Ask a Vail Sports Doc: Dangers of repeated shoulder dislocations (column)
May 22, 2018
People who live here in the mountains tend to play hard. Injuries are not uncommon, and it is not unusual for me to see young people in my office who have dislocated one or both of their shoulders.
When someone dislocates their shoulder for the first time, the initial injury is usually due to a high energy fall. In most cases, the ball (humeral head) tends to dislocate anteriorly off the front of their shoulder socket. The labrum that attaches to the edge of the shoulder socket tears off the front of the socket.
Unfortunately, the labrum does not heal in the correct position after a dislocation and for this reason, young, active people are very likely to continue to dislocate their shoulder after dislocating it for the first time. These recurrent dislocations usually occur more and more easily. It can get to the point where people dislocate their shoulder simply putting on a shirt or when sleeping. Unfortunately, there is a correlation with shoulder dislocations and the development of future shoulder arthritis.
Don't Wait to see a specialist
For a variety of reasons, people with dislocating shoulders may not come to see an orthopedic shoulder specialist until after they have sustained many dislocations. Unfortunately, with each additional dislocation, there is more damage being done to the shoulder.
People start out with a simple labral tear, but after continuing to dislocate their shoulder, they further tear the ligaments in the shoulder and also injure the bony socket or glenoid of the shoulder. With an initial dislocation or with a recurrent dislocation, one can fracture the edge of the shoulder socket or simply wear it away as the ball continues to shear over the edge of the socket.
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I explain to patients that the shoulder joint is like a golf ball on a golf tee. The ball is held in place due to the concavity of the golf tee and by ligaments, but if you crack the edge of the golf tee, the shoulder becomes very unstable as the bony congruency is critical to shoulder stability.
In the office, a good deal of information can be obtained from examining the patient's shoulder and also obtaining X-rays and possibly an MRI. In cases of suspected bone loss from the shoulder socket, a CT scan is performed. Think of a CT scan as a 3-D X-ray. It shows the bony structures very well whereas an MRI is better for showing the soft tissue structures such as tendons, ligaments and muscle.
In someone who comes to me for the treatment of recurrent shoulder dislocations where they have not only torn the ligaments but have lost a significant amount of bone from their shoulder socket, patients require a surgical procedure that rebuilds the bony socket and restores bone to the edge of the shoulder socket where it has been lost.
The most common procedure for accomplishing this is called a Latarjet procedure and was described by a group of French surgeons. In this surgical procedure, a piece of bone near the shoulder socket is taken and transferred to the edge of the socket. Two screws are used to hold this bone fragment against the deficient shoulder socket, so it can heal there and reconstitute the normal size of the socket. This procedure is highly successful at preventing further shoulder dislocations. Unfortunately, patients can still go on to have arthritis in their shoulder given the history of multiple prior dislocations.
Dr. Rick Cunningham is a knee and shoulder sports medicine specialist with Vail-Summit Orthopaedics. He is also a physician for the U.S. Ski Team. Visit his website at http://www.vailknee.com. For more information about Vail-Summit Orthopaedics, visit http://www.vsortho.com.