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Shoulder injuries are common among young athletes and especially those that participate in throwing sports like football, baseball and javelin. Nearly 95% of the shoulder injuries I treat in youth athletes are due to unstable shoulders, which is a switch from some of my middle aged and older patients I see who tend to suffer from issues with their shoulder being too tight.
In order to fully understand any issues with your shoulder it’s important to know about the shoulder’s anatomy. When I look at the anatomy of the shoulder, I look at it in layers to keep it simple. The outer layers are the big muscles like the deltoid and the trap, which don’t provide stability. The next layer down is the rotator cuff muscles. The rotator cuff is made up of four muscles that sit on the shoulder blade and attach to the shoulder as tendons. They are the ones that provide the shoulder with stability. The rotator cuff muscles are the dynamic stabilizers, helping the ligaments in the next layer down. It’s these ligaments that can tear.
When we look at shoulder injuries, we have to look at the athlete. For example, a swimmer who comes into the office with a shoulder injury is most likely due to overuse and hyper flexibility, while a football player who comes in most likely has a traumatic injury.
We also look to see if the shoulder is dislocated, which means it came out of the socket or if it subloxes, which is very common and means that it slips in and out of the socket. I see this often in both swimmers and gymnasts. Then we need to look and see where the shoulder came out. All of this helps to determine how we will treat the shoulder instability.
The acute traumatic anterior dislocation is the most common shoulder dislocation we see and the initial treatment for that has not changed much over the years. If the shoulder is out of the socket then the first thing we need to do is reduce it or put it back in the socket. Once we do that, we will get an x-ray to ensure there’s no fracture and that the shoulder is back in the socket. A shoulder that is out of the socket for a day or two can be a serious problem.
In my younger patients, I generally order an MRI. In 90 percent of my younger patients I find a Bankart lesion, which is a tear of the labrum off of the bone itself. Most often, those tears don’t heal on their own and require surgery. For all of my patients under 30 who have a Bankart lesions
In most cases, I do the surgery to repair Bankart lesions arthroscopically, which means there will be very little scar tissue created. I do still perform the open procedure on some of my more active patients that I know will rip through the arthroscopic repair. Most of those patients tend to be wrestlers who are harder on their shoulder.
Not every patient who suffers from shoulder instability will need surgery. For my patients who have dislocated their shoulder for the first time and are middle aged, I generally treat them with a sling for a short period of time followed by rehab program. But for my younger patients, there is a 90% chance they will dislocate again. That’s due to a higher activity level and their anatomy. I generally immobilize them for a longer period of time before starting a rehab program and study them closely with imaging.
In some of my patients who dislocate their shoulders I will use a brace for a short period of time. Really what I am doing is buying them time because they will need some type of surgery to stabilize their shoulder. The brace just protects the shoulder so it doesn’t get into that position where it’s going to slide out. This is most effective for football players and almost impossible for basketball and volleyball players.
Though I’m not a physical therapist I do have a strong interest in physical therapy and realize just how important it is to the recovery. The rehab for shoulder instability really focuses on strengthening the shoulder with light weight high repetition exercises. In order for rehabilitation to be effective, it’s important to communicate with your therapist.
Shoulder instability can be prevented by wearing the proper protective gear in sports, a good shoulder strength training program and taking care to avoid falls.