By Dev K. Mishra, M.D.
President, Sideline Sports Doc
Clinical Assistant Professor of Orthopedic Surgery, Stanford University
- Shoulder dislocation in a young athlete who is in-season can sometimes be managed without surgery, allowing the athlete to complete the season
- Proper rehabilitation and use of a shoulder brace can help to improve the chances of return to play, often by 3-4 weeks after the dislocation
- The risk of another dislocation is high, and these decisions should be carefully discussed with an orthopedic surgeon who has experience working with athletes
A shoulder dislocation is a common injury in collision based sports such as football. But there is some controversy around possible in-season return to play, possible need for surgery, and the timing of surgery. We’ll enounter these situations fairly often in young athletes and in some instances it’s possible to return to play in the same season, without surgery. Proper rehabilitation, use of a shoulder brace, and a clear understanding of possible risks are key aspects to discuss with your orthopedic surgeon.
One important consideration is that this is a decision that’s best made in consultation with an orthopedic surgeon with experience managing shoulder dislocaitons in athletes. I wouldn’t recommend that you leave this to the advice of your primary care doctor, this is really a decision to be made with a specialist.
The choice between early surgery and nonsurgical treatment is based on the sport, position and age of the patient. Young people with shoulder dislocation have a high likelihood of another dislocation, regardless of the sport. But that risk goes up if it’s the dominant arm of a collision sport athlete at a risky position (for example football linebacker) versus the nondominant arm of a lower risk position (such as the kicker).
The orthopedic surgeon should work with you to consider the risks associated with another dislocation along with other factors such as the sport, position, and career goals.
Early surgery with no return to play that season might be recommended if there are some specific anatomic issues found on MRI or other imaging, or if there is also an injury to the rotator cuff. If the athlete sustained the injury near the end of the season or had multiple dislocations, surgery is usually recommended.
But management without surgery and with early return to play can be considered for some young athletes with first time dislocations. We typically recommend a simple arm sling, gentle range-of-motion exercises and cryotherapy during the first week after the injury.
During the second week, you can start strengthening exercises for the dynamic stabilizers such as the rotator cuff and shoulder blade muscles. I will recommend that an athletic trainer or physical therapist supervise these exercises. When your range of motion and strength are comparable to the uninjured shoulder, we’ll put you into a shoulder brace and start sport-specific drills. There are several brands of shoulder stabilizing braces available online and at retail locations, and a brand I particularly like is Don-Joy. You can see a very good one here. No brace can fully prevent another dislocation but we often find that they reduce the chances.
If all has gone well you can usually return to play with a brace at about 3-4 weeks after the dislocation. In many instances we’ll expect that there will be another instability event during the season but oftentimes we can find a way to have you successfully complete the season. Every situation is different and I’ll mention again: this is one decision to be made in consultation with an experienced shoulder specialist who works with athletes.