I'm a West Point cadet with a bum shoulder. I dislocated it while playing soccer with my fellow cadets. The surgeon here wants me to have surgery right away. My home doctor suggests waiting and completing a rehab program to see if a more conservative approach could stabilize the shoulder. My biggest concern is that I will have to pass my physical fitness test before the end of this year. Will I be able to do this better with surgery or without?
Military records suggest that the conservative approach is not as successful for soldiers as for the regular population. The physical demands on the shoulder are just too great to prevent future dislocations. Since your training and daily activities can't be modified, nonoperative treatment is not as effective as surgical repair early on.
Some of this may depend on the type of damage and severity of soft tissue involvement. First-time dislocations with severe damage to the shoulder are more likely to be repaired surgically. This is often the case when there has been a capsulolabral avulsion. This type of injury refers to the fact that the labrum has pulled away from the bone. The labrum is a dense ring of fibrous cartilage around the shoulder socket. It gives the shoulder socket some depth and provides the shoulder with increased stability.
If the labral tear extends up far enough, it will even pull some of the biceps tendon away from where it inserts into the labrum. The surgical procedure used most often to treat this type of injury is called the Bankart repair. During the arthroscopic procedure, the surgeon repairs each of the soft tissues damaged by the dislocation. Suture anchors are used to hold the biceps in place.
A recent military study was published with the long-term results of almost 50 soldiers treated surgically for a first-time acute anterior (forward) shoulder dislocation. Studies show that early results of surgical stabilization are excellent. This study attempted to report on the long-term results. They followed their patients for at least nine years (some as long as 14 years). They used patient questionnaires to ask about shoulder/arm function, pain levels, and patient satisfaction with the results.
Because this was mostly a military group, return to athletic activity and physical conditioning (such as doing push-ups) were also monitored. The study group was able to complete the necessary physical training with an average of 282 points (out of 300) on the Army Physical Fitness Test (push-ups, sit-ups, and 2-mile run). Only one person left the military for medical reasons and that was not for a shoulder problem.
MAJ Brett D. Owens, MD, et al. Long-Term Follow-up of Acute Arthroscopic Bankart Repair for Initial Anterior Shoulder Dislocations in Young Athletes. In American Journal of Sports Medicine. April 2009. Vol. 37. No. 4. Pp. 669-673.
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