Is it better to treat anterior shoulder dislocations in athletes right when it happens (on the field or court) or transport them to the hospital first?
Most first time shoulder dislocations in athletes are anterior (forward direction). The structures around the shoulder (e.g., ligaments, capsule, muscles) are designed to prevent dislocations. But with enough force and with the shoulder in just the right position, these safeguards can be overcome. Forceful movement of the head of the humerus (upper arm bone) over the lip of cartilage around the shoulder socket is called a Bankart lesion.
There is some disagreement on whether to reduce the shoulder immediately to alleviate the athlete's pain (which is usually intense) or transport to the hospital for X-rays and a proper diagnosis. A quick and accurate diagnosis is needed before the best plan of care can be established. The goal is to minimize further damage to the shoulder joint and surrounding soft tissues.
Some experts advise having an X-ray before trying to reduce the shoulder. Reduce means to put the shoulder back in the socket. Usually, the person is in so much pain, a closed (without surgery) reduction seems like the right thing to do. But there could be other injuries that need attention and that could be made worse by a closed reduction.
X-rays confirm the direction and severity of the dislocation. Any bone fractures present will show up on an X-ray. Other clinical tests may be performed to assess nerve, blood vessel, and soft tissue structures. If more details are needed, a CT scan and/or MRI may be ordered. MRIs with a dye injected into the joint can show the location and size of a labral tear.
Once the exam is completed, the surgeon can decide on the best plan of care for that patient. Reducing the dislocation is the first step. Sometimes this can be done without surgery. In many cases, the decision to treat immediately versus transport is really a judgment call. Age of the individual, severity of pain, and expertise of those trained to perform a closed reduction on site are some of the factors to consider.
Type of sports involvement and timing of the injury (preseason, during season, end of season) are also factored into the decision. Besides treating the immediate problem, consideration must be given to preventing future (repeat) dislocations. With all these variables to consider, you can see why there isn't a quick and easy answer to your question.
Robert Y. Wang, MD, FRCSC, et al. The Recognition and Treatment of First-Time Shoulder Dislocation in Active Individuals. In The Journal of Orthopaedic & Sports Physical Therapy. February 2009. Vol. 39. No. 1. Pp. 118-123.
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