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Management of mid-season shoulder dislocation in young athletes requires careful consideration
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Clinicians must consider numerous factors before recommending treatment for young athletes who suffer mid-season traumatic anterior shoulder instability, according to a recent review article published in the Journal of the American Academy of Orthopedic Surgeons.
“Shoulder instability is common in athletes,” Brett D. Owens, MD, chief of orthopedic surgery service at Keller Army Hospital in West Point, N.Y., told Healio.com. “The management of in-season injuries requires an understanding of the natural history of shoulder instability, as well as an understanding of the athlete and his or her requirements. Options include rehabilitation and return, bracing and surgical stabilization.”
Brett D. Owens
The choice between early stabilization and nonsurgical treatment should be based on the sport, position and age of the patient. The physician should also consider the risks associated with recurrent instability and the patient’s sport and career goals.
According to Owens and colleagues, patients with large bony Bankart lesions or significant glenoid or humeral bone loss are candidates for early surgical stabilization, as are patients with an axilliary nerve lesion or rotator cuff pathology. If the patient sustained the injury near the end of the season or has recurrent instability, surgery is also recommended.
Nonsurgical treatment should be considered for patients with primary instability events and soft tissue lesions, according to the researchers. Simple sling use, gentle range-of-motion exercises and cryotherapy during the first week after sustaining the injury are recommended.
During the second week, the patient can perform strengthening exercises for the dynamic stabilizers — including the rotator cuff — as well as periscapular strengthening exercises. When the patient’s range of motion and strength are comparable to the contralateral side, sport-specific drills can be initiated and patient’s return to play — typically after 3 weeks — can be considered.
“Traumatic anterior glenohumeral subluxation or dislocation that occurs during the competitive season presents a substantial treatment dilemma,” the researchers wrote. “The goal of treatment is to return the athlete to competition safely and efficiently, minimize time away from competition, prevent further injury and restore function.”
Disclosure: Dr. Owens reports no relevant financial disclosures. See the study for the full list of disclosures.
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