Orthopedics focuses on the musculoskeletal system. Learn about the diagnosis, treatment, and rehabilitation of bone, joint, ligament, and muscle conditions.
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The treatment journey for a dislocated shoulder begins with the immediate reduction and extends through months of rehabilitation or surgery. The goal is simple: put it back, keep it in, and make it strong. However, the path to that goal varies wildly depending on your age, activity level, and the extent of the damage. A 17-year-old quarterback will have a very different treatment plan than a 60-year-old librarian.
This section covers the spectrum of care. We will explain the reduction maneuvers used in the ER, the debate between surgery vs. rehab for first-time dislocations, and the details of common surgical procedures like arthroscopic stabilization. We will also outline the recovery timeline, so you know when you can drive, work, and return to sport.
The first step is reduction. This should be done as soon as possible by a trained professional. Muscle spasms set in quickly, fighting the reduction. Doctors often use sedation or intra-articular injections (numbing the joint) to relax the muscles.
There are many techniques. The traction-countertraction method involves pulling the arm while an assistant pulls a sheet wrapped around the chest. The FARES method involves gently oscillating the arm while lifting it. The Stimson maneuver involves lying on your stomach with a weight hanging from your wrist. The goal is a gentle, controlled clunk back into place, followed by immediate relief of pain.
Once reduced, the arm is placed in a sling. The duration of immobilization is debated. Traditionally, it takes weeks. Now, evidence suggests that for young people, prolonged immobilization doesn’t significantly lower the recurrence rate. A few days a week for comfort is often sufficient before starting gentle motion.
Physical therapy is the cornerstone of non-surgical treatment. The focus is on strengthening the rotator cuff and scapular muscles. These muscles act as dynamic stabilizers, compensating for the loose ligaments. For older, sedentary patients, this is often the only treatment needed.
For young, active patients, especially those who play contact sports, surgery is often recommended after the first dislocation to prevent recurrence. The most common procedure is an arthroscopic Bankart repair.
This procedure is a minimally invasive surgery using a camera and small incisions. The surgeon locates the torn labrum (the bumper) and reattaches it to the rim of the socket using small suture anchors (screws with threads). They also tighten the stretched capsule. This restores the tension in the joint. It is highly successful for patients with excellent bone stock.
If there is significant bone loss (from the socket rim or a large Hill-Sachs dent) or if a previous soft-tissue repair has failed, a Latarjet procedure is performed. This is an open surgery, not arthroscopic.
The surgeon cuts a piece of bone from the coracoid process (a hook of bone on the front of the shoulder blade) and screws it onto the front of the glenoid socket. This bone block physically extends the socket and acts as a barrier to dislocation. It also moves a tendon attachment, creating a “sling” effect that holds the joint in. It is a more rugged, durable repair for high-risk athletes (like rugby players) or those with bone loss.
This French term means “to fill in.” It is an arthroscopic technique used to address the Hill-Sachs lesion (the dent in the ball).
The surgeon takes the tendon of the infraspinatus muscle (part of the rotator cuff) and sews it into the dent. This fills the hole so it can’t catch on the rim of the socket. It is often done in combination with a Bankart repair to provide extra stability (“belt and suspenders” approach).
Recovery is a marathon. Whether surgical or non-surgical, biology takes time.
Risks of surgery include infection, stiffness (loss of motion), and nerve injury. The most common “complication” is recurrence—the shoulder popping out again despite surgery. This risk is higher in collision athletes or those with bone loss who only had a soft tissue repair.
Arthritis is a long-term concern. A dislocation damages the cartilage. Surgery stabilizes the joint but can sometimes overtighten it, also leading to arthritis. The aim is to achieve a repair that strikes a balance between stability and freedom of movement.
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Typically, you must wear the sling for 4 to 6 weeks after surgery, depending on the specific procedure. You take it off for showering and exercises. Sleeping in it is often recommended for the first few weeks to prevent accidental movements.
You cannot drive while on narcotics or while in a sling. Once you are out of the sling and have enough strength to steer safely with both hands (usually 6 weeks post-op), you can drive.
Most patients regain functional motion. However, some loss of external rotation (reaching behind the head) is common and sometimes intentional—tightening the joint slightly helps prevent dislocation.
It has a lower recurrence rate but is a bigger surgery with higher risks of complications. It is usually reserved for patients with bone loss or failed previous surgeries, not as a first-line treatment for everyone.
Yes, eventually. However, you may need to modify exercises. Avoid “behind the neck” presses and wide-grip bench presses that stress the anterior capsule. Keep elbows in front of the body.
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