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Shoulder Dislocation: Surgery or Sling?

You don't have to dislocate your shoulder to sense how much it would hurt. The ball of the upper arm bone, the humerus, gets pulled out of the socket, the glenoid. An injury like this can end up stretching and possibly even tearing important shoulder structures. 

Doctors will often put the shoulder back in place, then have the patient wear a shoulder sling for a few weeks. Unfortunately, the shoulder often dislocates again. The chance of dislocation is generally higher for younger patients and those participating in sports. Shoulders tend to dislocate again because the shoulder "anchors" have been stretched and damaged from the initial injury. 

Some orthopedic surgeons questioned whether the traditional way of dealing with dislocated shoulders (using a sling) was good enough. They wanted to know whether repairing the injured tissue by arthroscopic surgery would be more helpful.
 
Over a period of eight years, these surgeons worked with 46 people under age 30 who had dislocated their shoulder playing a sport. The average age was 21, and the most common sport was rugby. The surgeons provided the traditional option of wearing a sling after the shoulder was put back in place. The other option was surgery, along with a shoulder sling. Both groups received the same intensive physical therapy and rehab program after surgery.
 
The result was startling. Of the 28 who had surgery, 25 had an "excellent" outcome. This meant they had full shoulder motion, no pain, and a stable shoulder. The other three in the surgery group had a "good" outcome. In the years after surgery, only one person in the surgical group went on to dislocate the shoulder again.

Of the 18 patients who opted for the traditional approach, only one had a "good" outcome. Seventeen ended up dislocating the same shoulder again within about one year (six months average). If other studies have similar results, surgery will likely replace the sling as the gold standard for treating a dislocated shoulder.

References: Mario V. Larrain, MD, et al. Arthroscopic Repair of Acute Traumatic Anterior Shoulder Dislocation in Young Athletes. In Arthroscopy. April 2000. Vol. 17. No. 4. Pp. 373-377.

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