Welcome to a weekly series on DrDavidGeier.com where I take readers’ questions and answer them in a public forum. I’ve realized over the first few weeks that many questions I’ve gotten would be good topics for discussion. I will use only a first name, city, and state to protect the anonymity of the writer. In this Ask Dr. Geier column, I discuss getting an MRI for a shoulder dislocation now or at the end of the season.
Volleyball Mom in Daniel Island, SC asks:
My 21-year-old daughter who plays D1 volleyball just told me she has a dislocated shoulder with a possible tear which she injured during a tournament this last weekend. She and her trainer have decided to forego an MRI because if it comes back showing the tear she will be sidelined for the season. She is a senior and wants to play her final season. They have decided to “rest it” and she is wearing a brace with the intention of playing in a couple of weeks.
I know this is done but I really think it is not for the best could you please give me your opinion on how best to proceed.
This is a fantastic question for many reasons, and it represents a situation where an athlete and a sports medicine physician have to make a very difficult decision.
Risk of a shoulder dislocation
In general, a young athlete who has dislocated his or her shoulder is at high risk for having continued shoulder instability, meaning that the shoulder could pop out of place again and again. Athletes under the age of 21, especially if they are under 18, are very likely to tear the labrum (a cartilage bumper) surrounding the glenoid (socket) or stretch out the capsule of the shoulder. This damage creates the potential for the player to have continued instability of the shoulder. The trend over recent years among sports medicine orthopaedic surgeons has been to proceed to arthroscopic surgery more quickly. The surgeon can look in the shoulder with an arthroscope and repair the labrum and tighten the capsule to prevent the injury from happening again.
When should you get an MRI for a shoulder dislocation?
When a first-time shoulder dislocation occurs during the season, the decision-making becomes even more difficult. Do you let the athlete try to play the rest of the season and hope it doesn’t happen again? Do you pull the athlete out immediately and performed an MR arthrogram to try to determine if structural damage, such as a labral tear, has occurred?
Playing sports after a shoulder dislocation
Unfortunately, there is not an answer to that question that’s always right or always wrong. First and foremost, I like to give the athlete and his or her family as much information as possible about the risks and benefits so that they can make the decision that is best for them. Most high school and college athletes, in my experience, want to try to play the rest of the season and deal with a shoulder injury at the end of the season. If that is the case, I discuss the risks of recurrent instability and the potential for further damage to the shoulder if another dislocation occurs, such as cartilage or bone injury. In some sports, such as football, an athlete can wear a brace to try to decrease the chance of another dislocation occurring. I do emphasize to the athlete and his or her family that if another dislocation occurs during that season, then we might strongly encourage the player to consider having the shoulder evaluated with the necessary tests (usually an MR arthrogram) and consider surgical stabilization, if necessary.
Also in my experience, most parents want to pull the athlete out of sports right away, at least long enough to obtain the necessary tests to determine if any structural damage has occurred, such as a labral tear. If that study comes back negative, then we are all more confident that he or she can get back into the sport without risking further damage after a short course of rehabilitation. If the study comes back showing pathology that needs to be fixed surgically, the parents usually want to proceed with the surgery right away to prevent further damage. Again I think it’s a discussion of risks and benefits. The advantage of early surgery is that you decrease the chance of any further injury occurring from another dislocation. The downside is that the season will be over, as recovery from the surgery usually takes 4 to 6 months before he or she is allowed to return to sports.
Timing of surgery
There is another point to consider when deciding whether or not to have surgery, and this really applies to any decision regarding timing of surgery with respect to sports. I see this all the time in youth and high school sports, where an athlete plays multiple sports throughout the year or even one sport with multiple teams throughout the year. Recovery from the surgery, as I said, usually takes 4 to 6 months before the athlete can return to sports. Let’s say hypothetically that he is in the middle of a season for a club team. He might tell you that the club team and its season are not as important to him as the upcoming season several months later for his high school. In that case, it might be beneficial to go ahead and have surgery early, go through the entire rehabilitation process, and be ready for sports at the start of the more important high school season.
The main point I want to emphasize here is that decisions such as these with respect to deciding whether to proceed with diagnostic workup, ending the season and proceeding with surgery, or trying to get back into the season and having surgery at the end of the year are complicated decisions. Long discussions between the athlete, coaches, trainers, and family with the physician are important to understand the risks and benefits and make the decision that is best for the athlete.