Surgery for Shoulder Dislocations

When Is Surgery Necessary for a Shoulder Dislocation

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Treatment of a shoulder dislocation depends on a number of factors, and some patients may require surgery. When a patient dislocates their shoulder from a traumatic event (e.g. a sports collision, fall, automobile accident, etc.) they are at-risk for sustaining recurrent dislocations in the future. The chance of shoulder dislocations becoming a recurring problem depends most significantly on the age of the patient.

The percentage of re-dislocations are about:

  • Less than 20 years old: 90%
  • 20-30 years old: 75%
  • 30-40 years old: 30%

These are ballpark figures, and other factors contribute to an individual patient's risk of repeat dislocation of their shoulder.

Is Surgery Necessary?

Traditionally, most orthopedic surgeons would not choose to operate on a patient after a first dislocation. Rather, after a brief period of immobilization, followed by physical therapy, the patient would gradually resume their normal activities. If the patient sustained a second, or recurrent, dislocation, then surgery was considered.

More recently, there is good scientific evidence to support early surgery, especially in young patients who are at a high risk for repeat dislocation. If you sustain a shoulder dislocation, and are interested in surgery, discuss with your doctor the potential benefits of surgical versus nonsurgical treatment.

Options For Treatment

When surgery is selected as a treatment option, the goal is to repair the damage that occurred when the shoulder came out of socket. The most common injury that occurs is where one of the major stabilizing ligaments attaches to the labrum of the shoulder socket. This specific type of injury is called a Bankart tear, and is simply a description of a specific type of injury that occurs as the result of the shoulder dislocating.

When a Bankart tear is in need of repair, this can be accomplished either through an open surgery or an arthroscopic shoulder surgery. Most often these days an arthroscopic treatment is favored, however, there are some situations when a traditional open surgery may be the better alternative. A Bankart repair is performed by reattaching the damaged labrum to the socket of the shoulder, restoring the normal ligament tightness that holds the ball in the socket.

There are non-surgical treatments also available for people who have sustained a shoulder dislocation. Most often people will try physical therapy to strengthen muscles that help to stabilize the ball of the shoulder in the socket. While the labrum does not heal in its normal position, it is sometime possible to compensate by strengthening the muscles around the shoulder that many people can resume their normal activities. There have also been some studies showing that immobilizing the shoulder in a specific position can also help to prevent the chance of repeat dislocations.

This is a seldom used treatment because the position required for immobilization is very awkward with the arm turned out away from the body.

What Should You Do?

As mentioned, there is controversy about which treatment is best. In young athletes who play contact sports (including football or ice hockey) surgery is probably a good treatment after a first dislocation since the chance of repeat dislocation is so high if they don't have a surgery. In most others, it is reasonable to try nonsurgical treatments in an initial effort to manage these injuries. If a second dislocation occurs, then surgery should probably be considered.

Sources:

Kirkley A, et al. "Prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus immobilization and rehabilitation in first traumatic anterior dislocations of the shoulder: long-term evaluation." Arthroscopy. 2005 Jan;21(1):55-63.

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