The August 2012 issue of the Journal of the American Academy of Orthopaedic Surgeons included an excellent review article outlining a treatment plan and a return to sport plan if an athlete dislocates their shoulder in the middle of a competitive season. Dr. Owens et al. presented an algorithm that outlines the treatment plan.
Shoulder dislocations are most common in contact sports such as football, wrestling and hockey. In athletes that dislocate their shoulder, over 45% lost at least 10 days of practice/competition after a shoulder dislocation. Young male athletes are at highest risk for sustaining a shoulder dislocation and also at highest risk for having recurrent dislocations.
Hovelius et al. reported on a group of athletes with shoulder dislocations and found that athletes older than 30 years of age have a 27% chance of recurrent dislocations and for athletes younger than 23 years, the rate of recurrent dislocation was 72%. Robinson et al. found that 87% of patients between the ages of 15 to 20 years would have recurrent instability.
Indications for nonsurgical management of shoulder dislocations include the following:
- Initial dislocation
- No evidence of any broken bones or soft tissue that requires surgery around the shoulder joint
- Athlete desires to return to sport in season
- Non overhead or non-throwing athlete
- Athlete plays a non-contact sport
- Athlete can compete in sport specific drills without instability
Absolute and relative indications for early surgery following shoulder dislocation include the following:
- Associated injury
- Greater than 50% tear of the rotator cuff
- Irreducible dislocation
- Failure trial of dislocation
- Inability to tolerate shoulder restrictions
- Inability to perform sport specific drills without shoulder instability
- Humerus fracture or glenoid osseous defect greater than 25%
- More than two shoulder dislocations during the season
- Overhead or throwing athlete
- Contact sport athlete
- Injury near the end of the season
- Age less than 20 years old