Traumatic shoulder dislocation is a frequent injury in the sports population. An acute shoulder dislocation often means a one time traumatic episode, whereas chronic shoulder instability indicates frequent dislocations.
Following an initial shoulder dislocation, doctors will debate whether or not to perform a surgery to prevent recurrence. If the patient in under 30 years of age, shoulder surgery is typically recommended because younger athletes are much more prone to repeated dislocations than older athletes.
What are the surgeons operating on? A ligament, specifically the glenohumeral ligament that helps keep the shoulder in place. The tear in this ligament is referred to as a “Bankart lesion.”
Surgery for chronic shoulder dislocation
Surgery for shoulder separations can be effective for some but as always, surgery should be considered a last option because of issues of complications, down time (immobilization), and for the “weekend warrior,” or professional athlete, a weakening of the shoulder through the removal of and damaging of other connective tissue in the surgical process.
Some athletes may opt for surgery immediately because the long healing time required of a Bankart lesion. Usually six months. As pointed out by research, “Repairs of degenerate and torn tissue are often prone to failure due to many intrinsic and extrinsic factors,” and that Platelet Rich Plasma Therapy has been shown to reduced pain and improved recovery in shoulder tears. 1
The shoulder is made of a complex matrix of bone and soft tissue that allows it an extreme range of motion. But there is a price the shoulder pays for that range of motion. Greater risk for chronic injury.
The shoulder is held together by soft tissue stabilizers lead by the ligaments that connect bone to bone. Over the course of time, especially in sports that involve heavy shoulder to shoulder contact such as hockey, lacrosse, football, wrestling and basketball, the ligaments stretch out and become “lax.” When the ligaments become lax, the risk for dislocation and separation becomes greater.
In a study published in the British Journal of Sports Medicine, researchers took a look at rugby players with measurable shoulder laxity to gauge the risk of shoulder dislocation. What they found was that 50% of those athletes tested were at significant risk.
How does shoulder dislocation occur?
It is estimated that 95% of shoulder dislocations occur when the athlete suffers a blow to the shoulder that forces the shoulder joint “back’ or downward or when they fall to the ground with their arms stretched over their heads.
Shoulder dislocation alternative treatment
The key to avoiding shoulder surgery or devastating shoulder separation requiring surgery is to strengthen the shoulder capsule. This can be accomplished by working the strong shoulder muscle group and/or by treating the weakened shoulder ligaments with a simple injection technique called Prolotherapy or for more complex cases of chronic shoulder dislocation Platelet Rich Plasma therapy or stem cell therapy may be employed
To understand the importance of the need of strong ligaments to hold the shoulder together, the athlete needs to understand that the severity of shoulder separation injury is measured by the degree of injury to the ligaments.
The acromioclavicular (AC) and the coracoclavicular (CC) ligaments hold the shoulder together at the point where the collarbone (clavicle) and the end (acromion) of the shoulder blade (scapula) meet.
- In type I level separation the AC is partially torn, the CC is not.
- In type II separation the AC is completely torn, the CC is partially or not torn
- In type III separation both ligaments are completely torn.
Obviously the more significant the tearing, the longer the athlete is out of their sport.
Untreated shoulder instability can lead to an alteration of an athlete’s game to “protect” the sore shoulders or worse chronic shoulder separation that can keep them away from their sport for significant amounts of time.
Email Dr. Darrow with your questions about shoulder instability and dislocation
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