By Dev K. Mishra, M.D.
President, Sideline Sports Doc
Clinical Assistant Professor of Orthopedic Surgery, Stanford University
- There is a lot of variability in timelines for return to activity and sports after shoulder stabilization surgery
- Important individual factors to take into account are the type of surgery, whether it’s your dominant arm, type of sport, and position within your sport
- As a very rough guideline we target return to full contact and collision sports at 6 to 9 months
In today’s article I’d like to provide some general guidelines about return to play after surgery for a shoulder dislocation. Your individual situation will be unique, based upon multiple factors so for specific guidelines you’ll need to discuss this carefully with your orthopedic surgeon. It’s also important to note that surgeons will have considerable variability in their personal preferences for return to play.
Here are the targets I will typically aim for:
- Noncontact overhead sports, full swing golf, racket sports: four months
- Pitcher throwing from the mound: six months
- Full contact and collision sports: 6 to 9 months
Let’s have a look at some of the factors involved in the decision process.
The decision to proceed with surgery is in itself somewhat controversial. Occasionally we will recommend surgery after a first time dislocation. More commonly surgery is performed after repeated dislocations.
One of the first factors affecting the speed of rehabilitation and return to sport is the exact type of procedure that was performed. The traditional shoulder stabilization surgery is called a “Bankart repair”. In some instances the ligaments become stretched out requiring a procedure called a “capsular shift”. If the bone at the front edge of the socket has become damaged it may require a procedure called a “Latarjet”. And if the bone at the back of the ball portion has become damaged it may require a procedure called a “remplissage”.
As you can see there are many ways to stabilize a shoulder! Some of these procedures allow for a faster rehabilitation and recovery than others, so this will be one of the most important factors for you to discuss with your surgeon.
Here are some other key factors that will determine the speed of recovery:
- Is this your dominant or nondominant shoulder? It may be possible to return to sports sooner if it is your nondominant shoulder.
- What is your sport and what is your position? Different sports and different positions within the sport will have different physical demands on the operated shoulder. A cyclist is likely to return to sport sooner than a rugby player. An NFL kicker is likely to return to sport sooner than a linebacker.
Recognizing that there is a lot of variability here are the general steps that you can expect.
Surgery is typically done as “outpatient surgery”, meaning that you get to go home the same day. For about 4 to 6 weeks after the surgery the operated arm will be placed into a device called an immobilizer, to assist with tissue healing. You will come out of the immobilizer for bathing, dressing, or for performing physical therapy exercises.
I like to have my patients start physical therapy in the first week after the surgery. These are very gentle exercises initially, but starting the therapy early builds a sense of trust with the physical therapist and also gives the patient some early progress targets to reach. I find that this helps greatly with the psychological process of healing.
The physical therapist and the surgeon will then look for various milestones to help us determine appropriate activity levels. These will include the patient’s comfort level, range of motion of the operated shoulder, and strength.
Assuming all goes well, here are some very rough guidelines for return to activity:
- Return to school and desk work: 1 to 2 weeks
- Light duty manual office work: 3 to 4 weeks
- Heavy duty work: 3 to 6 months
- Sport activity targets will be as noted in the second paragraph of this article
American Academy of Orthopedic Surgeons: Shoulder Instability