Friday, June 1, 2018

Shoulder Subluxation

Shoulder subluxation refers to a partial dislocation of the shoulder joint. This occurs when the ball of the upper arm bone, called the humerus, partly comes out of the glenoid socket in the shoulder.

The shoulder is the most mobile joint in the body. It contains several bones, ligaments, and muscles that work together to keep it stable. Because the shoulder is so mobile, it is very susceptible to dislocation. Shoulder subluxation is often the result of trauma, injury or a stroke that weakens the arm muscles.

Symptoms of a shoulder subluxation can include a visibly deformed or out-of-place shoulder, pain, swelling, numbness or tingling or trouble moving the joint. A person may be able to feel the ball of the humerus moving in and out of the shoulder socket. They may also notice a clicking or catching sensation especially when reaching overhead.

Treatment aims to reposition the humerus back into the socket and ensure that it stays in place. Treatment options include: 1. Closed reduction involves a doctor attempting to gently maneuver the bone back into position. When this is achieved, severe pain should improve almost immediately. 2. Surgery may be recommended when dislocations recur or when nerves, blood vessels, or ligament in the shoulder have been damaged. 3. A splint, brace, or sling for a few days or weeks to prevent the shoulder from moving. The length of time will depend on the extent of the dislocation. 4. A muscle relaxant and an anti-inflammatory agent, such as ibuprofen, for pain and swelling. 5. Rehabilitation following surgery or time spent in a sling.

When a person seeks medical attention promptly and receives a correct diagnosis, shoulder subluxation is treatable. When no surgery is recommended, several months may pass before a person call tell how well the treatment is working.

My Take:
Shoulder subluxation is quite common. I perform closed reduction on shoulder subluxation daily. It is by far, the preferred treatment method and often results in immediate relief as noted above. Typically, a simple exercise, pendulum rotations, will maintain and gradually increase range of motion. I use omega-3 fatty acids, ginger or Boswellia to reduce inflammation rather than NSAIDs. If I am unable to manipulate the shoulder back into position on the initial visit, the patient performs the pendulum exercises for a week and we try again. In over 40 years of practice, I have not lost a patient to shoulder surgery if I was able to manipulate the shoulder.

I strongly disagree with the use of a sling or brace. Immobilizing the shoulder results in lost range of motion leading to a “frozen shoulder”. This can occur within hours of restricting motion. Manipulation of a frozen shoulder can be effective but is often very painful as the adhesions in the joint release. The longer the joint is “frozen” the more painful the manipulation.
I advise my patients with shoulder subluxation to continue moving the shoulder to maintain the current pain free range, while they gradually recover any lost range of motion with exercise.

The Bottom Line:
If you have symptoms of shoulder subluxation, consult with a chiropractic physician that performs extremity manipulation. Use natural anti-inflammatory supplements and avoid the use of a sling or brace.

Source: May 23, 2018 National Institutes of Health

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