Brief overview
- Affected joints: Generally possible in any joint, but mainly in joints that are particularly susceptible to injury such as the shoulder, elbow, hip, knee
- Chassaignac’s paralysis: special case at the elbow only in children, often triggered by a strong jerking movement of the arm; referred to as paralysis as the forearm becomes immobile, doctor restores the radial head
- Special case of cervical vertebrae: slippage of the first cervical vertebra in relation to the second, caused by accidents, malformation or connective tissue weakness, pain in the neck area, motor or sensory disorders and even paralysis
- Chiropractic treatment: method in which the therapist manually releases the blocked vertebral and limb joints
What is a subluxation?
In a joint, the bones are more or less flexibly connected to each other. The parts of the bones that lie against each other are called articular surfaces. They have a smooth cartilage layer. Ligaments, a joint capsule and muscles almost always hold the bones of the joint in position.
External force can cause their stabilizing function to be insufficient and the joint surfaces to shift against each other. If this does not happen completely, but they still have partial contact with each other, this is referred to as a subluxation.
Read more about this in the article Dislocation.
Which parts of the body are affected?
In principle, a subluxation is possible in any joint. However, just like dislocation, it mainly affects joints that are particularly susceptible to injury due to their anatomy or position on the body, such as the shoulder, elbow, hip and kneecap (patella). Both cases of complete or incomplete displacement also occur in teeth as a result of external forces. If the tooth is still in contact with the jaw bone recess, this is a subluxation.
At certain joints, the bone parts almost never shift completely, so subluxation is much more common here. One example is the dislocation of vertebral bodies.
Chassaignac’s paralysis (pronatio dolorosa)
A special form of subluxation that only occurs in children is Chassaignac’s palsy. It is a special case among subluxations, as it only occurs in children up to the age of six. Chassaignac’s palsy is named after the French surgeon Charles Chassaignac and is one of the most common injuries at this age. Because the affected children are barely able to move their forearm, it is referred to as paralysis – which is not entirely medically accurate.
What causes Chassaignac’s palsy?
A typical case of how Chassaignac’s palsy develops is as follows: the child is standing on the street with an adult by the hand and suddenly starts running, the adult pulls the child back by the hand because a car is coming.
The resulting forces may lead to dislocation of the radial head, also known as the radial head. This is because the ligamentous apparatus that holds the radial head in its two joints is not yet very stable in smaller children. As a result, the radial head sometimes slips out of the ball and socket joint with the humerus. An unfavorable force is also exerted on the elbow joint in the popular game “angels fly”.
The children then hold their arm slightly bent and turned inwards. They hardly experience any pain in this protective posture.
Treatment of Chassaignac’s palsy
This type of subluxation is easy to treat. In the ideal case, the radial head springs back into the ring-shaped retaining ligament with a targeted movement by the doctor and the pain and restriction of movement are resolved just as quickly as they occurred. The arm does not usually need to be given any special rest after the dislocation is restored.
Complications of Chassaignac’s paralysis
As with every subluxation and dislocation, there is an increased risk of a new dislocation after an injury of this type. If the radial head slips out of the annular ligament again shortly after reduction, an upper arm cast can help. This is applied for around two weeks and holds the arm in an outwardly rotated position. In this way, a new subluxation is prevented.
Subluxation of the vertebral bodies
If the first (uppermost) cervical vertebra is displaced in relation to the second cervical vertebra, this is referred to as an atlantoaxial subluxation. Neurological symptoms and even paraplegia are possible consequences.
How does an atlantoaxial subluxation occur?
The first cervical vertebra has the structure of a ring on which the head rests. A bony protrusion (dens axis) grows from the second cervical vertebra through this ring from below. In this way, the first and second cervical vertebrae form the atlantoaxial joint, which allows the head to rotate sideways.
Symptoms and treatment of atlantoaxial subluxation
The greatest danger with an atlantoaxial subluxation is that the spinal cord, which also runs through the cervical vertebral ring, is damaged. In addition to pain in the neck area, especially when bending the neck, motor or sensory disorders of the limbs are possible. In severe cases, all limbs are paralyzed (“high paraplegia”, tetraplegia).
In the case of a subluxation caused by malformations, the symptoms usually appear gradually in the first few months of life, whereas in the case of an acute subluxation they appear very suddenly. An atlantoaxial subluxation must be confirmed by an imaging procedure. If the spinal cord is damaged, surgery is usually unavoidable.
Subluxation in chiropractic
Subluxation plays a relatively large role in chiropractic treatment. This treatment method involves the manual release of subluxations of vertebral and extremity joints. It is important that the treatment is carried out correctly so as not to injure nerves, muscles, bones or ligaments.
The concept of chiropractic and its specific effectiveness are controversial and not clearly proven by studies.
