Surgery or No Surgery after Shoulder Dislocation- How to Decide?

Shoulder dislocations can be painful and debilitating. Whether it's caused by a sports injury, a fall, or a sudden twist, a dislocated shoulder can significantly impact your daily life. While the pain may settle within a few weeks, the ongoing impact on your movement, and limitation in activity can be devastating. So when it comes to deciding whether to have surgery after a shoulder dislocation, it's important to consider several factors.

What is a shoulder dislocation?

A shoulder dislocation occurs when the upper arm bone pops out of the shoulder socket. This can happen in different directions, such as forward (anterior dislocation) or backward (posterior dislocation). The severity of the dislocation can vary, with some cases requiring immediate medical attention. More information on the types of shoulder dislocations can be found here

Non-surgical treatment options

In many cases, non-surgical treatment options can effectively treat a shoulder dislocation. These options include:

Reduction: A healthcare professional can manually manipulate the shoulder joint to put it back into place. There are a few different ways to do this, but thee is no evidence that one technique is better than another. Prompt relocation can quickly reduce your pain. However, there is minimal evidence that the length of time that your shoulder is out of your socket has any long term effect on your recovery (provided there is no nerve damage).
Immobilization: After the reduction, the shoulder may be immobilized with a sling or brace to allow the tissues to heal. We know that having your shoulder immobilised significantly decreases your risk of having another dislcoation. Immpbilisation can be in the form of a sling across your body, or in a brace that holds your arm in external rotation. There is some disagreement about the position of immobilisation with some authors advocating for your forearm positioned away from your body (but still by your side). What is known, is that there isn't any difference in recurrence if you immobilise for between 1 or 3 weeks, so general advice is to keep your sling on for at least 1 week, and no more than 3 weeks as your symptoms allow.
Physical therapy: Once the initial healing is complete, physical therapy can help restore strength and range of motion to the shoulder. This should be gentle initially and not provoke any pain. Isometric exercises (where you use the muscle without using the arm) are a good way to start. It is very important that your physical therapist develops a programme to increase strength and motor control in your rotator cuff, deltoid, pectoral and scapula muscles. Your rehabilitation should continue until you are replicating the forces and loads that you would normal perform.

When surgery may be necessary

While non-surgical treatment options are often successful, there are situations where surgery may be necessary. These include:

Recurrent dislocations: If you have experienced multiple shoulder dislocations, especially with minimal trauma, surgery may be recommended to stabilize the joint.
Bony Bankart fracture: The presence of a bony Bankart fracture can increase your risk of recurrent shoulder instability. Check out this page here for more information on the pathology of shoulder dislocations.
Bankart tear: A Bankart tear is a specific type of shoulder injury where the labrum, a piece of cartilage in the shoulder socket, is torn. There is currently no evidence that a bankart tear increases the risk of recurrent instability.
Hill-Sachs lesion: A Hill-Sachs lesion is a dent in the upper arm bone caused by repeated dislocations. It seems that the relationship between a Hill Sachs lesion and a Bony Bankart Fracture may be important in predicting the risk of further shoulder instability

What are the surgical options?

There are several surgical options for shoulder dislocations, including:

Arthroscopic stabilization: This minimally invasive procedure uses small incisions and a tiny camera to repair and tighten the torn ligaments and tissues in the shoulder joint.
Open stabilization: In more severe cases, an open surgical approach may be necessary to repair the damaged structures in the shoulder joint.
Either of these approaches can involve a soft tissue repair of the capsule, a repair of the labrum, or a laterjet surgery, which is a bony repair to the front of your shoulder

There are some videos here that show you what happens during surgery along with some animations so that you better understand your injury and the surgical process.

What are the potential risks and benefits of surgery?

As with any surgical procedure, there are risks involved. These may include infection, bleeding, nerve damage, and stiffness. There is also typically between 5-6 months of rehabilitation after surgery, so timing the surgery so that it fits with your schedule is an important consideration. However, surgery can also provide significant benefits, such as:

Reduced risk of recurrent dislocations
Improved shoulder stability and function
Relief from chronic pain

How to make the decision?

Deciding whether to have surgery after a shoulder dislocation is a personal choice that should be made in consultation with a healthcare professional. Factors to consider include:

The severity and frequency of dislocations
The impact of dislocations on daily activities and quality of life
The individual's age, occupation, and activity level
The potential risks and benefits of surgery

Ultimately, the goal is to choose the treatment option that will provide the best long-term outcomes and improve the individual's overall shoulder health.

It's important to have a thorough discussion with your healthcare professional about the potential risks and benefits of surgery, as well as the expected recovery time and rehabilitation process. They can provide you with the necessary information to make an informed decision that is best for your individual situation. There is further information here that shows the risk of further shoulder instability. https://www.margieolds.com/pris/

Conclusion

While surgery may be necessary for some individuals with shoulder dislocations, it is not always the right choice for everyone. Non-surgical treatments can often effectively manage the condition and prevent future dislocations. The decision to have surgery should be based on a thorough evaluation of the individual's specific circumstances and in consultation with a healthcare professional