The shoulder joint is extremely flexible, with a high degree of motion in multiple directions. This mobility allows us to position the arm and hand around ourselves and provides much of the function of the upper extremity. Unfortunately, the down-side of this mobility is that the shoulder is inherently much less stable than other major joints in the body. This means that shoulder dislocations are a common injury, especially among young athletes. A dislocation typically occurs when there is an impact to the arm in an overhead position, as can occur during throwing, climbing, or swimming sports. When this occurs, the labrum – a gasket-like cartilage ring that helps stabilize the joint – is often torn, along with the joint capsule.
The initial treatment of a dislocated shoulder typically occurs in the emergency room and consists of a closed reduction – the manipulation of the shoulder to “pop” it back into place. Subsequent treatment often involves physical therapy, and focuses on overcoming pain and inflammation, and recovering use of the arm for activities of daily living and eventually for sports.
Unfortunately, a shoulder that has dislocated once becomes more likely to dislocate again, and multiple dislocation episodes predispose the patient to developing joint injuries and arthritis. If physical therapy and activity modification are not able to prevent recurring dislocations, surgery to stabilize the shoulder can be an effective option. There are many different surgical procedures for this problem, but the most common is a repair of the torn labrum, also known as a Bankart procedure. Our preference is to perform this procedure arthroscopically, meaning the joint is visualized through several small incisions using video cameras and minimally-invasive equipment.
Although shoulder arthroscopy is an outpatient procedure, full recovery does take a significant length of time. This is because the repaired tissue needs to heal fully before it is strong enough to withstand the stress of heavy activity, especially the activity that led to the initial injury. Patients can expect to spend six weeks in a sling, with two to three months of intensive physical therapy to regain strength and range of motion. High-risk sporting activities are generally not recommended until at least six months after surgery.