Ask a Vail Sports Doc column: Dealing with dislocated shoulders before football season
August 29, 2017
Recently in the office, I saw an 18-year-old football player from Buena Vista.
He was participating in a pre-season football training camp and suffered a first-time shoulder dislocation while tackling another player. He plays on both the offensive and defensive lines for his high school and is one of the team's best players.
He wants to play football in college, and several Division 2 and 3 colleges have expressed interest in having him play for them. It is obviously very important to him to be able to play in his upcoming high school season as a senior with scholarship offers to play football in college.
Ball and Socket
The shoulder joint has the greatest range of motion of any joint in the body, but it is also the most commonly dislocated large joint. The highest percentage of first-time shoulder dislocations occurs in young males (ages 10 to 20) followed by middle-aged adults (ages 50 to 60).
By comparison, there is less range of motion in a hip joint compared to a shoulder, as the hip joint has a deep bony socket, but this also confers better bony containment and stability, leading to a much lower incidence of hip dislocations.
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Most shoulders dislocate when the arm is abducted and externally rotated. Imagine a pitcher that is winding up to throw a baseball, and this is the vulnerable arm position that puts the shoulder at risk for dislocation. With the arm in this position, the arm is then pushed posteriorly beyond the normal excursion of the joint when tackling another player or falling off of one's mountain bike.
The head of the humerus then pops out of the front of the shoulder. Posterior dislocations, in which the head goes out of the back of the shoulder, are much less common. With the typical anterior dislocation of a shoulder, the labrum is usually torn off of the front of the shoulder socket and the ligaments are stretched. In middle-aged patients, there is a high incidence of associated rotator cuff tears when one dislocates a shoulder.
As for our 18-year old high school football player who dislocated a shoulder one month before the start of his season, I recommended that we try to avoid surgery currently.
Instead, he is going to start physical therapy. When he has regained full range of motion and strength, he can resume playing football, but I have recommended that he wear a sully brace when he returns to play.
A sully brace prevents the shoulder from excessively rotating and forward flexing and in so doing can hopefully prevent a recurrent dislocation. However, in an 18-year-old male who participates in a collision sport such as football, he stands a very high likelihood of having further dislocations.
If he goes on to have another one or two dislocations, then I would recommend an arthroscopic Bankart repair surgery where the labrum and the shoulder capsule is repaired and shoulder stability is restored.
Dr. Richard Cunningham, M.D. is a board-certified, fellowship-trained orthopedic surgeon and knee and shoulder specialist with Vail-Summit Orthopaedics. For more information, visit http://www.vailknee.com.
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