A shoulder dislocation is common in young athletes, especially those who play contact and collision sports. Traumatic events lead to shoulder dislocations, which usually require a physician or athletic trainer to reduce them, or subluxations, which reduce without formal reduction. These episodes often prevent the athlete from playing for extended periods of time.
What is the best treatment for a shoulder dislocation during the season?
Much debate exists about the best treatment option for a young athlete with a traumatic shoulder dislocation or subluxation during the season. Should he undergo surgery right away and miss the rest of the season? Should he wear a brace or shoulder immobilizer for a period of time, and if so, for how long? Should he undergo physical therapy? Should he try to return to play, and if so, when?
Research performed at the John A. Feagin Jr. Sports Medicine Fellowship and Keller Army Program in West Point, New York tried to answer those questions. The authors presented their findings about in-season shoulder instability among college athletes recently at the American Orthopaedic Society for Sports Medicine’s (AOSSM) Annual Meeting in Seattle, Washington.
New study of injured college athletes
The authors collected data on college athletes in contact sports at three Division I athletic departments who suffered traumatic shoulder instability events – either dislocations or subluxations. All of the athletes immediately began physical therapy programs, and none were placed in shoulder immobilizers. Each athlete was cleared to return to play when he or she met the following criteria: no pain or other symptoms with rehab exercises, had full strength, and could perform all sport-specific exercises.
45 college athletes were included in the study. These athletes suffered shoulder injuries in a variety of sports including football (28), rugby (6), wrestling (4), baseball (2), judo (2), lacrosse (2), and boxing (1).
Did many athletes return to play after a dislocated shoulder in the same season?
The authors found that 73% of college athletes with in-season shoulder instability successfully returned to their sports during the same competitive season. 12 of the 45 athletes did not achieve sufficient shoulder function to allow them to return to sports during the season.
58% of the shoulder instability events were dislocations, while 42% were subluxations. The athletes who suffered shoulder subluxations were 5.3 times more likely to return to sports during the season than were athletes who suffered dislocations. Also, athletes who suffered subluxations returned to sports more quickly (median of 3 days) compared to those who suffered dislocations (median of 7 days with a much wider variation in the length of the absence).
How likely are recurrent episodes of shoulder instability?
64% of the athletes who successfully returned to play in season experienced episodes of recurrent instability. 20 athletes used a brace upon returning to competition after an in-season instability event, but there appeared to be no association between wearing a brace and a lower incidence of recurrent instability.
In the conclusion of the paper, lead author Jonathan F. Dickens, MD summarizes the group’s findings. “Athletes who experience an in-season subluxation event are much more likely to return to sport during the same competitive season when compared to those who experience a dislocation. The majority of athletes that sustain an in-season shoulder instability event can expect to return to sport within 10 days, with athletes sustaining a subluxation event returning sooner when compared to those experiencing a dislocation. The majority who return to participation during the same season can also expect to complete the remainder of the season; however, recurrent instability events are common regardless of whether the initial injury was a subluxation or dislocation.”
Also read and listen to this podcast discussion:
Surgery for shoulder dislocations might be most cost-effective option
Episode 26: Should surgeons operate on young athletes with shoulder dislocations
Return to play after a shoulder dislocation and the goals of team doctors
The goal of the team physician at every level of sports is to return an injured athlete to sports as quickly as possible, but it must be done in a way that helps the athlete return to full function and does so in the safest manner possible. Recurrent instability is a very common problem with shoulder dislocations and subluxations in young athletes. Treatment decisions regarding return to play in season have to keep the long-term health of the athlete in mind.