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Shoulder dislocations occur typically as a traumatic event, frequently as the result of an event during sports. The ball typically moves forward on the socket and gets caught in the front of the socket. In a small percentage of patients, the ball actually moves behind the socket and this type of injury is best recognized by an experience shoulder physician. This usually requires emergent “reduction” or a setting of the ball back onto the socket. This results in significant damage to the labrum and ligaments that maintain stability of the shoulder joint. While this can be treated with a period of rest and physical therapy, recent studies have shown earlier anatomic restoration of the labrum can lead to better long-term results in higher level athletes. The decision between surgical repair and rest/therapy is a joint process and based largely on your desired level of activity going forward—our goal is always to restore you to the highest level of activity you desire. Often in patients with lower overall demands on their shoulders, nonsurgical management results in a successful return to all desired activities. For higher level athletes, particularly collision athletes, surgical repair may provide a more predictable path back to high level participation.
While we know that ligaments and labrum are damaged in a dislocation, the degree of collateral damage plays a significant role in determining proper treatment. X-rays and MRI are frequently necessary to determine the extent of the damage. With certain types of ligament tears, surgery may be more likely to help. Likewise, the socket or the ball can also be damaged by a dislocation and depending on the severity of such damage, surgery may be more or less likely to be recommended.
Arthroscopic repair will be recommended for typical patients with dislocations requiring surgery. This involves a repair of the damaged labrum along with a tightening of the ligaments which typically are stretched from the shoulder dislocating. This is a relatively minor and outpatient surgery but return to sport may take 4-6 months depending on the demands your particular sport places on your shoulder. Several months of therapy are also necessary for a full recovery.
Several variations of shoulder damage can result from a dislocation and this subtly is of paramount importance to recognize, as the recovery and treatment can vary significantly. If there is bony damage, a Latarjet procedure can become necessary. This involves the transplant of bone from one part of the shoulder to the damaged area. This is an uncommon procedure but highly successful for athletes with more severe collateral damage to their shoulders. With more advanced types of tearing of the shoulder ligaments, a standard shoulder stabilization operation will likely fail. These require an advanced ligament repair for a successful outcome and the recognition of these injuries is crucial to performing the appropriate procedure. The surgeons at MCO are trained in complex shoulder injuries and we often get these types of patients referred to us due to our extensive experience with these unusual types of injuries.
Some athletes have a condition in which the ball repeatedly comes close to dislocating but does not quite come completely out and lock in front of the socket. This is known as a subluxation. While less dramatic than a dislocation, these can negatively affect confidence and ultimately, performance in an athlete. Additionally, the cumulative damage of this lesser injury can, over time, approach the amount of anatomic damage that can be done with a single dislocation event. When shoulder subluxations are treated early and appropriately, frequently a full recovery can be made without surgery. If this becomes a more chronic condition, surgical repair via outpatient arthroscopy could become necessary.