Question:I'd like to get some advice about a shoulder dislocation. Our daughter plays hockey and dislocated her left shoulder. The MRI shows a tear in the cartilage, too. The coach says just rehab it and get her back in the game as soon as possible. The surgeon says to repair it now before more damage occurs. Which way should we go?
Answer:The best treatment for traumatic shoulder injuries can be difficult to determine for each patient. History, clinical exam, and imaging studies help guide the surgeon.
When there is minimal soft tissue damage, conservative care may be all that's needed. Rehab can be effective in returning players to their chosen sports. But if there is damage to the cartilage around the shoulder socket, then the risk of dislocating it again goes up.
More serious injuries such as Bankart lesions often require surgery. The labrum, a fibrous ring of cartilage attached to the bone, tears away from the bone with a bone fragment attached. Without the labrum, the depth and stability of the shoulder socket is altered. Chronic dislocation can occur.
Arthroscopic surgery to repair a Bankart lesion is possible now. The operation is much less invasive and the recovery time is shorter. Players can resume noncontact sports four to six months after the procedure. Contact sports may require a longer time to rehab.Giuseppe Porcellini, MD, et al. Long-Term Outcome of Acute Versus Chronic Bony Bankart Lesions Managed Arthroscopically. In The American Journal of Sports Medicine. December 2007. Vol. 35. No. 12. Pp. 2067-2072.
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