By Roger C. Sohn, MD
The shoulder is the most mobile and flexible joint in the body. For this reason, the arm can be used for throwing, climbing, and many other athletic movements.
When the shoulder dislocates, it damages some of the ligaments that stabilize the ball and socket joint. These don’t always heal back in their proper position so the shoulder can continue to feel unstable. Patients in their 30’s or older have a 40% chance the shoulder will dislocate again at some point in the future. In those 18 or younger at the time of the first dislocation, the chances are close to 100% of a repeat dislocation. Patients can reduce this risk by doing things such as physical therapy and scapular strengthening. Some people can learn the “bad” positions to avoid and modify their daily activities to avoid further dislocations.
Each dislocation causes internal damage to the cartilage and bone structure of the shoulder. This can make the shoulder even more unstable. If the condition persists, the shoulder can become arthritic from all of the additive damage to the joint.
Many patients choose to have a surgery to repair the unstable joint to reduce or prevent the chance of future recurrences. The surgery is usually performed using an arthroscope to visualize the damaged ligaments and bone. In many cases, anchors are placed in the bone, securing the labrum and torn ligaments back down to the bone.
After surgery, patients participate in a structured physical therapy program for approximately 4 months. After that point, they are allowed to resume training for sports. Surgery carries risks such as infections, damage to nearby nerves, stiffness, and recurrent dislocations. The risk of a recurrence is approximately 10-20% after a surgery. That risk is lowered in the right patients by performing additional procedures at the time of the surgery. These procedures include the Remplissage procedure, Latarjet procedure, and dynamic stabilization with the long head of the biceps tendon.
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