Is Surgery Necessary?
If you sustain a shoulder dislocation and are wondering about surgery, discuss the potential benefits of surgical versus nonsurgical treatment with your healthcare provider.
In general, most orthopedic surgeons would not recommend surgery after a first shoulder dislocation, though there are exceptions. After a brief period of immobilization, followed by physical therapy, you can expect to gradually resume your normal activities.
If you sustain a second dislocation, then surgery may be considered. Younger age is associated with a higher risk of redislocation.
Options for Treatment
Non-surgical treatments are generally used for treating a shoulder dislocation.
Conservative Management
Your healthcare provider would recommend that you begin physical therapy to strengthen the muscles that help stabilize the ball of your shoulder in its socket. While the labrum (the cartilage around your shoulder) does not necessarily heal in its normal position, you can strengthen the muscles around the shoulder to compensate. This approach may allow you to resume normal motion of your shoulder.
Some studies have suggested that immobilizing the shoulder in an “external rotation” position—with the upper arm against the body and the forearm pointing forward, parallel to the floor—can also help reduce the chance of repeat dislocations. However, this is a seldom-used treatment approach because this position is very awkward, and more recent research hasn’t found it to be better than a traditional sling.
Surgery
The goal of surgery is to repair the damage that occurred when the shoulder came out of its socket.
The most common injury that occurs due to a shoulder dislocation is a Bankart tear. This injury is a tear in one of the major stabilizing ligaments that attach to the labrum of the shoulder socket. A Bankart repair is performed by reattaching the damaged labrum to the socket of the shoulder, restoring the normal ligament tightness that holds the ball in the socket.
Surgical repair can be done with open surgery or arthroscopic shoulder surgery. Arthroscopic treatment is usually favored. However, there are some situations when traditional open surgery may be a better alternative.
What Should You Do?
The treatment for shoulder dislocation varies depending on the symptoms, extent of the injury, and risk of recurrent dislocation. Often, it’s recommended that young athletes who play contact sports (including football or ice hockey) have a surgical repair after a first dislocation since the chance of repeat dislocation is high without surgery.
Most of the time, however, when there’s a lower risk of recurrent dislocation, it is reasonable to try nonsurgical treatments as an initial step to manage these injuries. If a second dislocation occurs, then surgery is generally considered.
