Sports Medicine/Shoulder Instability

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QUESTION: Hi Dr. Arthur!

I've had shoulder problems for the past few years. It all began when I was at gymnastics practice and during a certain skill I felt my left shoulder slip out of the socket and then pop back in once I took pressure off of my arm. The pain was horrible, so much that I think my vision went black for the moment that my shoulder was displaced. Following the incident my shoulder was very sore for weeks, and has never been the same.

Since the first incident, my left shoulder has slipped out of the socket about 7 times and my right shoulder has done so once. My shoulder has always instantaneously relocated, but it still hurt quite badly. I've heard that a partial dislocation is called subluxation, and I think that might be what I've experienced.

My question is, shoulder I seek surgical treatment for my shoulder? I've heard that it is highly recommended for young patients with shoulder dislocations to be treated surgically, but as my shoulder has never officially dislocated I'm not sure where I stand.

I experience quite a bit of soreness and weakness in both of my shoulders now throughout my daily life. I've found that it's very uncomfortable to lift my arms above a certain point, and my shoulder feels quite unstable when I put my arms above my head. I've had to adjust my sleeping positions because I cannot lay flat on my back with my left arm raised without my shoulder feeling very loose.
I can push the ball of my shoulder around inside the socket with roughly a 1 cm leeway with little to no effort. In fact, if I relax my arm and poke my shoulder, the arm with become loose on it's own. Not enough to dislocate, but it gets close.

I'm quite flexible throughout my body, which I've heard can contribute to ligament looseness as well.

Anyway, what would you recommend? I've been trying generally physical therapy for years now, and I feel like there has to be a better way to solve my problems. I keep thinking that one of these days instead of subluxing my shoulder, I'm going to completely dislocate it, and I'm NOT looking forward to what that must feel like!

Thank you,
Lauren

ANSWER: Hello Lauren,

You gave me a very good synopsis of your shoulder problems, but forgot to give me your age,which in most cases would be of particular interest. To illustrate some of the ligaments and tendons responsible for keeping the shoulder(s) in their proper joint mechanics, I will review a simplistic shoulder joint anatomy:

Although three ligaments protect and surround the shoulder joint, most of its stability comes from the powerful muscles and tendons of the rotator cuff. The rotator cuff consists of four muscles which play an integral part in moving the shoulder/arm into different rotatory motions, and extension/retraction movements.

The joint is held together by these extensive ligament and muscle attachments, there are certain types of forces that can weaken the shoulder easily. The shoulder joint is vulnerable to dislocations from sudden jerks of the arm, especially in children before strong muscles have developed, and often called the "Curb "Dislocation". Because of the weakness of this joint in children, parents should be careful not to force a child to follow them by yanking on their arm, or pulling their body up with one arm to cross the street.  Dislocation of the shoulder is extremely painful and may require surgical repair or even cause permanent damage. Repetitive or sudden stress can cause tears in the tendons of the rotator cuff and lead to pain and instability of the shoulder joint.

As in your case, the description is very accurate as far as the possibility of surgical intervention is concerned. There is no medical wording for "Officially Dislocated", but rather any loosely connected joint which changes the mechanics of the joint itself is considered dislocated.  Because your history of a 7 time dislocation of the left shoulder, and a one-time incidence with the right shoulder, I would suggest very strongly that you seek an Orthopedic surgeon who specializes in shoulder mechanics.  Before you do anything else to stress the soft tissue around the joints, this consult is mandatory for you.

I hate to be so dynamic in encouraging surgical care, but realize that no amount of PT, resting, splinting, etc., will fix the tears in the soft tissues.

Thank you for considering using the About.Com/Experts, and I hope you will write back to let me know how it is working out for you.

Best of luck,

Dr. Patricia Arthur

---------- FOLLOW-UP ----------

QUESTION: Hi Dr. Arthur,

Sorry, I'm seventeen years old. I was fifteen when I first dislocated my left shoulder and the right shoulder occurred about two months ago. Ironically, I hurt my right shoulder when I subconsciously guarded my left shoulder during a skill.

I realized that I never told you the direction of displacement! I actually hurt both shoulders during the same skill, a back handspring. My shoulder pushed out when I was in a handstand and my arms were completely above my head. The shoulder actually seemed to push backward, in a sort of down and out feeling.

I can push my left shoulder "out", if I relax, with very little effort both forward and downward (if I pull on the arm). In these circumstances there is absolutely no pain, but it feels and looks incredibly strange.

Yeah, I haven't heard of many injured shoulders that were completely healed without surgery. Part of the reason I've been putting off a consultation is that I am still in gymnastics and I knew that if I ended up having surgery I would be out of the sport for several months.

Sorry to add this follow-up. You had a fantastic first response, I just realized that I forgot to add a few things.

Thank you so much!

-Lauren

Answer
Good Morning Lauren!

Thank you very much for your answers to my lingering questions.  I know you are not anxious to hear the answer, but I  must advise you to seek a consult with the best Orthopedic Shoulder Specialist.

Lauren, I realize that taking some time off of training and competition is disappointing, but the consequences of not having the necessary soft tissue fixed and rehabilitated, could prove to be disastrous in the long run.  Realizing that you are probably upset with my conclusion, please my experience with shoulder injuries outstrips any other bodily injuries in my career.

Another thought which might make a difference in your decision, is if you are contemplating a college scholarship, or possibly an Olympic tryout, the coach, trainer, and/or the Team Physician will surly notice the irregularity in some shoulder movement attitudes.  Just the two years you have been working with the dual misarticulating shoulder joints, you have caused some additional extraneous  injuries, ie: when you physically pull your arm from its' normal juxtaposition, and there is no pain, you have caused a dramatic change in the neural complex  of the joint.  

You seem to be a very intelligent young man, and I am worried that you will continue using the arms and shoulders to the detriment of your future.  Hoping I am wrong in my theory, I wish for you to obtain a specialized consultation as soon as possible, and let me know what they say.  The doctor will also tell you how long you will be out of practice, but the PT prescribed will speed the healing along.

Please let me know, Lauren, and if you have further questions or concerns, please do not hesitate to write me.
Good luck, and I expect good news in the near future!

Thanks for getting back to me,

Dr. Patricia Arthur

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Dr. Patricia B. Arthur, DC, MRC, CST

Expertise

As a 30-year practicing Chiropractic Physician, my specialty was Sports Medicine. For 8 years I had the distinct pleasure of working with the USOC, and traveled the world to care for the athletes in the Pre-Olympic venues for the Summer Games. When I wasn't traveling, I had a private practice, and a hospital practice, in Kamuela, Hawai'i. Questions I couldn't answer usually dealt with pharmeceuticals. This was not my expertise, but the simple questions pertaining to familiar drugs I was able to digress, or refer to someone that was knowledgable in that field. Most Sports Medicine field injuries were familiar to me, but I always aired on the side of caution. In my office practice, I would tend to see more patients with the weekend injuries who would try to self-treat, only making the injury worse than it should have been! Nevertheless, I never took anything for granted, and so it was my conservative approach to the "cause-and-effect" mechanisms that were vitally important to the healing process.

Experience

Following my competitive nature, I knew Sports Medicine would always be a part of my life. After graduation from Palmer University in Iowa, the old adage taught at the school dealt only with the spinal column......anything connected to the spine was outside our scope of practice. To me, this was too simplistic, because the complex body also had arms and legs! From this point, I developed specific technigues which would encorporate the body as a whole rather than haphazard segments. There is nothing traumatic that happens to a single ligament, tendon or joint that doesn't effect a secondary, or possibly a tertiary element in that area. In order for that space to heal, all the factors must be addressed. Volunteering my time teaching referrees, coaches, and interested parents about the realities of probable sports injuries was worth a thousand words!j

Organizations
American Chiropractic Association; Local Emergency Response Committee; Hazardous Materials Response Team; Urban Search and Rescue Team - Operations and Planning; Federal Corps of Engineers Committee; Earthquake Advisory Board; Big Island Wildfire Committee

Publications
Papers published focusing on the importance of proper care of sports injuries; Authored medical columns for the syndicated magazine "The People's Doctor "; Published papers in professional journals on Head Injuries in Sports; Published papers on Drug Abuse in Sports.

Education/Credentials
Robert Packer Hospital - Certified Surgical Technician - CST; Palmer University - Doctor of Chiropractic - D.C.; Wright State University - Masters in Counseling/Psychology; Wright State University - Masters In Couseling of the Severely Disabled.

Awards and Honors
Selected US Olympic Physician -1988; Graduated Wright State University with a 3.75 GPA; Graduated Palmer University with a 3.5 GPA; Faculty Appointment - Palmer University Post Graduate Education; Faculty Appointment- Hawai'i/Kapiolani Community College - Skills Team Tester;

Past/Present Clients
Cincinnati Bengals Football Team pre-season training; Summer Olympic Athletes worldwide; Kona Ironman Triathletes - Finish - line physician

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