Cadets Salute Arthroscopy for the Treatment of Dislocated ShouldersIf you dislocate your shoulder, the usual treatment calls for a sling followed by rehabilitation. Unfortunately, this doesn't reduce the chance that you'll dislocate your shoulder again. If you're young, you're at an especially high risk for re-injury. Studies have shown that up to 94 percent of athletes under age 25 who dislocate their shoulders do it again.
Is there a better treatment? One that prevents re-injury in young patients? These authors looked at a surgical treatment for young athletes who dislocated their shoulders. The procedure involved an arthroscope--a camera-like device that lets surgeons see inside the joint. It requires very small incisions. (This is different from "open surgery," in which surgeons make bigger incisions to see the joint.) Special tacks were used to keep shoulders in place.
The participants were 57 cadets at West Point. Six of them chose not to have surgery. They wore slings for three weeks and then did strength exercises. The goal was to return them to full activity in three months.
The rest of the patients chose surgery. Three of them had injuries that could not be fixed with arthroscopy; these patients had open surgery instead.
The other 48 patients had the arthroscopic procedure. Forty-five were men and three were women. Their average age was 20. Most of the patients were injured while boxing, playing football, doing military training, or wrestling.
Patients had surgery within 10 days of injury. After surgery, they wore a device to keep their shoulders from moving for a month. Strength training started at two months. Full activity was allowed four months after surgery.
Two to five years after surgery, 88 percent of the shoulders that had the arthroscopic treatment were completely stable. When asked to rate their shoulders on a scale from one to 100, with 100 being totally normal, patients who had arthroscopy gave their shoulders a 96. All of the patients with stable shoulders were able to return to sports. These patients also scored well on physical function.
Six patients who had the arthroscopic procedure dislocated their shoulders again. These injuries happened within a year and a half of surgery--or soon after patients resumed full activity.
What led to re-injury? Patients who'd had problems in both shoulders were at greater risk. So were those with more looseness and those who had poor tissue quality at the time of surgery. The authors think that playing collision sports may put patients at risk for another dislocation. But since all of the patients who had surgery returned to sports, this could not be evaluated.
Of the six patients who chose not to have surgery, only two had stable shoulders at follow-up. The other four had problems within a year and a half of treatment. Three of them wound up having surgery.
The arthroscopic procedure seems to be a safe, effective treatment for young athletes. The authors feel that arthroscopic treatment reduces the chance of re-injury compared to other kinds of surgery or no surgery at all.
Thomas M. DeBerardino, LTC, MC, USA, et al. Prospective Evaluation of Arthroscopic Stabilization of Acute, Initial Anterior Shoulder Dislocations in Young Athletes. In The American Journal of Sports Medicine. September/October 2001. Vol. 29. No. 5. Pp. 586-592.
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