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SHOULDER DISLOCATION
Ross Hauser, M.D.
Shoulder dislocation occurs when
a patient falls on an outstretched hand or when an anterior force to the
shoulder occurs when the shoulder is abducted and externally rotated. This is the position of the shoulder when, for example, a person is waving to someone. Very few people dislocate their shoulder for the first time without having a significant force or injury.
There is more than one type of shoulder dislocation, but far and away the most important is the anterior dislocation, which occurs in approximately 95 percent of all cases. In this dislocation, the anterior static shoulder stabilizers, including the anterior capsule and the inferior
glenohumeral
ligament, are torn away from the bone.
In some cases a chip of bone from the posterolateral aspect (Hill-Sachs lesion) of the humeral head (ball) or a torn rim (Bankart lesion) of the
glenoid (socket) may occur. If the athlete is young there is a high likelihood that the dislocation will occur with further sports participation. Older individuals are less likely to dislocate because of less elasticity in the tissues. Exercise and rehabilitation usually follow a period of
immobilization after an anterior dislocation and, if this fails to restore strength and stability to the shoulder, surgery is usually recommended.
In one definitive 10-year prospective study it was found that half of those treated with immobilization had recurrent dislocations and, of these, half had surgical treatment. This study included 247 patients with first-time dislocations. It demonstrates an alarming number of athletes who are unable to continue their sport without further dislocation or the need for surgery. This also does not address the percentage of athletes who do have surgery and return to their sport. In our experience, an athlete who undergoes surgery rarely is able to perform as well as before surgery. If an athlete desires to enhance their athletic performance, the best option is
Prolotherapy not surgery.
While surgery can treat the anterior dislocation effectively in many cases, post-operative pain, lengthy rehabilitation, and a chance of not returning to a previous level of sports participation are reasons to consider Prolotherapy as an alternative to standard treatment approaches.
Prolotherapy injections directed at the anterior shoulder capsule and the insertions of the middle and inferior glenohumeral ligaments will increase joint strength and allow pain-free motion through the wide range of movement in overhead throwing sports. Once pain has been reduced, a gradual return to one’s previous level of activity can be expected. Substantial improvement may be noted in as few as one to two Prolotherapy treatments, and the scar tissue from surgery can be avoided. There are other advantages to Prolotherapy over surgery for shoulder instability. Prolotherapy is the only treatment that is designed to help repair the painful area. It involves no cutting, suturing, sewing, or stapling. The athlete is also encouraged to exercise while undergoing Prolotherapy, whereas after surgery there are careful limits to activity.
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Ross
Hauser, M.D.
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