My Shoulder Dislocated, How Do I know If I Need Surgery?
Dr. Bill Sterett is a Board-Certified Orthopaedic Surgeon and a Specialist in Sports Medicine at Vail-Summit Orthopaedics & Neurosurgery (VSON). He is a member of the American Shoulder and Elbow Society, which requires not only specialty training in Shoulder Surgery, but an ongoing commitment to the advancement and understanding of shoulder injuries. Additionally, Dr. Sterett is the former Head Team Physician for the US Womens Alpine Ski Team for over 25 years, overseeing the Teams’ medical needs through 6 Olympic Games.
Shoulder dislocations are common, although often confusing to the athlete. Does a shoulder dislocation need surgery? Can this be treated with rehabilitation and strengthening?
In this discussion, Dr. Sterett, top shoulder surgeon at VSON, concentrates on the distinct characteristics of shoulder dislocations, including their cause clinical presentation, diagnosis, and treatment options. Hopefully you will come away with a better understanding of shoulders that “pop out”, are first time dislocations, and who is at risk for recurrence or other related injuries.
Types of Shoulder Dislocations
Traumatic shoulder dislocations can be classified into two primary categories: anterior and posterior dislocations.
Anterior Shoulder Dislocation: This is the most frequently encountered type of shoulder dislocation, characterized by the displacement of the upper arm bone (humerus) anteriorly, i.e., out of the glenoid’s front aspect. It is typically the result of traumatic events such as falls or sports-related injuries.
Posterior Shoulder Dislocation: In contrast, posterior shoulder dislocation involves the humerus being displaced posteriorly, or out of the glenoid's rear aspect. These occurrences may result from forced internal rotation or direct trauma.
Another way of thinking about shoulder dislocations are traumatic versus atraumatic. Atraumatic dislocations rarely need surgery.
Did I Dislocate My Shoulder?
The clinical manifestations of both anterior and posterior shoulder dislocations share commonalities, including intense pain, limited range of motion, and an evident shoulder deformity. The differentiation lies in the mechanism of injury and the direction of the displacement. Anterior dislocations are typically associated with the arm being placed in the abducted and externally rotated direction levering the ball out of the socket in the forward direction, while posterior dislocations involve a backward force usually with the arm out in front of you.
Believe it or not, diagnosing posterior dislocations can be challenging due to their less frequent occurrence and more subtle symptoms. Most patients feel that since the arm was out in front of them, then it must have dislocated out the front. Nope. For the shoulder to dislocate out the front, your hand had to be above your shoulder and behind your body. Seems odd.
Do I need Surgery for My Dislocated Shoulder?
Selecting the appropriate treatment for the first time shoulder dislocation hinges on several factors, including the patient’s age, type of physical activity, and the extent of the injury. Some individuals may benefit from non-surgical approaches such as physical therapy and activity modification. In my experience, however, patients are rarely making their way out to Vail to be told that if they just stop doing the sports that they love, their shoulders won’t dislocate anymore.
Age At Time of Your First Shoulder Dislocation
Age < 20 – These athletes can have almost a 100% chance of re-dislocating in the future, and will almost always need surgical intervention to stabilize their shoulder.
Age > 35 – These athletes have less than a 10% chance of ever dislocating again but have a >50% chance of having torn their rotator cuff at the time of dislocation. An MRI is typically required to make sure that you did not sustain this complication from your dislocation. This is an important one not to miss.
Athletes that participate in extremely high-risk sports such as kayaking, hang gliding and big mountain skiing, may put their life at risk if they dislocate at a critical time. These “consequence” athletes should rarely be allowed to participate in such high consequence sports until their injury is fixed surgically, even after their first dislocation, and regardless of their age.
Traumatic vs. Atraumatic Shoulder Dislocations
Patients that dislocate their shoulders in an atraumatic fashion while participating in their activities of daily living, are typically born loose jointed or with congenital hyperlaxity. Fixing these surgically have a very high failure rate and as such are usually treated with physical therapy to strengthen the muscles around the shoulder girdle called the “dynamic stabilizers”. When performing an MRI on these patients, it is quite often misread as “normal” because the problem is simply with loose tissues, nothing is actually torn.
So, if you were to unfortunately dislocate your shoulder, let us help walk you through your own personal algorithm about physical therapy, sling use, surgical decision-making and when to return to sports.
Hopefully this little blog has helped answer some of your questions.
Get Back in the Game with Team Sterett’s Expert Care
Dr. Sterett and his team of sports medicine specialists at Vail-Summit Orthopaedics & Neurosurgery are the preferred choice for those wanting the highest level of care for knee ligament injuries.
Contact Team Sterett today for personalized knee injury treatment that will get you back to your peak performance. Call (970) 476-7220 today or request a consultation using our online form.
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