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My 78-year old aunt dislocated her shoulder last week. She's wearing a sling and wondering how to decide if she should have surgery. How can we know what's best for her? Is putting surgery off likely to make things worse in the end?

The need for immediate surgery after a first shoulder dislocation is not predictable. Many patients opt to wear a sling for a week or so. Then they start to gradually work on getting their motion and strength back. Sometimes people don't even bother with the sling.

Each patient must make his or her own decision about whether or not to have surgery. Is it their dominant arm? That's important because in older adults, a shoulder dislocation can set them back in terms of function. Was the doctor able to put the shoulder back in place easily? If so, that would suggest minimal additional trauma to the soft tissues around the joint.

Was an X-ray, CT scan, or MRI done to show any damage done to the area? A torn rotator cuff or fractured bone might swing the decision more toward surgical intervention sooner than later.

A study to show the natural history of a first-time shoulder dislocation in people of all ages and occupations has been done. Natural history refers to what happens (final outcome) if the person is followed over a period of years. They reported that not all people needed surgery.

Those who had a rotator cuff repair did not dislocate again. Many patients who didn't have surgery recovered fully. After five years, their shoulder was as stable as those who did have the repair operation.

The results of studies like these help us all realize that everyone is different. It's not always possible to predict the best course of action. Sometimes, after looking everything over, it's clear what to do. In other cases, doctors encourage their patients to take the conservative route. They advise patients to try rehab first, because they can always have the surgery later if that seems best.

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