Subluxation

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A subluxation is an incomplete or partial dislocation of a joint or organ. [1] According to the World Health Organization, a subluxation is a "significant structural displacement" and is therefore visible on static imaging studies, such as X-rays. [2] [3] [4] Unlike real subluxations, the pseudoscientific concept of a chiropractic "vertebral subluxation" may or may not be visible on x-rays.

Contents

The term is used in the fields of medicine, dentistry, and chiropractic. There is no scientific evidence for the existence of chiropractic subluxations or proof they or their treatment have any effects on health.

Medical

Joints

X-ray showing metacarpophalangeal subluxation of the thumb of a 71-years old woman due to trapeziometacarpal osteoarthritis Metacarpophalangeal subluxation.svg
X-ray showing metacarpophalangeal subluxation of the thumb of a 71-years old woman due to trapeziometacarpal osteoarthritis

A subluxation of a joint is where a connecting bone is partially out of the joint. [5] In contrast to a luxation, which is a complete separation of the joint, a subluxation often returns to its normal position without additional help from a health professional. [6] An example of a joint subluxation is a nursemaid's elbow, which is the subluxation of the head of the radius from the annular ligament. Other joints that are prone to subluxations are the shoulders, fingers, kneecaps, ribs, wrists, ankles, and hips affected by hip dysplasia. A spinal subluxation is visible on X-rays and can sometimes impinge on spinal nerve roots, causing symptoms in the areas served by those roots. In the spine, such a displacement may be caused by a fracture, spondylolisthesis, rheumatoid arthritis, [7] severe osteoarthritis, falls, accidents and other traumas.

Ophthalmology

A subluxation of the lens within the eye is called ectopia lentis, wherein it is displaced or malpositioned. [8] Subluxated lenses are frequently found in those who have had ocular trauma and those with certain systemic disorders, such as Marfan syndrome, Ehlers–Danlos syndrome, Loeys–Dietz syndrome and homocystinuria. Some subluxated lenses may require removal, as in the case of those that float freely or those that have opacified to form cataracts.[ citation needed ]

Dental

A subluxation of a tooth is a dental traumatic injury in which the tooth has increased mobility but has not been displaced from the mandible or maxilla. This is a common condition and one of the most common dental traumatic disorders. [9] Dental subluxation is a non-dental-urgency condition, i.e., unlikely to result in significant morbidity if not seen within 24 hours by a dentist, [10] and usually treated conservatively: good oral hygiene with 0.12% chlorhexidine gluconate mouthwash, a soft and cold diet, and avoidance of smoking for several days. [10] In painful situations, a temporary splinting of the injured tooth may relieve the pain. [11]

Subluxation may also occur in the mandible from the articular groove of the temporal bone. [12] The mandible can dislocate in the anterior, posterior, lateral, or superior position. Description of the dislocation is based on the location of the condyle in comparison to the temporal articular groove. [13]

Chiropractic

Unlike real subluxations, the pseudoscientific concept of a chiropractic "vertebral subluxation" may or may not be visible on x-rays. Nor may it involve a significant displacement or even pain or clear dysfunction. [14] Straight chiropractors claim that vertebral subluxation has considerable health effects and also add a visceral component to the definition. Mainstream medicine and some mixer chiropractors consider these ideas to be pseudoscientific and dispute these claims, as there is no scientific evidence for the existence of chiropractic subluxations or proof they or their treatment have any effects on health. [15] [16] [17] [18] [19] [20]

Related Research Articles

<span class="mw-page-title-main">Chiropractic</span> Form of pseudoscientific alternative medicine

Chiropractic is a form of alternative medicine concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially of the spine. It has esoteric origins and is based on several pseudoscientific ideas.

<span class="mw-page-title-main">Vertebral subluxation</span> Chiropractic concept

In chiropractic, a vertebral subluxation means pressure on nerves, abnormal functions creating a lesion in some portion of the body, either in its action or makeup. Subluxations are not necessarily visible on X-rays.

Coccydynia is a medical term meaning pain in the coccyx or tailbone area, often brought on by a fall onto the coccyx or by persistent irritation usually from sitting.

<span class="mw-page-title-main">Joint dislocation</span> Medical injury

A joint dislocation, also called luxation, occurs when there is an abnormal separation in the joint, where two or more bones meet. A partial dislocation is referred to as a subluxation. Dislocations are often caused by sudden trauma on the joint like an impact or fall. A joint dislocation can cause damage to the surrounding ligaments, tendons, muscles, and nerves. Dislocations can occur in any major joint or minor joint. The most common joint dislocation is a shoulder dislocation.

<span class="mw-page-title-main">Spinal adjustment</span>

Spinal adjustment and chiropractic adjustment are terms used by chiropractors to describe their approaches to spinal manipulation, as well as some osteopaths, who use the term adjustment. Despite anecdotal success, there is no scientific evidence that spinal adjustment is effective against disease.

<span class="mw-page-title-main">Avulsion fracture</span> Tearing away of a bone by physical trauma

An avulsion fracture is a bone fracture which occurs when a fragment of bone tears away from the main mass of bone as a result of physical trauma. This can occur at the ligament by the application of forces external to the body or at the tendon by a muscular contraction that is stronger than the forces holding the bone together. Generally muscular avulsion is prevented by the neurological limitations placed on muscle contractions. Highly trained athletes can overcome this neurological inhibition of strength and produce a much greater force output capable of breaking or avulsing a bone.

<span class="mw-page-title-main">Ectopia lentis</span> Medical condition

Ectopia lentis is a displacement or malposition of the eye's crystalline lens from its normal location. A partial dislocation of a lens is termed lens subluxation or subluxated lens; a complete dislocation of a lens is termed lens luxation or luxated lens.

The National Association for Chiropractic Medicine(NACM) was a minority chiropractic association founded in 1984 that described itself as a "consumer advocacy association of chiropractors". It openly rejected some of the more controversial aspects of chiropractic, including a basic concept of chiropractic, vertebral subluxations as the cause of all diseases. It also sought to "reform the chiropractic profession away from a philosophical scope of practice and towards an applied science scope of practice." It stated that it was "dedicated to bringing the scientific based practice of chiropractic into mainstream medicine" and that its members "confine their scope of practice to scientific parameters and seek to make legitimate the utilization of professional manipulative procedures in mainstream health care delivery." "While the NACM is focused on furthering the profession, its primary focus is on the rights and safety of the consumers." The NACM was the object of much controversy and criticism from the rest of the profession. It quietly dropped out of sight and its demise apparently occurred sometime between May 30, 2008 and March 6, 2010.

<span class="mw-page-title-main">Mandibular fossa</span> Depression in the temporal bone that articulates with the mandible

The mandibular fossa, also known as the glenoid fossa in some dental literature, is the depression in the temporal bone that articulates with the mandible.

<span class="mw-page-title-main">History of chiropractic</span> History of chiropractic

The history of chiropractic began in 1895 when Daniel David Palmer of Iowa performed the first chiropractic adjustment on a partially deaf janitor, Harvey Lillard. Palmer claims to have had principles of chiropractic treatment passed along to him during a seance by a long-dead doctor named Dr. Jim Atkinson. While Lillard was working without his shirt on in Palmer's office, Lillard bent over to empty the trash can. Palmer noticed that Lillard had a vertebra out of position. He asked Lillard what happened, and Lillard replied, "I moved the wrong way, and I heard a 'pop' in my back, and that's when I lost my hearing." Palmer, who was also involved in many other natural healing philosophies, had Lillard lie face down on the floor and proceeded with the adjustment. The next day, Lillard told Palmer, "I can hear that rackets on the streets." This experience led Palmer to open a school of chiropractic two years later. Rev. Samuel H. Weed coined the word "chiropractic" by combining the Greek words cheiro (hand) and praktikos.

Joint manipulation is a type of passive movement of a skeletal joint. It is usually aimed at one or more 'target' synovial joints with the aim of achieving a therapeutic effect.

The Toftness Radiation Detector is an instrument used by some chiropractors. It was patented by Irwing N. Toftness in 1971, and was banned from use in the United States in 1982. Toftness claimed that it detected electromagnetic radiation emanating from vertebral subluxations. The device consisted of a plastic cylinder with a series of plastic lenses inside, as well as a clear plastic "detection plate". A patient would rub their finger against the detection plate while the device was held close to an area of their body, and report the degree of perceived resistance against the movement of their fingers. An increase in perceived resistance would indicate which area of the body required chiropractic manipulation.

Chiropractors use their version of spinal manipulation as their primary treatment method, with non-chiropractic use of spinal manipulation gaining more study and attention in mainstream medicine in the 1980s. There is no evidence that chiropractic spinal adjustments are effective for any medical condition, with the possible exception of treatment for lower back pain. The safety of manipulation, particularly on the cervical spine has been debated. Adverse results, including strokes and deaths, are rare.

Throughout its history, chiropractic has been the subject of internal and external controversy and criticism. According to magnetic healer Daniel D. Palmer, the founder of chiropractic, "vertebral subluxation" was the sole cause of all diseases and manipulation was the cure for all disease. A 2003 profession-wide survey found "most chiropractors still hold views of Innate Intelligence and of the cause and cure of disease consistent with those of the Palmers". A critical evaluation stated "Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today." Chiropractors, including D.D. Palmer, were jailed for practicing medicine without a license. D.D. Palmer considered establishing chiropractic as a religion to resolve this problem. For most of its existence, chiropractic has battled with mainstream medicine, sustained by antiscientific and pseudoscientific ideas such as vertebral subluxation.

<span class="mw-page-title-main">Sherman College of Chiropractic</span>

Sherman College of Chiropractic is a private graduate college focused on the health sciences and located in unincorporated Spartanburg County, South Carolina, with a Boiling Springs postal address; it is outside of the Boiling Springs census-designated place. It was founded in 1973 and named after chiropractor Lyle Sherman. Sherman College offers the doctor of chiropractic degree. The college is home to approximately 450 students representing 42 states and 13 countries and has more than 3,000 alumni around the world. Sherman college supports the "straight" vertebral subluxation-based focus as different from diagnosis and symptomatic treatment focus of "mixed" U.S. chiropractic schools. The name of the college was changed to Sherman College of Straight Chiropractic the late 1970s, but changed back to the original name in 2009. Sherman College also has digital x-ray services in the Health Center for use of interns and local chiropractors.

<span class="mw-page-title-main">Dental trauma</span> Medical condition

Dental trauma refers to trauma (injury) to the teeth and/or periodontium, and nearby soft tissues such as the lips, tongue, etc. The study of dental trauma is called dental traumatology.

Dental subluxation is a traumatic injury to the periodontal tissue in which the tooth has increased mobility but has not been displaced from its tooth socket.

<span class="mw-page-title-main">Dental avulsion</span> Medical condition

Dental avulsion is the complete displacement of a tooth from its socket in alveolar bone owing to trauma. Normally, a tooth is connected to the socket by the periodontal ligament. When a tooth is knocked out, the ligament is torn.

<span class="mw-page-title-main">Daniel David Palmer</span> Founder of chiropractic (1845–1913)

Daniel David Palmer was the founder of chiropractic. Palmer was born in Pickering Township, Canada West, but emigrated to the United States in 1865. He was also an avid proponent of pseudoscientific alternative medicine such as magnetic healing. Palmer opposed anything he thought to be associated with mainstream medicine such as vaccination.

Anti-vaccinationism in chiropractic is widespread, but there are notable differences within the trade. Chiropractic is a form of alternative medicine founded on the idea that all disease is caused by disruption of the flow of "innate" in the spine, by so-called vertebral subluxations – a pseudoscientific concept. Over time chiropractic has divided into "straights" who adhere to the subluxation theory and "mixers" who adhere more closely to a reality-based view of anatomy. "Straight" chiropractors are very likely to be anti-vaccination, but all chiropractic training tends to reduce acceptance of vaccines.

References

  1. "Definition of SUBLUXATION". Merriam-Webster. Retrieved January 4, 2018.
  2. Schwarz, N. (1998-04-01). "The fate of missed atlanto-axial rotatory subluxation in children". Archives of Orthopaedic and Trauma Surgery. 117 (4): 288–289. doi:10.1007/s004020050249. ISSN   1434-3916. PMID   9581264. S2CID   27358348.
  3. Laiho, K.; Soini, I.; Kautiainen, H.; Kauppi, M. (2003-03-01). "Can we rely on magnetic resonance imaging when evaluating unstable atlantoaxial subluxation?". Annals of the Rheumatic Diseases. 62 (3): 254–256. doi: 10.1136/ard.62.3.254 . ISSN   0003-4967. PMC   1754452 . PMID   12594114.
  4. Garth, William P.; Allman, Fred L.; Armstrong, William S. (1987-11-01). "Occult anterior subluxations of the shoulder in noncontact sports". The American Journal of Sports Medicine. 15 (6): 579–585. doi:10.1177/036354658701500610. ISSN   0363-5465. PMID   3425785. S2CID   37203250.
  5. Page 107 in: Betsy J. Shiland (2014). Medical Terminology & Anatomy for ICD-10 Coding (2 ed.). Elsevier Health Sciences. ISBN   9780323290784.
  6. page 63 in: Ted Eaves (2011). The Practical Guide to Athletic Training. Jones & Bartlett Publishers. ISBN   9781449662684.
  7. Calleja, Michele (May 25, 2011). Chew, Felix S (ed.). "Rheumatoid Arthritis Spine Imaging". Medscape reference. WebMD LLC. Retrieved March 12, 2013.
  8. Eifrig, Charles W (July 22, 2011). Roy Sr, Hampton (ed.). "Ectopia Lentis". Medscape. WebMD LLC. Retrieved March 12, 2013.
  9. Zadik Y, Levin L (February 2009). "Oral and facial trauma among paratroopers in the Israel Defense Forces". Dent Traumatol. 25 (1): 100–102. doi:10.1111/j.1600-9657.2008.00719.x. PMID   19208020.
  10. 1 2 Zadik Y (December 2008). "Algorithm of first-aid management of dental trauma for medics and corpsmen". Dent Traumatol. 24 (6): 698–701. doi:10.1111/j.1600-9657.2008.00649.x. PMID   19021668.
  11. Flores MT, Andersson L, Andreasen JO, Bakland LK, Malmgren B, Barnett F, et al. (April 2007). "Guidelines for the management of traumatic dental injuries. I. Fractures and luxations of permanent teeth". Dental Traumatology. 23 (2): 66–71. doi: 10.1111/j.1600-9657.2007.00592.x . PMID   17367451. S2CID   24626715.
  12. Chaudhry, Meher (April 19, 2012). Kulkarni, Rick (ed.). "Mandible dislocation". Medscape Reference. WebMD LLC. Retrieved March 12, 2013.
  13. Haddon, Robert & Peacock IV, W Franklin (2003). "240". In Tintinalli, Judith E; Kelen, Gabor D & Stapczynski, J Stephan (eds.). Face and Jaw Emergencies. Emergency Medicine: A Comprehensive Study Guide (6th ed.). McGraw-Hill. pp. 1471–1476. ISBN   978-0071388757.
  14. WHO guidelines on basic training and safety in chiropractic, p. 4, including footnote.
  15. Joseph C. Keating Jr.; Cleveland CS III; Menke M (2005). "Chiropractic history: a primer" (PDF). Association for the History of Chiropractic. Archived from the original (PDF) on 19 June 2013. Retrieved 2008-06-16. A significant and continuing barrier to scientific progress within chiropractic are the anti-scientific and pseudo-scientific ideas (Keating 1997b) which have sustained the profession throughout a century of intense struggle with political medicine. Chiropractors' tendency to assert the meaningfulness of various theories and methods as a counterpoint to allopathic charges of quackery has created a defensiveness which can make critical examination of chiropractic concepts difficult (Keating and Mootz 1989). One example of this conundrum is the continuing controversy about the presumptive target of DCs' adjustive interventions: subluxation (Gatterman 1995; Leach 1994).
  16. Keating JC Jr; Charlton KH; Grod JP; Perle SM; Sikorski D; Winterstein JF (2005). "Subluxation: dogma or science?". Chiropr Osteopat . 13 (1): 17. doi: 10.1186/1746-1340-13-17 . PMC   1208927 . PMID   16092955.
  17. Joseph C. Keating Jr. (1997). "Chiropractic: science and antiscience and pseudoscience side by side". Skeptical Inquirer. 21 (4): 37–43.
  18. Phillips RB (2005). "The evolution of vitalism and materialism and its impact on philosophy". In Haldeman S, Dagenais S, Budgell B, et al. (eds.). Principles and Practice of Chiropractic (3rd ed.). McGraw-Hill. pp. 65–76. ISBN   978-0-07-137534-4.
  19. Reggars JW (2011). "Chiropractic at the crossroads or are we just going around in circles?". Chiropractic & Manual Therapies. 19: 11. doi: 10.1186/2045-709X-19-11 . PMC   3119029 . PMID   21599991.
  20. Suter E, Vanderheyden LC, Trojan LS, Verhoef MJ, Armitage GD (February 2007). "How important is research-based practice to chiropractors and massage therapists?". Journal of Manipulative and Physiological Therapeutics. 30 (2): 109–15. doi:10.1016/j.jmpt.2006.12.013. PMID   17320731.