Understanding shoulder dislocations and how they’re treated S houlder dislocations are common injuries in structures in the front to become damaged as the adolescent athletes, and can keep young athhumeral head “plows” through this location. letes off of the playing field for an extended The most important structure usually damaged is called the labrum. The labrum is a cartilage period of time. Unfortunately, one dislocation can bumper around the glenoid that prevents the increase the risk of subsequent dislocations with shoulder from moving out of joint during normal recurrence rates ranging from 60-100 percent in activities (imagine a rubber bumper that would be patients under 18. placed around the outside of a golf tee to prevent The shoulder is a ball and socket joint made the ball from falling off). up of the head of the humerus (the long bone in Most shoulder dislocations can be relocated on the arm) which is the “ball,” and the glenoid (part the playing field. On rare occasions, patients need of the shoulder “blade”) which is the “socket.” Dr. Nirav K. Pandya to go to the emergency room to have it done. For Imagine, a golf ball resting on a golf tee. The golf most first-time shoulder dislocations, treatment ball (head of the humerus) needs to be resting on consists of a brief period of immobilization (3-5 the tee (glenoid) at just the right location so that it weeks) in a sling followed by physical therapy. Patients can does not fall off. go back to sports when they have full range of motion and So what exactly is a traumatic shoulder dislocation? strength without feelings of instability. When you dislocate your shoulder, the golf ball (head of the For patients who continue to have recurrent instabilhumerus) violently falls off the tee (the glenoid). This can ity, even after physical therapy, they may require surgical happen because the arm is rapidly forced into an awkward intervention. Your doctor will likely order an MRI of your position, or due to a high-energy fall onto the arm. shoulder to see what structures have been injured, paying Unlike a golf tee, there are multiple structures in the particular attention to the labrum. Sometimes the physician shoulder that help to prevent the humeral head from falling may have dye injected into your shoulder during the MRI off the glenoid, including the rotator cuff muscles, shoulder to get a better image of the labrum. If there is a large labral ligaments/capsule, cartilage, and even the shape of the joint tear that the surgeon feels is contributing to your instability, itself. The majority of the time the humeral head dislocates he/she will likely discuss minimally invasive arthroscopic out the front of the shoulder joint, causing many of the surgery with you. The procedure involves repairing the la-
Support Your Local Business • Say You Found Them In SportStars™
brum around the glenoid to re-establish a “bumper” that can prevent dislocation. After surgery, patients are kept in a shoulder immobilizer for a period of time, and gradually begin physical therapy. Based on the type of sport played and the injury pattern, return to sports after surgery can be anywhere from three to six months. It is important to note that traumatic shoulder dislocations are very different from a patient who suffers from non-traumatic shoulder instability. These patients have “loose” joints, and can voluntarily dislocate parts of their body without any distinct injury. These patients are not generally candidates for surgical intervention, and should perform extensive physical therapy. With our current knowledge of shoulder anatomy, new imaging techniques, and advances in minimally-invasive shoulder arthroscopy, patients with traumatic shoulder dislocations can get back onto the field quickly and at a high level of performance. ✪
Dr. Nirav K. Pandya is a pediatric orthopedic surgeon specializing in pediatric sports injuries at the Children’s Hospital in Oakland. He sees patients and operates in Oakland and our facility at Walnut Creek. If you have any questions or comments regarding the “Health Watch” column, write the Sports Medicine for Young Athletes staff at Health@SportsStarsOnline.com.
February 2, 2012
East Bay Issue 40