Many patients come to my office after a shoulder that has dislocated for the first time. Often this follows a trip to the emergency room where x-rays can be helpful in confirming the diagnosis and the direction of the dislocation. Most commonly the acute traumatic dislocation is anterior. What is the right thing to do at this point?
Numerous, well- controlled studies still support non-operative treatment of most patients with a first time dislocation. Over the age of 27, about 2 out of 3 will not have another dislocation or symptoms of instability. The rate of recurrence, however, can be much higher in the younger, active patient. In some studies, this recurrence rate was found to be as high as 90%. The military academies for many years have surgically fixed these first time dislocations. In this setting there is often an important reason a recurrence could be a serious problem.
As surgical treatment has become less invasive with arthroscopic techniques becoming just as successful as open techniques, an increased interest has arisen in perhaps fixing the younger, active athlete after a traumatic, anterior, first time dislocation. It is my typical recommendation, though, to treat the first time dislocation conservatively with a temporary sling and shoulder rehab exercises as soon as discomfort allows. I then allow a return to sports as tolerated. However, if the shoulder comes out a second time, it will inevitably come out again. Recurrence or any persistent symptoms of instability despite appropriate rehab are indications for surgical repair.
The shoulder is a very complex piece of machinery. Its elegant design gives us the ability to do many things. This design gives the shoulder joint great range of motion but not much stability. As long as the parts of this elegant machine are in good working order, the shoulder can move freely and painlessly. An injury to the shoulder, or wear and tear in the parts of the shoulder, can lead to pain with movement or stiffness in the shoulder. Many people are probably familiar with the term bursitis. Any pain in the shoulder is sometimes mistakenly referred to as bursitis. The term bursitis really only means that the part of the shoulder called the bursa is inflamed. In reality, there are many different problems that can lead to symptoms from inflammation of the bursa, or bursitis. Impingement is one of those things that can cause bursitis. Let’s see how this machine called the shoulder is put together and what might cause a breakdown.
A popliteal cyst, also called a Baker’s cyst, is a soft, often painless cyst on the back of the knee. A cyst is usually nothing more than a bag of fluid. These cyst occur most often when the knee is damaged due to arthritis, gout, an injury, or from inflammation of the joint lining. Treatment of the cyst is most successful when the underlying cause of the cyst is also treated. Otherwise, the cyst can reoccur.
Dr. Maffet’s chapter on “Superior Labral Injuries” of the shoulder has just been published in the latest edition of Orthopedic Sports Medicine.
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