Description
A joint dislocation, or subluxation, is the occurrence of one or more bones in a single joint being forced out of place, the most commonly known being the shoulder joint. The shoulder joint includes 3 bones: the humerus (bone of the upper arm), the scapula (bone of the shoulder blade), and the clavicle (collar bone), the ball-and-socket formation being produced by the head of the humerus (the ball) and the glenoid fossa of the scapula (the socket). In a typical shoulder joint dislocation, the humerus is forcefully removed to the front of the joint, or anteriorly, from the socket formed by the scapula, surrounding tendinous musculature, and a protective, fibrous capsule. Close to 95% of subluxation in children occurs anteriorly.
Joint dislocation is typically very painful, and can render the limb immobile until the subluxation is properly reduced, or in Layman's terms, until the bone is put back into place.
Dislocations can occur at any joint in the body, the most frequent aside from the shoulder include digits (fingers), the patella (kneecap), the hip, the clavicle (collar bone), the mandible (jaw) or in certain cases where the child is being pulled on, the wrist and ankle.
Negative Effects
The negative effects of subluxations during childhood are greater than that of an adult, as this significantly increases the risk for dislocating again - even with proper initial treatment. When dislocation occurs, due to the sheer amount of force that's required to tear a bone from it's socket, it's likely that some of the ligaments, muscle tendons that insert on that joint, or cartilage will tear, and therefore, decrease stabilization. The tearing of stabilizing tendons or cartilage is called a Bankart lesion.
Why Children?
While children and teens in their adolescence are notoriously resilient - their bodies recuperating faster than that of an adult - the increased risk comes from both an active or athletic lifestyle, and having many joints in which the protective capsules either have not yet fully formed, or fully stabilized, depending upon their age. This joint flexibility is the same reasons kids can sit cross-legged whereas the average adult loses that capability with age. Joint flexibility is in it's prime during youth due to lack of stabilization in a joint because the fibrous protective capsules that surround the entire joint have not yet fully formed. This leads to an increased risk for subluxation and destruction of the joint capsule, which in turn, puts them at a higher risk for a second subluxation. A second subluxation is more often repaired via surgery, which will surgically create more stability.
Higher Risk
Those children at a higher risk for a dislocation are those who are active, the most commonly reported being adolescent boys who play contact sports, but dislocations can occur due to a number of circumstances. Those high at risk include young children, children playing contact sports, children who live in a physical disciplinarian household, adolescents playing higher level contact sports, and those who have a higher risk of falls (skiers, gymnasts, kids who frequent jungle gyms, etc.)
Prevention
Preventative measures include proper strengthening, consistent work on range of motion, and using as much protective padding as possible. Specifically for active children or those with a high fall risk like gymnasts and skiers, it's also necessary to teach them how to land as safely as possible, either by rolling to lessen the force of the landing, or having as much protective padding on the body as possible to negate the natural reaction to slow down one's landing. Reaching arms out front of you (like a zombie) to catch yourself is at a lower risk of causing subluxation than does reaching your arms out to the side of your body, or reaching behind you. Another preventative measure parents can utilize in their daily lives while their children are still young is avoiding lifting the child by their hands or arms. Lifting a child by their hands, even in the most seemingly harmless way, puts the force of the child's entire body weight on a shoulder joint that has yet to solidify.
Treatment
Immediate treatment of a subluxation would be contacting your physician or visiting an urgent care or emergency room. It's imperative that parents or children DO NOT reduce or reset the dislocation themselves - please seek medical training immediately. Risks of reducing a subluxation include causing further damage to the joint, but more importantly, can trap nerves, blood supply, and muscle tendons. Trapping nerves can lead to possible nerve damage, trapping blood supply can lead to serious side effects such as tissue and bone death or clotting, and trapping small muscle tendons will require surgery - regardless of age. The limb may be braced or put into a sling for a short time, and then the injury will require physical therapy. In certain circumstances, surgical procedures are recommended, but are more often than not minimally-invasive, arthroscopic procedures.
Reaching behind is the most common cause of subluxation in adults, and happens frequently when an older individual falls, when skiers hit the water, or when snow skiers wipe out backwards and try to slow themselves down while going downhill. Not only does landing with your arms reaching behind you have an increased risk of subluxation, but also frequently occurs with fractures to the bones of the hand, wrist, or possibly the elbow.