Dislocated shouler and the necessity for surgery

Hi everyone,

I dislocated my shoulder last week while skiing in Colorado. I'm 30 year-old, It is my first dislocation on this shoulder, and while the pain was intense, x-rays do not show any broken bones.
I had been on an extensive training plan to tackle a few of my mountaineering goals this summer which I obviously have to cancel.

I understand there are plenty are threads on the subjects (and I've read all of them), however I wanted to share with you my concern regarding the need for surgery.

I went to see my Orthopedics yesterday, and right off the bat, he mentioned the need to undergo surgery to repair a possibly torn labrum. We are not expecting the MRI results until next week so I was very surprised to hear that given he hadn't had the opportunity to assess  the damage inside.
I went to one of the most reputable center here in Los Angeles, however my first reaction when exiting the doctor's office was: "This guy just wants to makes money".

I was born in Europe, we have a culture of avoiding unnecessary surgery / medication whenever possible. My experience in the US is that doctors tend to over medicate and over recommend surgery. Most of the people on this forum who have had similar issues seemed to have chosen to undergo surgery.

If any of you have had similar experiences, I would love to hear your opinion on whether surgery is required to get back to full capacity.

Try doing pt and if after a few months you are being limited by the injury, try the surgery.

I’m climbing on a torn shoulder without it limiting me. Maybe some day it will get to the point that it’s affecting climbing and I’ll get surgery but not until it’s necessary. I’ve had the surgery in the past and it’s a long recovery and not guaranteed to fix you.

I have a long history with shoulder problems and surgeries. I won't bore you with the whole story but I have had multiple surgeries and I would recommend rehab vs. surgery if possible. The only way I would get it repaired would be if it regularly dislocates. I'm NOT a doctor, just speaking from experience.

Completely agree with Trevor. I also climb on a torn shoulder without much limitation.

Highly recommend checking out Crossover Symmetry. They have a really good program that I have found pretty effective .

I dislocated my shoulder in 2014 while climbing. I had a torn muscle (can't remember what or how bad) but I don't think it was too major since the dislocation was due to making an awkward move, not due to an impact. My doctor said surgery was an option, but I was like you and only wanted to go that route as a last resort. I did PT and was back to easy climbing within a month and felt normalish after about two months. I continued to do the PT exercises for a year after to ensure I fully strengthen the damaged muscles. I'm still to this day conscience of my movements with that arm while climbing, but that's more out of paranoia of re-injuring than any physical limitation.

I have a neighbor who's shoulder dislocates all the time and, at 40, has become a real problem - anyone here had that problem and had it fixed? If so, what's the name of the procedure that was done to correct it?

Bankart repair.

Thanks...

Sometimes if you are a hammer, everything looks like a nail... You should absolutely seek second opinion from a different dr.

It wasn't my experience with drs (pushing surgery). But I always go to PT first. It was my PT, in fact, who diagnosed the tear based on functional testing, and suggested that I should go to the dr, while also telling me that surgery is rarely the first/immediate option with a labrum tear.  The Dr. confirmed that I likely had a SLAP tear (torn labrum that you are referring to). The MRI was rather inconclusive, and it might well be in your case also, depending on where the tear is, but there is more to the orthopedic assessment than just looking at MRI.

But the Dr didn't recommend surgery initially. In fact, I was told by this surgeon that many people live with torn labrum just fine, and, if you were to randomly check a bunch of 40-somethings off the street, you will find a lot of asymptomatic labrum tears, so the Dr's advice was to do PT, and see how I felt in a few months, because even if decided to have the surgery eventually, there was no urgency, the shoulder wouldn't get worse if I waited.

So I had done extensive PT, and the shoulder was rehabbed pretty well. I was able to climb on it, and I was mostly pain-free. But it wasn't quite 100%. And I got fed up with random dislocations and guarding the shoulder, and feeling like I had to always watch it and hold back. Don't regret the surgery at all. 

Lena, I'd normally agree, but in this case, my friend's shoulder has come out dozens of times and can come out just swinging his arm wrong so I suspect it's not likely to be a case where PT alone is going to solve his problem. He just went for an MRI Friday and hasn't gotten word back yet, will be interested to hear what they say.

i took a fall 6 months ago and had an anterior dislocation of my shoulder.  i tore my labrum - you can't dislocate and not tear it.  I also have a hill sachs lesion as a result of the dislocation. i had a fracture in my humerus that fortunately healed perfectly and did not need surgery.  i went to two orthos, one of whom is very well known - both said the exact same thing...in my case...do not get surgery - do PT, see how it goes.  I am now climbing as hard a I was before.  I still have a little pain every now and then and I'd say my range of motion is 90-95% of what it was before.  I did PT for like 4 months.  I continue to do my rehab exercises at home several times a week.  My doc told me I can continue to improve for a year to 18 months post injury if I work at it.  That's my experience thus far - glad I didn't get on the operating table.  Some things need surgery, some don't.  I would definitely get another opinion.  I am no doc but I know enough to know not all labrum tears need surgery.  You can strengthen the muscles around it and learn more motor control to not need it...it is possible...in some cases.

How did you fall?

PT like hell then consider considering surgery.

Healyje wrote: Lena, I'd normally agree, but in this case, my friend's shoulder has come out dozens of times and can come out just swinging his arm wrong so I suspect it's not likely to be a case where PT alone is going to solve his problem. He just went for an MRI Friday and hasn't gotten word back yet, will be interested to hear what they say.

I think you misunderstood my post. I DID end up having a surgery. Same experience as your friend -- my shoulder would dislocate randomly, and multiple times, despite doing PT and getting it to be mostly pain-free in daily life. My surgery was 2 years ago, as of this April, and I do not regret having it at all. Surgery solved the problem that I was having, and got me back to normal.

I was responding mostly to OP, who had JUST had his shoulder injured, and does not yet know whether the PT will get it back to normal, or not. Labrum tear is not an emergency surgery.

In case of your friend, if it's been a while, and the shoulder is not stable, then that is a different story.

I have dislocated my shoulder many times (torn labrum) and I do not recommend surgery. From my experience, it takes a few weeks for the shoulder to feel strong again and you are likely to dislocate it again sometime in the next few months. (hurts less the second time) If you can make it two months or so without another dislocation, then you should be 99.9 percent perfect. Surgery does not always work either. I've had a friend with the same problem get surgery and then pop it out six months later, right after his release. BTW I was climbing pretty hard grades only a few weeks after. Keep your head up, don't get surgery, climb some slabs, and you will be good in no time!

Thanks everyone for your output, I really appreciate it. I will get the results from the MRI by the end of the week. I will have the opinions of two different doctors (one in LA, one in France).
I will share these with you and hopefully my case will help other people faced with a similar decision.

@Healyje: My accident was quite unfortunate. I am a backcountry skier and rarely do resort skiing. My friend who is a snowboarder would not go to the backcountry and convinced me to go to a resort instead. We ended up in a sno-park. I had never been to a sno-park and had no idea they had metal bars for snowboard to slide on. One of the metal bar was partially covered with snow, I did not see it and upon breaking to make a stop, my skis got caught with the bar, did not release and sent me flying, offering me no opportunity to make a safe landing.
Moral of the story: stick to the backcountry !

Ouch...not even climbing.

Healyje wrote: How did you fall?

i was on a climb...i made a questionable placement below a crux.  a very small cam.  i had followed the climb twice previous with no issues.  I went for a move and missed - the placement ripped and i smacked the wall/ledge on the way down.  I did not deck - my next placement held but I injured my shoulder and foot on the way down.  I learned several valuable lessons with a somewhat harsh slap on the wrist.  It could have been much worse.  Small, questionable placements on what for me is a difficult or questionable move will surely be doubled up from now on, or I will back off, or french free past the move, or whatever I need to do not to fall and get hurt.  Falling is fine when the pro is bomber and the fall is safe...not so much when it's not.

Sorry, got the posts mixed up. Yeah, double that shit up and really look hard at small placements as millimeters can count. And backing off is sometimes the sound strategy and why downclimbing is a good skill to have in trad climbing.

I've had surgery on both shoulders to repair a labrum tear (the injuries were ~3 years apart).  Both times I was able to climb certain routes with no issue, but others would irritate it.  Straight up splitters were no problem, stemming was bad, and everything in between was a toss up.  The recovery, 6 months before climbing again, was extremely frustrating, but I came back from each one climbing stronger than before.  Probably because of the focus I put on shoulder strengthening during recovery.  My doctor also told me that surgery is surgery for something like this, and that if I ended up beating it up more he'd still be able to fix it all the same, so he recommended PT until a good time for me to be down for 6 months.  Ended up planning the second one for the day I got back from a 3 week climbing trip right as the rainy season was starting, missed a snowy ski season but was back in time for a full climbing season.

For these types of injuries I found there are doctors who try to help get you back to "normal" life, and there are doctors who try to get you back to your sport.  Look around to try to find the latter.  Same goes for PT.

Sixty or so years ago, I had three dislocations of the R shoulder. The first was playing football. Reaching out with the R arm to make a tackle, I was blocked. Needed to have the shoulder reset by a doctor after the football uniform was cut loose from my body. The shoulder had probably been weakened by softball pitching the previous summer. At that time not much in the way of diagnosis as there were none of the hi-tec radiographics now in use.
Two years later, the shoulder dislocated, when I threw a basketball. Reset by itself. The next year, I was riding on a T-lift when a supporting cable broke, and I was hoisted off the ground hanging on to the T-bar with my R-arm. Had to go to the hospital to have it reset. Some vague talk of surgery—not that much PT around at that time. Read some stuff in the great classic, karpovich   ( amazon.com/weight-training-…)
And very gradually started high repetition, light to medium weight dumbbell exercises for the shoulders. Various flys and presses. I’ve been climbing for 47 years now and no real problems with the shoulders. A lot of the PT is common-sense so that if you’re motivated you can do on your own. Just be careful to back off if something hurts and if you’re not improving, do see a PT.
No guarantees but something like this is worth trying out before opting for surgery. Don’t rush things.
Rob.calm

Wow Im surprised how early you climbers returned to normal. I am about 3 months out from a torn labrum and partially torn rotator and I am still quite sore/clicky despite doing PT religiously. Strength is almost normal and ROM is really good except 1 particular direction but its still pretty tough to put on a shirt or wipe without pain. Maybe just being middle aged, not sure, also have bursitis which could account for stalling progress. My MRI was too good to have surgery, lol.