to try and stay calm. The more you stay calm when these events happen and manage it yourself, the easier it should get each time.