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Shoulder Dislocations
Shoulder dislocations are very painful, and the first step in managing them is to go to the emergency room to get the shoulder reduced. Once the ball is lined up properly with the socket, they will usually have you wear a sling until you come to see me in the office for a conversation about the potential treatment options. If you are a competitive athlete, we need to discuss the options in context with where you are in your season. The good news is that many people who have had a shoulder dislocation will never have another one with the proper treatment which may be exercises to stabilize the shoulder joint or surgery if that is not successful.
The Role of Shoulder Excercises
Think of the shoulder like a golf ball on top of a golf tee, and a dislocation is if the ball falls off the tee. One way to keep the golf ball from falling off the tee again is by pushing down on top of the ball and increasing the contact pressure between the ball and the tee. This is what the rotator cuff can do if properly strengthened and balanced. Going to physical therapy to learn the proper exercises will help you to strengthen your rotator cuff muscles and help the muscles to work together properly to keep the ball centered on the socket and prevent the shoulder from dislocating again.
Types of Surgery
While the decision of whether to do surgery and what surgery to do is made on a case by case basis, the main two types of surgery that I offer patients are the arthroscopic labral repair and the open Latarjet coracoid transfer. With the labral repair, the goal is to restore the normal anatomy of the shoulder, and the best candidates for this surgery are patients who have only had one dislocation of their shoulder. The patients who should consider the Latarjet procedure are those who have significant risk factors for failure with labral repair which include age younger than 20 years old, bone loss, recurrent dislocations, and baseline shoulder laxity. Some patients who have a 1 in 3 chance of having a future dislocation after a labral repair can decrease that risk to less than 1 in 20 with a Latarjet, but this comes with a significant increase in risk and change in your normal anatomy. There are no easy decisions with shoulder instability, but as long as we work through the options together we can always make the best possible decision with the information that we have and move forward together with a treatment plan.