Question:I dislocated my shoulder six weeks ago while doing an adult outdoor ropes course. I think I should have surgery to fix the problem. My doctor advises a two-month course of physical therapy first. It seems like a waste of time if I'm just going to end up having surgery. Am I off base in my thinking here?
Answer:Orthopedic surgeons know from personal experience and the results of published studies what works best for each type of injury. A single episode of dislocation may not need the cost and possible complications from surgery. A short course of physical therapy may be all that's needed.
The surgeon bases his or her decision on several factors. The history (how it happened) and then the results of the physical exam are taken into consideration. There are some specific tests the doctor will carry out to assess how stable (or unstable) your shoulder joint is.
At least two episodes of dislocation are usually needed before surgery is considered. An MRI will show if the important ligament-labral complex has been torn or detached. This area of soft tissue and cartilage helps hold the shoulder in place. Without it, surgery is almost always needed.
Your age, activity level, and general condition are also part of the decision. Older, less active adults are often at less risk of another dislocation. Surgery may not be needed for these patients because rehab has good results. On the other hand, young active adults who are capable of an aggressive rehab program may be able to strengthen the shoulder without invasive surgery.
You will probably have a better result all around if you understand your surgeon's thinking in this decision. Don't hesitate to ask for an explanation. If you don't think rehab is valuable, you may be less likely to follow through as you should.Fotios P. Tjoumakaris, MD, et al. Arthroscopic and Open Bankart Repairs Provide Similar Outcomes. In Clinical Orthopaedics and Related Research. May 2006. No. 446. Pp. 227-232.
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