Shoulder Dislocation: Risk of Recurrence

X-Ray of Shoulder Dislocation

Recurrent shoulder dislocation, also known as shoulder instability, occurs when the shoulder joint repeatedly slips out of its normal position. Several factors can contribute to an increased risk of recurrent shoulder dislocation. These risk factors include:

  1. Previous Shoulder Dislocation: Once an individual has experienced a shoulder dislocation, the risk of recurrence is higher compared to someone who has not had a previous dislocation. The risk increases further if the initial dislocation occurred at a younger age.
  2. Ligamentous Laxity: Some individuals naturally have looser or more lax ligaments, which can contribute to increased shoulder joint mobility and instability. Ligamentous laxity can be genetic or acquired through repetitive overhead activities or trauma.
  3. Trauma or Injury: High-impact injuries or trauma to the shoulder joint, such as a fall, sports-related injury, or motor vehicle accident, can damage the stabilizing structures of the shoulder, making it more prone to recurrent dislocations.
  4. Structural Abnormalities: Certain anatomical variations or structural abnormalities can predispose individuals to shoulder instability. The “Bankart” lesion or anterior labral tear is the structural damage that results from a dislocation. When the labrum/ligament remains displaced there is a loss of restraint that keeps the shoulder in place. Bone loss from an initial and more commonly repeated dislocations or subluxations increase the risk of recurrent dislocations and may need to be corrected at the time of surgery in addition to repairing torn ligaments. Other abnormalities, such as a loose joint capsule or abnormal bone shapes, can also contribute to instability.
  5. Muscle Weakness or Imbalance: Weakness or imbalances in the muscles surrounding the shoulder joint, particularly the rotator cuff and scapular stabilizers, can disrupt the dynamic stability of the shoulder and increase the risk of dislocation.
  6. Participation in Contact Sports or Overhead Activities: Engaging in sports or activities that involve repetitive overhead motions, forceful throwing, or contact can put stress on the shoulder joint and increase the risk of dislocation. Sports such as rugby, football, basketball, volleyball, and swimming are commonly associated with recurrent shoulder dislocation.
  7. Poor Rehabilitation or Noncompliance with Treatment: Inadequate rehabilitation following an initial shoulder dislocation or noncompliance with treatment protocols can lead to persistent muscle weakness, decreased joint stability, and an increased likelihood of subsequent dislocations.
Bone loss associated with recurrent shoulder dislocation. Glenoid (socket) bone loss leads to smaller surface area for humeral head (ball) to make contact with socket (glenoid).

It’s important to note that while these factors increase the risk of recurrent shoulder dislocation, not everyone with these risk factors will experience dislocations. Treatment options for recurrent shoulder dislocation may include physical therapy, strengthening exercises, bracing, and in some cases, surgical intervention to repair or stabilize the shoulder joint and reduce the risk of future dislocations. Consulting with a healthcare professional, such as an orthopedic specialist or sports medicine physician, can help assess individual risk factors and develop an appropriate treatment plan.

Surgical options I utilize include minimally invasive arthroscopic repairs and open repairs that address that pathology. Treatments are individualized based on the patients activity level, type of sports, age, hand dominance and lesions present.

Example of arthroscopic Bankart or ligament repair for recurrent shoulder instability

Lecture: Prevention of Throwing Injuries

This is a short lecture on prevention of throwing injuries with the focus on baseball pitchers. The principles apply to athletes who participate in all overhead sports including tennis, javelin, football etc…

Closeup of baseball ball
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