Management of Subluxation
Context-Specific Approach
The management of subluxation depends entirely on the anatomical location—dental subluxation requires no immediate treatment with observation only, while shoulder subluxation requires functional electrical stimulation and positioning strategies, and joint subluxations elsewhere may need surgical intervention.
Dental Subluxation (Primary and Permanent Teeth)
Primary Dentition
- No immediate treatment is indicated for subluxated primary teeth 1
- Observe for pulpal necrosis, which manifests as gray tooth discoloration or parulis (gingival abscess) adjacent to the affected tooth 1
- Refer to dentist within a few days if tooth discoloration or localized parulis develops 1
- Immediate dental referral is warranted if extensive gingival or facial swelling occurs 1
Permanent Dentition
- No treatment is indicated for subluxated permanent teeth 1
- Monitor closely for future pulpal necrosis through serial observation 1
- Parents should maintain vigilance for symptoms including gingival swelling, increased mobility, or parulis development 1
Post-Injury Care Instructions
- Soft diet for first 10 days after injury 1
- Restrict pacifier or digit sucking if possible 1
- Maintain good oral hygiene practices 1
- Systemic antibiotics are not routinely indicated unless medical condition requires coverage 1
Shoulder Subluxation
Prevention and Positioning
- Use functional electrical stimulation to improve shoulder lateral rotation and prevent subluxation 1, 2
- Implement shoulder strapping (sling) to provide support and prevent trauma 1, 2
- Staff education is critical to prevent trauma to the affected shoulder 1
- Avoid overhead pulley exercises as they encourage uncontrolled abduction and may worsen subluxation 1, 2
Active Treatment Interventions
- Improve range of motion through stretching and mobilization techniques, focusing especially on external rotation and abduction 1, 2
- Apply modalities including ice, heat, and soft tissue massage for pain management 1, 2
- Implement strengthening exercises for rotator cuff and scapular stabilizers 2
- Consider neuromuscular electrical stimulation as adjunctive treatment, which has demonstrated significant treatment effect for pain-free lateral rotation 1, 2
Advanced Management
- Intra-articular corticosteroid injections (Triamcinolone) provide significant pain relief when conservative measures fail 1, 2
- Suprascapular nerve blocks may be effective for up to 12 weeks 2
- Botulinum toxin injections can reduce severe hypertonicity in shoulder muscles 2
- Surgical tenotomy may be considered for severe restrictions in shoulder range of motion 2
Sternoclavicular Joint Subluxation
First-Line Management
- Conservative management with NSAIDs, physical therapy, and close monitoring is the cornerstone of treatment 3
- Recurrent inflammatory arthropathy at the sternoclavicular joint with subluxation typically responds well to anti-inflammatory treatment 3
Physical Therapy Components
- Range of motion exercises 3
- Positioning and supportive devices 3
- Patient education on joint protection and activity modification 3
Escalation Strategy
- Close follow-up with reassessment in 1-2 weeks 3
- Consider short course of oral corticosteroids if no improvement with conservative management 3
- Intra-articular corticosteroid injection if conservative management fails after 2-4 weeks 3
- Surgical consultation reserved for severe cases with persistent pain despite maximal conservative therapy 3
Critical Pitfall
- Always evaluate for septic arthritis if fever, systemic symptoms, or failure to respond to initial therapy occurs 3
Other Joint Subluxations
Atlantoaxial Subluxation
- Posterior C1-C2 joint space dissection and release followed by on-table manipulation achieves optimal or near-optimal reduction in most cases 4
- Transoral decompression is rarely needed and reserved for cases with bony growth preventing posterior reduction 4
Sacroiliac Joint Subluxation
- Recurrent subluxation may require sacroiliac stabilization with screws for definitive management 5
- Conservative treatment options should be exhausted before surgical intervention 5