Question:Our 16-year old daughter dislocated her shoulder playing soccer. We've been told she should have surgery by one surgeon and by another to try rehab first. What's the current thinking on this?
Surgery to stabilize the shoulder after dislocation used to be saved for patients who had recurrent dislocations. It wasn't routinely done after the first dislocation. Surgery has its complications and rehab worked for many people. This same guideline is still used by many surgeons. The change has come in patient selection.
Patients who are at high risk for another dislocation on the same side may be advised to have stabilization surgery after the first dislocation. Studies show that early repair makes a big difference in quality of life. This is especially true for younger patients (less than 30 years old).
Recurrence rates are as high as 75 percent in active individuals who try four weeks of immobilization followed by a rehab program. This compares to 11 percent in patients who are surgically repaired.
Recurrence rates have dropped and results have improved as surgical techniques have changed over the years. Now surgeons recognize the need to repair any damage to the soft tissues around the shoulder after dislocation.
For a young, active, athlete like your daughter the data suggests that early repair and rehab will put her back on the playing field sooner and with fewer problems compared to a wait-and-see rehab approach. You may want to get a third opinion to make sure there aren't good reasons to choose one treatment approach over the other.Dominic S. Carreira, MD, et al. A Prospective Outcome Evaluation of Arthroscopic Bankart Repairs. In The American Journal of Sports Medicine. May 2006. Vol. 34. No. 5. Pp. 771-777.
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