3rd Shoulder Dislocation
A 25-year-old gentleman in my clinic came in because he was recently in the emergency room with his 3rd shoulder dislocation in the past 7 years. He was placed in a sling by the emergency room and was alarmed when I told him this would probably all happen again.
You see, I told him, “The shoulder is rather like a golf ball on a tee. What holds it in is primarily the muscles around it, the shape of the bones, and some small fibrous chalk-block type ligaments around the very shallow cup (the tee). These ligaments are called the labrum. The military did some very nice studies years ago showing that 100% of men under the age of 20 tear off those ligaments with their first-time dislocation, and it leads to a very high redislocation rate, basically 100%. You can almost always see this on a contrast MRI or when you have arthroscopy of the shoulder. That rate of repetitive dislocation goes down as we get older and less active. Physiotherapy CAN help but if you’re super ACTIVE (no age discrimination here!) the chance of having a dislocation again is… very high”
Shoulder Dislocation Treatment
In general, I tell each patient that if you’re a first-time shoulder dislocator, I would wear the sling until your initial swelling goes down and you’re regaining your range of motion. Then I’d get an MRI of the shoulder with contrast injected into it. If the MRI shows a nicely defined tear of those anterior ligaments I’d get it repaired when it’s easy to do, in other words now. If the MRI shows ill-defined stretching or indeterminant findings. Do your physical therapy and see how it goes. If you have a repeat dislocation, fix it!
Shoulder Dislocation Recovery
Every time your shoulder comes out you ding up the anterior cartilage in your shoulder and make things worse, finally shaping the small cup ( the tee) into an inclined plane where the shoulder wants to slide out almost no matter what you do. Frequently also, the pain one has with the shoulder 10-15 years down the road with chronic dislocations is now due to the loss of cartilage along the anterior rim of the cup. A stability procedure and this point may not cure the pain. Make you more stable, but not cure the pain.
This is only a brief summary of this type of problem. Certainly one can also injure the rotator cuff tendons with dislocations. In general, don’t hesitate to seek advice and information about your body. Information is power.
