Two year shoulder pain due to recurrent shoulder dislocation

Patient

Q: I separated my shoulder almost seven years ago, and then re-injured it a little over 2 years ago. The doctor took x-rays and let me go saying I would be fine and that it would heal in the next few weeks. I have always had shoulder pain since then. I am now involved in volleyball and come back from practices everyday with excruciating pain in my shoulder. I do everything I know to do (ice, heat, medicine), but nothing really helps. Should I get re-examined and maybe even look into surgery?

Doctor

A:    According to your description, I understand that when you said “separated shoulder” you meant “dislocated shoulder”, and this has occurred to you more than once, so it can be called “recurrent”, then generally, if your shoulder is wrenched upward and backward, you may dislocate it out of its socket .Basically now, try to avoid shoulder straining movements and activities that could potentially produce a new dislocation. The shoulder dislocation is both painful and incapacitating. The force required is often that of a fall or a collision with another person or object (both of which can occur during many sports). You can wear a sling, If a sling is not available, rig one by tying a long piece of cloth in a circle (a bed sheet or towel may do nicely). A pillow placed between the arm and body may also help support the injured shoulder. After a period of immobilization (usually a few weeks), slowly and gradually begin to increase the range of motion at the shoulder joint. This helps to preserve natural movement and lessen the risk of recurrent dislocation which is your particular case here. When good progress is made with range of motion, strengthening exercises may be added to help you to  return to full function. According to the current medical literature, the recurrence rate for shoulder instability is highly dependent on the age of the patient. Conservative treatment should be tried first before think of surgery. Most patients are able to rehabilitate their shoulder with rest, anti inflammatory medication  and physical therapy. In patients , as your case, who have recurrent shoulder instability, operative care should be highly considered. Several studies have shown the increased likelihood of traumatic shoulder  arthritis in patients with multiple shoulder dislocations. Operative care may consist of both open or arthroscopic treatment of the cause of instability, and of course a Rehabilitation program after surgery to control pain, limitation and regain full function.

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