Current Approach Following A Shoulder Dislocation
Shoulder dislocations are a rare, yet disabling problem that happen to thousands of athletes annually. Shoulder instability unfortunately can be not only painful, but costly to an athletes’ productivity on the field as well as result time in the emergency department. Often a shoulder dislocates from an unusual collision or awkward position during an event. If the athlete is unable to spontaneously reduce the shoulder back into position, frequently a trip to the ER results in a few hours of discomfort. Fortunately, the majority of dislocations can be easily reduced with mild sedation by an emergency physician.
After the shoulder is “put back into place” (i.e. reduced), the injured athlete will benefit from a week or two of sling immobilization, followed by some simple exercises. Most athletes can be back on the field/court/ice within 2 to 3 weeks. The problem with a dislocation however is the incidence of recurrence. Under the age of 20, the recurrent rate of dislocation approachs 90% in the first couple years. The reason for this is based on the anatomic injury that occurs during a dislocation.
Since the shoulder is similar to a golf ball on a shallow tee, it has very little inherent stability (unlike the hip joint which is a deep ball and socket). Consequently, the ligaments which keep the ball and socket together, rip or tear fairly easily during a dislocation. The tear of the ligament is known as a Bankart lesion. Because the ligament has been injured, it tends to result in a less stable joint which is more susceptible to dislocation.
Unfortunately, therapy, rest, slings, braces do not affect the recurrence rate very much. Sometimes however, a second dislocation may not happen for many months to years, so I generally take a “wait and see approach”.
However, once an athlete has a second dislocation, I generally recommend surgery for a few reasons:
1.)Multiple trips to the ER can become a hassle.
2.) The dislocation can be painful.
3.)More dislocations result in more damage to the joint.
4.) Multiple dislocations can make the shoulder anatomically more difficult to surgically “fix”. Certainly none of us wants to have surgery, but in the select cases it is necessary to prevent the above problems.
Arthroscopic shoulder surgery has seen tremendous advances over the last decade. Shoulder stability surgery once required an overnight stay, a four inch incision and a complete opening up of the shoulder joint. Nowadays, it can be done through two 8 mm incisions in an outpatient setting. True surgical time can be under an hour in many cases.
Patients spend four weeks in a sling, but many only require pain medicine for the first few days. In general the rehabilitation is straight forward with success rates around 95%. (5% redislocation rate). Most athletes can expect to be training again within 3 months and competing again in 4 to 6 months.
Although many athletes can be at risk, we have solutions that have improved greatly over the last decade.
Marc Milia, MD is a board certified orthopedic surgeon specializing in Sports Medicine and arthroscopic and reconstructive surgery of the knee and shoulder. Dr. Milia is the Team Physician for Wayne State University and Medical Director of Oakwood Sports Medicine.