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Rheumatic Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
The upper cervical spine is often involved, and subluxation of the vertebrae is a serious but now rare complication. The earliest and most common symptom of cervical subluxation is pain radiating up into the occiput.
Modalities
Published in Michael Weir, Law and Ethics in Complementary Medicine, 2023
At the core of chiropractic practice is the identification of chiropractic subluxations, sometimes using x-rays. This technique brings with it the need for responsible and competent use of the information obtained. Is a chiropractor liable in negligence for the interpretation of the results of an x-ray? If a chiropractor doesn't perceive a fracture shown on an x-ray, does that create liability for any resulting injury?
Mechanically Induced Periarticular and Neuromuscular Problems
Published in Verna Wright, Eric L. Radin, Mechanics of Human Joints, 2020
Chronic subluxation is defined as the momentary displacement of the normal configuration of the two parts of a joint with spontaneous relocation. The relocation, which is instantaneous, creates impulsive intraarticular loads. Repetitive subluxation, as any repetitive impulsive load, is prearthrotic (28). Occasional subluxation can lead to osteochondral injury (29). Osteochondritis desic-cans is probably a traumatic event, either occurring through a preexisting abnormality in the joint’s secondary center of ossification or an osteochondral fracture (30). Joint instability can also be prearthrotic (31,32). This is generally secondary to ligamentous instability and chronic subluxation. We suspect that what reduces the subluxed joint is the immediate contraction of appropriate muscles. This creates a pulsatile force, which if repetitive is very deleterious and is prearthrotic (33). Joint instability from torn ligaments needs to be treated, but in many cases physical therapy seems as effective as surgery (34).
Contribution of injured posterior ligamentous complex and intervertebral disc on post-traumatic instability at the cervical spine
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
Marie-Hélène Beauséjour, Yvan Petit, Jeremy Hagen, Pierre-Jean Arnoux, Jean-Marc Mac Thiong, Eric Wagnac
Some limitations of this study should be listed. Flexion only was performed since the PLC is mostly solicited in flexion and current cervical collars do not restrict neck flexion efficiently. Furthermore, excessive flexion of an unstable spine could lead to subluxation and dislocation. However, having a complete overview of PLC and disc injuries effect on spinal stability would require studying all three anatomical planes. Also, loading was done in pure flexion which is a simplification of the multidirectional physiological loads present in the spine. The contact at the facet joints was simplified as a frictionless interface which could have facilitated the facet subluxation that was observed for injury at C2-C3. Future works could integrate a sensitivity analysis on the facets interface type. Muscles were not modeled while it has been shown that muscles activation can restrict movements with voluntary subjects (Eckner et al. 2014). Furthermore, gravity was not taken into account. The addition of a pre-load to represent the gravitational forces would pre-constrain the spine but would only minimally increase the mobility of the cervical spine in flexion (Barrey et al. 2015).
Multimodality Intraoperative Neurophysiological Monitoring (IONM) During Shoulder Surgeries
Published in The Neurodiagnostic Journal, 2020
Faisal R. Jahangiri, James Blaylock, Nida Qadir, Jason A. Ramsey
Shoulder surgeries, such as total shoulder arthroscopy (TSA), reverse shoulder arthroscopy (RSA), Latarjet procedure for treatment following massive rotator cuff tears, rotator cuff dysfunction, shoulder instability and fracture, etc. are associated with a high risk of nerve injuries involving axillary, radial and suprascapular nerves (Leschingera et al. 2017). For example, a higher incidence of nerve injury is reported with RSA as compared to TSA with a frequency of 0.5% to 4% (Shinagawa et al. 2019). Furthermore, the reported incidence of postoperative neurological deficit secondary to TSA is between approximately 1% to 16%. Still, the actual incidence rate might be higher because subclinical neurological deficits that can only be seen with neurological monitoring are likely to be unreported (Malik et al. 2014). Shoulder surgeries that include the use of prosthetics to replace or stabilize the shoulder joint risk misalignment, joint instability, subluxation, and loosening of the device. As demonstrated in Figure 1, these prosthetics are complex, often adding risk to already complicated surgeries. Iatrogenic mechanisms of injury include stretching/lengthening of the arm, nerve laceration, nerve ischemia, surgical exposure, cement extrusion, prosthesis implantation, and incorporation of suture line in a nerve, etc. (Leschingera et al. 2017).
Rehabilitation methods for reducing shoulder subluxation in post-stroke hemiparesis: a systematic review*
Published in Topics in Stroke Rehabilitation, 2018
Kamal Narayan Arya, Shanta Pandian, Vinod Puri
Various rehabilitation methods to reduce subluxation have been developed and investigated since decades.2,3 The management ranges from shoulder supports to functional electrical stimulation (FES). The basic principle of these techniques was either to stabilize the joint by counteracting the gravitational pull or facilitating the action of paretic muscles responsible for stability. Stroke rehabilitation practice guidelines recommend the methods of positioning and supporting the arm and electrical stimulations to manage the shoulder subluxation in stroke.18,19 Supporting devices are applied in order to prevent subluxation as well as to realign the humeral head in the glenoid fossa. The support may also alleviate pain.20,21 Electrical stimulation is usually applied to activate the muscles responsible for the position of the humeral head.22 These intervention techniques are also applied to prevent the subluxation.21,23,24 However, no method has been clinically accepted for the successful management of this usual complication.