When a young person is treated for a dislocated shoulder, the first priority is getting the shoulder back into its socket, but this is often followed by discussion of possible treatment to prevent recurrent shoulder dislocation.
Shoulder dislocations are an unusual case in which a younger patient is likely to be a more suitable candidate for joint repair surgery than an older patient. The reason for this is that a younger person, like a teenage athlete who has suffered a dislocated shoulder, is more likely to have the injury repeated in the future, causing other chronic injuries, as compared to someone who is in their 30s seeing a doctor for a shoulder dislocation for the first time.
Studies have also shown a trend of earlier surgical intervention proving to be more economical and more effective in the long run. While a common approach to shoulder dislocation treatment in young people is to treat the first instance as a stand-alone case and wait to see if a second dislocation marks a need for further discussion, some Orthopedic surgeons have made the case for pursuing surgical repair after the first dislocation.
Chronic shoulder instability is often accompanied by symptoms such as:
- Feeling of looseness in the joint
- A “dead arm” sensation
- Among athletes, issues of not being able to throw objects as far, fast or accurately as before their shoulder injury
A common shoulder repair is arthroscopic stabilization, or Bankart repair, also called arthroscopic labral repair. In this procedure an Orthopedic surgeon, using arthroscopic tools, installs about three or four anchors in the bone, which are used to fix the damaged labral tissue in place, supporting the shoulder joint.
If there is bone injury, soft tissue repair may not be enough to keep the joint in place. Given the large surface area of the ball of the upper arm compared to the cup of the shoulder joint, the arrangement is often compared to a golf ball and a tee.
When there is damage to the edge of the tee, or the joint, the ball will no longer reliably stay centered in place. During a Latarjet shoulder stabilization procedure, the Orthopedic surgeon will cut a piece of shoulder bone with muscle from the coracoid process, grafting it to the broken part of the glenohumeral joint, and giving extra support by the movement of muscle tissue.
Shoulder surgery is often preceded by physical therapy to prepare the shoulder for repair, with therapy continuing after the procedure and initial recovery period. Patients are usually able to return to full activity, but should avoid contact sports for about six months.
Post-operative shoulder dislocation remains a possibility, but reduces from a recurrent issue to only reappearing in approximately 10% to 15% of patients.
After a full recovery over 90% of athletes are able to return to full activity, though some are unable to return to the same level of play as before their injury.
In some cases of repeated shoulder dislocation involving chronic joint injury, arthroplasty, or joint replacement surgery, may be appropriate. Reverse shoulder replacement surgery is a technique that has been specifically developed to treat those with a combination of joint damage and rotator cuff injury.
Appropriate treatment of shoulder instability can vary greatly, as in the case of some youth who are able to dislocate joints and pop them back into place without any pain. Although many doctors would not recommend they make a habit of that kind of “party trick,” it is often evidence of naturally loose joints more than a serious condition, and in some cases can be attributed to an athletic edge in certain sports like swimming or gymnastics.