Houston Methodist. Leading Medicine

Shoulder FAQ

Question:

I dislocated my shoulder two weeks ago and opted to try the conservative approach to treatment instead of surgery to repair the damage. Is there any way to predict how I'll do? Like -- will I recover? Will I dislocate this arm again?

Answer:

Anyone who has had a shoulder dislocation is understandably concerned that it might happen again. Your question is a good one: is there any way to predict who might have a second (recurrent) shoulder dislocation? The answer to this question is important because if someone is at increased risk of a recurrent shoulder dislocation, they might want to consider having surgery early on. Surgical repair can stabilize the joint and spare you from waiting to see if the joint will dislocate a second time. On the other hand, if you aren't at risk for a recurrence, you'll probably want to avoid unnecessary surgery. In a recent study, a group of Israeli surgeons evaluated the benefit of a specific test called the anterior apprehension test. This test is used in predicting shoulder redislocation after a first traumatic shoulder dislocation. As it turns out - no, that particular test wasn't sensitive enough. But let's step back and see how they came to that conclusion. First, what is the anterior apprehension test? This is a clinical test performed after someone has had a traumatic shoulder dislocation to see if the shoulder is unstable. The patient lies on a table face up. The shoulder is placed in a position of 90 degrees of abduction (arm is away from the body). The elbow is bent 90 degrees. The palm of the hand is facing the feet. The examiner holds the elbow with one hand and uses the other hand to rotate the shoulder back (external rotation) while moving the hand toward the patient's head on the table. The test is positive if the patient makes a face of pain or apprehension and says it feels as if the shoulder is going to pop out of the socket. The test was done in this study six weeks after the first dislocation after the patient had completed a program of physical therapy to restore normal shoulder motion, strength, and function. If shoulder motion needed for the apprehension test was still limited after six weeks, the patient completed another two to three weeks of therapy before undergoing testing. There were 52 men who participated in this study. Most were Israeli soldiers or soldiers-in-training. The first dislocation occurred during combat training or while playing soccer or basketball. Everyone was placed in a protective sling for four weeks and then attended physical therapy for two weeks before being tested. With such a low sensitivity rating, this test isn't really a good way to predict who would benefit from surgery after conservative care (nonoperative treatment) for the first dislocation. It misses too many of the patients who would benefit from surgical repair. It is not a useful diagnostic method for testing shoulder instability after a primary (first) shoulder dislocation. When it comes to figuring out who should have surgery right away to repair the damage after a first traumatic shoulder dislocation, the anterior apprehension test may not be the best tool to use. Avoiding unnecessary and unsuccessful surgeries is the goal, especially for an active individuals. At best, the test results can divide patients into two groups: those who have a higher risk for redislocation after the first dislocation and those who have a lower risk. And based on how the study was conducted, that information is accurate if the patient has been immobilized for four weeks and received two weeks of standard post-shoulder dislocation therapy. But it sounds like that might be your situation so the test might give you some valuable information but it can't provide an absolute definitive answer as a stand-alone test. Ori Safran, MD, et al. Accuracy of the Anterior Apprehension Test as a Predictor of Risk for Redislocation After a First Traumatic Shoulder Dislocation. In The American Journal of Sports Medicine. May 2010. Vol. 38. No. 5. Pp. 972-975.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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