Understanding When Surgery is Right -Shoulder Dislocation
The shoulder joint is one of the more interesting joints in the human body. It is not a weight-bearing joint and is held together by ligaments. Many sports and athletic activities require the shoulder along with its surrounding muscles and ligaments to act as a weight-bearing joint. This, as well as overhead activities, can lead to shoulder injuries.
Assessing the Damage. When it comes to choosing whether or not to do surgery, shoulder injuries are often a “wait-and-see” situation. For patients with first-time shoulder dislocations, I usually opt for conservative care and monitor the stability and strength of the joint.
Depending on the patient’s age and activity level, there is a 30 to 75 percent chance of having a recurrent dislocation with conservative care. That’s a huge window, and the rules change with every patient. For this reason, I treat each patient according to their specific needs instead of relying on statistics.
Exceptions. Even if it is a first-time dislocation, whenever I have a young, high-performance athlete come to me with a shoulder injury, I usually opt for surgical correction. When a patient has such an intense, active lifestyle, the chance for recurrent dislocations is higher than normal.
No matter what their recovery looks like, I want every patient to be able to heal and come out the other side just as strong or stronger than they were before. Sometimes this simply can’t be achieved through conservative care alone.
Conservative Care. If we decide to try a conservative care approach, the healing process begins with immobilizing the shoulder by using a sling. After a couple of weeks of immobilization, shoulder pain should subside, and it’s time to begin strengthening the shoulder stabilizing muscles.
The duration of recovery varies from patient to patient. Once your muscles have been sufficiently strengthened, you can resume sports and other activities. It’s recommended that you wear a shoulder brace to prevent recurring injuries.
Surgery. Once a patient comes back with a second dislocation, surgery becomes a more viable option. You can expect to be given a local anesthetic around the shoulder joint and general anesthesia to knock you out for the duration of the procedure. The local anesthetic helps control pain after the surgery as well.
If all goes well, you will return home from the hospital the same day. The initial recovery process can be painful, and it’s best to stay on top of the pain by regularly taking the medications prescribed to you. You will be given an ice machine to help with the pain and decrease swelling, as well as a continuous passive motion (CPM) machine to keep the shoulder moving.
The road to recovery will also include lots of physical therapy and strengthening exercises, just like the conservative care route would. The end goal is to create a stronger, more stable shoulder in order to avoid future injury. While you should start feeling good after just a few weeks, it takes six months to a year to fully recover from shoulder surgery.
Prevention. I see a lot of patients who have loose joints. They are prone to hyperextension and are usually pretty flexible. I always recommend they begin strengthening their shoulders now, rather than waiting for an injury to occur. Loose ligaments are not as supportive as they should be and put you at a higher risk of injury to start with.