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A Shoulder Dislocation Ahead of Football Season
July 30, 2017
Today in the office, I saw an 18 year old football player from Buena Vista, Colorado. He was participating in a pre-season football training camp and suffered a first time shoulder dislocation while tackling another player. He plays on both the offensive and defensive lines for his high school, and he is one of the team’s best players. He wants to play football in college, and a number of Division 2 and 3 colleges have expressed interest in having him play for them. It is obviously very important to him to be able to play in his upcoming high school season as a senior who has scholarship offers to play football in college.
The shoulder joint has the greatest range of motion of any joint in the body, but it is also the most commonly dislocated large joint. The highest percentage of first time shoulder dislocations occurs in young males (ages 10-20) followed by middle aged adults (ages 50-60). By comparison, there is less range of motion in a hip joint compared to a shoulder, as the hip joint has a deep bony socket, but this also confers better bony containment and stability, leading to a much lower incidence of hip dislocations.
The shoulder joint has a very shallow socket, and we rely largely on our ligaments to stabilize our shoulder joint. The shoulder is held in position by a combination of static restraints (ligaments and capsule) and dynamic restraints (muscles which compress the ball in the socket). A bumper of rubbery tissue called a labrum surrounds the shallow socket of the shoulder. Our ligaments and capsule insert into this labrum. I liken the ligaments and capsule to the grisly tissue that holds two chicken bones together.
Most shoulders dislocate when the arm is abducted and externally rotated. Imagine a pitcher that is winding up to throw a baseball, and this is the vulnerable arm position that puts the shoulder at risk for dislocation. With the arm in this position, the arm is then pushed posteriorly beyond the normal excursion of the joint when tackling another player or falling off one’s mountain bike. The head of the humerus then pops out the front of the shoulder. Posterior dislocations, in which the head goes out the back of the shoulder are much less common. With the typical anterior dislocation of a shoulder, the labrum is usually torn off the front of the shoulder socket and the ligaments are stretched. In middle aged patients, there is a high incidence of associated rotator cuff tears when one dislocates a shoulder.
As for our 18 year old high school football player who dislocated 1 month before his season starts, I recommended that we try to avoid surgery currently. Instead he is going to start in physical therapy. When he has regained full range of motion and strength, he can resume playing football, but I have recommended that he wear a sully brace when he returns to play. A sully brace prevents the shoulder from excessively rotating and forward flexing and in so doing can hopefully prevent a recurrent dislocation. However, in an 18 year old male who participates in a collision sport like football he stands a very high likelihood of having further dislocations. If he goes onto have another 1 or 2 dislocations, then I would recommend an arthroscopic Bankart repair surgery whereby the labrum and the shoulder capsule is repaired and shoulder stability is restored.
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