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So I dislocated my what?

A hard fall onto the shoulder can cause the humeral head (ball) to dislocate from the glenoid (socket), which can lead to a multitude of other associated injuries. The labrum is the soft tissue surrounding the glenoid that provides stability, but the shoulder also relies on the capsular ligaments and surrounding muscles to increase stability to the joint. For young athletes, injuries to the shoulder stabilizers are by far the main reason to seek out orthopedic evaluation after a trauma. As one ages, the chance of the rotator cuff tearing with a dislocation increases greatly, and the surgery required to address the problem is much different from the younger population.

Disruption of the soft tissue stabilizers will lead to continued feelings of instability in the shoulder, whether it’s pain with the arm in different positions, or just a generalized feeling that they cannot “trust” the shoulder when trying to perform specific athletic endeavors. Football players may struggle to reach and tackle, whereas baseball players may lose control or velocity when throwing.  

Unfortunately, once a dislocation has occurred, the chance of it happening again is quite high. Most studies report a recurrent dislocation rate of approximately 75% for age 12-20, 50% for the 20s, and 25% over 30. For patients who participate in contact sports, those numbers are even higher. What can also happen with first time dislocations, but more commonly with repeated dislocations, is that the bone on the glenoid and humeral head begin to be damaged as well, increasing the risk of subsequent instability events. In the short term, repeated dislocations will affect the athlete’s ability to participate at a high level, but with time, recurrent instability will lead to an increased risk of arthritis in the shoulder as well.

Traditionally most shoulder dislocations were treated conservatively with therapy and rest followed by gradual return to sport. Now that we are aware that the chance of redislocation is so high and that more bone damage leads to more complicated surgery, we are often addressing first time dislocators in a more aggressive fashion. Surgical intervention is now our most common recommendation as it decreases the redislocation rate to 5% on average.

With modern techniques, dislocations can be managed with minimally invasive arthroscopic surgery. This allows for lower risk, outpatient surgery for most patients. A series of suture anchors are placed to repair the damaged labrum and capsule back onto the glenoid, and modern advances in anchors have improved patient outcomes as well as increased surgical efficiency/safety. Delaying the surgery or allowing the joint to repeatedly dislocate can result in more significant bone loss. This could lead your surgeon to have to perform a more invasive, open stabilization surgery.

The take-home message on shoulder dislocation is to have the problem correctly identified early on and to discuss with your surgeon the risks and benefits of surgical intervention versus non-operative management. At that point, ensure your surgeon performs a high volume of these arthroscopic procedures and has the ability and knowledge to safely convert to open procedures when indicated.

Andrew Kersten, MD Asheville, NC based, dual board-certified in Orthopedic Surgery and Orthopedic Sports medicine, specializing in sports injuries, arthroscopy and joint replacement for shoulder, elbow, and knee conditions.

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Courtesy: AP

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