Should you have surgery after a shoulder dislocation?

The decision to have surgery after a shoulder dislocation can often be a difficult one, with many different factors to consider. We have listed the 8 different factors for you to consider while you make the decision about whether or not you decide to have surgery after your shoulder dislocation.

RECURRENT SHOULDER INSTABILITY

The number of times your shoulder has dislocated, is an important factor to consider. Margie Olds has just finished her PhD research which investigated the risk factors for recurrent shoulder instability and whether or not she could predict who was going to have another dislocation. The results from the study, are just in and are still being analysed but these are the factors from her study, that would indicate you have increased risk of recurrent shoulder instability (i.e. it is likely to happen again).

• BONY BANKART LESIONS - If you have a bony bankart (otherwise known as glenoid chip) then you are at increased risk for having another shoulder dislocation. Click here for to learn more about bony Bankart lesions
• AGE - if you are aged between 16 and 25 years of age, you are at increased risk of having another shoulder instability event, when compared with people who are aged 26-40 years. We are not exactly sure why this happens, There may be some hormonal changes inpeople as they grow that influences how stretchy your tissue is. Margie's research found that people aged 16049 years were also more likley to be involved in contact or collision sports in New Zealand, so that may have influenced the results for age.
• Your level of pain and disability after your have the shoulder dislocation. You can measure this with a scale called the SPADI (Shoulder Pain and Disability Index). Check here to get your score on the SPADI. high scores were more likely to have recurrent shoulder instability
• KINESIOPHOBIA - This is a measure of the level of fear of re-injury  and movement that you have after your injury. . Again high scores indicate that you more fearful and at more risk of re-injury.
• IMMOBILIZED. You are more at risk for recurrent shoulder instability if you do not have your arm in a sling after your dislocation. So keep your arm rested for as long as you need to be comfortable. There are really no strict guidelines as to how long your arm should be in a sling, but you should definitively keep it in a sling for the first week or so to keep it comfortable. Longer if you need to. you can take it off when it is not comfortable. 
• DOMINANT ARM: If you dislocated your dominant arm, then you are more likely to have another episode of shoulder instability.
• If you are interested in knowing more about the score that has been developed to predict the likelihood of you having another shoulder injury, then please email Margie and she will give you some more detail specific to you.

FIRST SHOULDER DISLOCATION

There is increasing evidence that if you have only had one shoulder dislocation, immediate surgery may not be necessary. This can depend on the factors mentioned above. Often a good rehabilitation programme which progressively strengthens your shoulder and scapula muscles can increase confidence and decrease the likelihood of further instability. Additionally, there is some recent research to show that if you are under the age of 16 years, there is a 50% that you will still have recurrent shoulder instability after some types of surgery.

TIMING OF SURGERY

having shoulder surgery is rarely a life-saving condition and so requires careful planning. You arm will be in a sling for a period of time (which depends upon your surgeon, but is typically 6 weeks in New Zealand). During this time it is difficult to brush your teeth, cut up your dinner or butter your toast, In the first few days after surgery you will need a hand for activities around the house. You may also need to arrange time from work or school as it is difficult to get back immediately to work with light duties, and impossible for heavier manual labouring jobs. These factors all need to be taken into account when you are making your decision

As you can see, there are many different factors to be considered after you have had a shoulder dislocation. Discuss these factors with your shoulder surgeon, or physiotherapist