Q: My 17-year-old son played football last week and dislocated his left shoulder. It had to be put back in place in the emergency room, and he was given a sling. The doctor said that he will be in a sling for about three weeks and then start rehabilitation. He also said there is a good chance that the shoulder could pop out again and that surgery may be an option. He said my son is out for the remainder of the football season. Are there any other options?
A: Dislocations and subluxations of the shoulder occur when the ball part of the shoulder, “humeral head,” comes out of place relative to the socket part, “glenoid.” A cartilage known as the labrum surrounds the glenoid like a clock. Ninety-five percent of shoulder dislocations are to the front “anterior,” usually a tear to the front part of the labrum known as a Bankart lesion. This could be associated with a small fracture as well. Statistically, in the 15-to-20 age group, once one dislocation has occurred there is a 95 percent chance it will happen again. A period of immobilization and rehabilitation do not significantly affect these statistics. It is possible that your son could get back for a portion of the football season after gaining a second opinion, but there is a good chance that the shoulder could dislocate again. Even a shoulder harness, a brace used during football to keep the shoulder in place, is not always effective.
Some orthopedic surgeons recommend the program as outlined by the doctor you saw, which is a brief period of immobilization followed by physical therapy, and if the dislocation occurs again to fix it at that time. However, many orthopedic surgeons now lean to a more aggressive approach due to the high incidence of re-injury and recommend obtaining an MRI scan after the first dislocation and depending on the findings suggesting surgical stabilization.
Most of these surgeries can be performed arthroscopically However, usually a period of four to six weeks of immobilization is necessary after the surgery with a sling followed by a rehabilitation program. Athletes are usually out of contact sports for six months post surgery. I would discuss these options with your son and consider a second orthopedic surgical opinion.
Dr. Harlan Selesnick is team physician of the Miami Heat and director of Miami Sports Medicine Fellowship, Doctors Hospital. Send your questions to HarlanS@baptisthealth.net