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Should Dislocationm


Baylor College of Medicine   (BCM)

November 30, 2016

For high school football players who suffer from chronic shoulder dislocation, the end of the football season is the best time to treat the condition with arthroscopic surgery, according to a sports medicine expert at Baylor College of Medicine.

The first time that a shoulder dislocation occurs, it is usually due to a collision where the arm is forced backward, which makes the shoulder pop out of the joint. This is usually very painful and needs to be addressed by someone who is trained in popping the shoulder back into place.

“Once the shoulder has dislocated the first time, it’s very prone to come out again, and it’s easier each successive time,” said Dr. Bruce Moseley, an orthopedic surgeon at Baylor. “The first time it comes out, it takes a pretty violent trauma. The second time, not as much. The third time, even less.”

Moseley said that with rare exception, the issue does not turn into anything worse. The biggest downside is that dislocation becomes easier.

“For some people, they can roll over in bed and their shoulder will pop out,” he said.

However, through an arthroscopic surgery that involves three small incisions, surgeons are able to fix the ligament that stabilizes the shoulder. The procedure has a 90 percent success rate in preventing the shoulder from dislocating again.

Recovery involves keeping the arm in a sling for three weeks, after which patients are able to return to day-to-day activities. Then, it is recommended that they wait three months before returning to the weight room. At three months, athletes can return to all athletic activities other than contact and collision sports, for which it is recommended they wait until the six month mark.

The best time for a high school football player with shoulder instability to have surgery is at the end of football season, because this allows for the six-month recovery period without contact before next year’s football season starts.

“When the season is over and the shoulder doesn’t come out anymore, many players think the problem is gone, but it has not gone away, they’re just not playing football. The next time they play football again it’s going to come out,” said Moseley.

Moseley notes that surgery is the only truly effective treatment for athletes with recurrent shoulder dislocation. For contact sports, there is a harness that athletes can wear that keeps the arm from being put in the position that puts it most at risk, but it limits what they can do with their arm and is not 100 percent effective in preventing dislocation.

While rehab is an option, it only strengthens the muscles around the shoulder. Since the injury is in the ligament as opposed to the muscles, making the muscles stronger will not prevent re-dislocation.

However, there is luck for older adults who may dislocate their shoulder for the first time – statistics show that the older you are at the time of your first dislocation, the less likely it is for the shoulder to pop out again. So for those above the age of 40, Moseley suggests non-surgical management, including rehab to get strength and movement back in the shoulder. This can help patients get back to normal in one month to six weeks. If it pops out again, then the orthopedic surgeon will work with them to see if surgery is needed.

 

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