Dislocated shouler and the necessity for 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.

if this is the case, your friend might also want to get genetic testing for Connective Tissue Disorders

Hi everyone, I wanted to give a quick update on my condition. I did an arthrogram (MRI with contrast) which shows a torn labrum with a small hill sachs lesion. I consulted with 3 different orthopedics and 2 physicians. Only 1 orthopedic recommended surgery. The other ones said I should wait and try PT. Some of them went as far as to tell that orthopedic eager to perform surgery was just trying to cash out on me and provide me with a procedure I didn't need (at least for the moment). That was also my gut feeling when I initially consulted with him.

So I am starting PT and hopefully this will resolve things. The hill sachs lesion should resolve on its own. The torn labrum will never heal on its own but I could live without it if the muscles that surround the shoulder joint are strong enough. Down the line, if the shoulder is unstable, then surgery might be needed. Hopefully this won't be the case.

Lessons for anyone who experiences an injury: Do not trust one single opinion. Consult deferent doctors and do your homework. I've learnt that unfortunately, not all surgeons will act in your interest. They get paid  way more money by performing surgery than by simply referring you to a PT. Also, I've learnt that going to a prestigious hospital doesn't mean you'll get the best advice as a patient.
The surgeon eager to perform surgery works at Cedars Sinai in Los Angeles, one of the most renowned care center in the world. Regardless, he had absolutely no interest in learning about the sports I practiced nor what were my athletic goals for the future. He just wanted to cut me open and didn't shy away from it.

J Squared wrote:

if this is the case, your friend might also want to get genetic testing for Connective Tissue Disorders

Turns out his socket is shot and is going to need going to a more extensive open Latarjet procedure.

Worth a gander for folks contemplating surgery:

​Cleveland Clinic 3/18 - Latest Techniques to Address Challenges in Recurrent Anterior Shoulder Instability​​​

Geordon Bean wrote: 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.

• Have you had any issues with subluxing since your dislocation? How long was your shoulder out before being reduced?
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samuel,
i hope the pt works out for you. i am three weeks post op for bankart repair. tore it while indoor bouldering on an awkward and multidirectional move. shoulder was out for about 1.5 hours. both ortho's i saw recommended pt first until i mentioned climbing again. they seemed to be concerned with any overhead sport that could endanger your life if you redislocated. they also suggested my lax joints (i have some hypermobility) would up my risk for redislocation.  
i dont know how successful the results are, but there is the option of newer stem cell and prp treaments you may want to check out.
I'm a bit obsessed with all things shoulder injury related so please keep us posted on your recovery!
best of luck!

Jennifer Morehead wrote: samuel,
i hope the pt works out for you. i am three weeks post op for bankart repair. tore it while indoor bouldering on an awkward and multidirectional move. shoulder was out for about 1.5 hours. both ortho's i saw recommended pt first until i mentioned climbing again. they seemed to be concerned with any overhead sport that could endanger your life if you redislocated. they also suggested my lax joints (i have some hypermobility) would up my risk for redislocation.  
i dont know how successful the results are, but there is the option of newer stem cell and prp treaments you may want to check out.
I'm a bit obsessed with all things shoulder injury related so please keep us posted on your recovery!
best of luck!

Jennifer,

I feel for you, I also dislocated my shoulder in the gym, and had to have it put back in, in the ER.  The time in between was quite painful.  Hang in there post-op and do your physical therapy, and you can have a full recovery and return to climbing harder.

When a shoulder dislocates the labrum is almost always torn and going forward there is a high chance that it will dislocate again. Surgery is the only way to completely fix the labrum. PT only strengthens the muscles surrounding the head of your humerus and doesn't correct the underlying condition which is the torn cartilage.   

FWIW, I dislocated my shoulder for the first time more than a decade ago and, as others have indicated in this thread, caused me to dislocate my shoulder many more times climbing / playing various sports. Ended up stopping climbing for a while until I had a SLAP repair surgery done on my shoulder. Didn't help much and was back to frequently dislocating my shoulder. Ended up having a Laterjet done and that was the only thing that really fixed the dislocation problem completely. Obviously I'm on the more extreme side of having shoulder problems, but the demands of climbing are not good for bad shoulders and YMMV with your standard shoulder repair surgery depending on how bad your initial dislocation was.

Jennifer Morehead wrote: samuel,
i hope the pt works out for you. i am three weeks post op for bankart repair. tore it while indoor bouldering on an awkward and multidirectional move. shoulder was out for about 1.5 hours. both ortho's i saw recommended pt first until i mentioned climbing again. they seemed to be concerned with any overhead sport that could endanger your life if you redislocated. they also suggested my lax joints (i have some hypermobility) would up my risk for redislocation.  
i dont know how successful the results are, but there is the option of newer stem cell and prp treaments you may want to check out.
I'm a bit obsessed with all things shoulder injury related so please keep us posted on your recovery!
best of luck!

Thanks Jennifer. I'm working hard at it. My PT also suggested stem cells treatment as well. I will let you know how things evolve. So far, the therapy has helped me re-gain some range of motion and muscle strength (6 weeks post injury). Let us know how your shoulder improves following the bankart repair. 

adeadhead wrote: When a shoulder dislocates the labrum is almost always torn and going forward there is a high chance that it will dislocate again. Surgery is the only way to completely fix the labrum. PT only strengthens the muscles surrounding the head of your humerus and doesn't correct the underlying condition which is the torn cartilage.   

Looks like science is split on the issue. I guess it varies depending on the type of tear, sports involved and just the individual as a whole. What I concluded from all my interviews and meeting with doctors is that it is better to start with PT (strengthening, motion gain) and then based on the results, assess the need for surgery. Some people seem to be climbing fine with a torn labrum, others need surgery.  Going into surgery for a labrum tear right after the accident didn't seem like a wise option, unless there are other issues involved of course.

I'm no doc but I'd say its all situational.  I dislocated and was out of the socket for 4 hours.  I have a torn labrum (bankart lesion), medium sized hill sachs lesion, and I fractured my greater tuberosity on my humerus - probably the reason my rotator cuff didn't tear.  The fracture healed perfectly - if it hadn't I surely would have needed surgery.  My orthopedist kept me in a sling for about 4-5 week before I did any movement besides a pendulum with my arm twice a day.  His hope was...first, the fracture would heal correctly and second being immobile for a good period of time would cause a level of tightness that would bring stability to my shoulder.  Also keep in mind it was my first ever dislocation, I am 42, and I am pretty thick and muscular with tight shoulders to begin with.  These factors helped reduce the likelihood of future dislocation.

After I started PT about 5 weeks after injury my Ortho did not think surgery was right.  He suggested a second opinion which I got and that doc independently said the exact same thing.  My fracture, size of hill sachs, age, history, non-torn cuff, size of bankart lesion, etc all pointed towards low risk of future dislocation and little benefit from surgery to repair labrum and hill sachs.  
I am now 7 months post injury climbing just as hard as I did before.  I'd say my range of motion is 95% of what it was and my strength at this point is 90% of what it was.  I have some pain at times from certain motions - I'd say the worst thing is to try and throw a ball overhand.  I don't do that so it doesn't matter to me.  I can do pullups, pushups, pull a roof when climbing, etc.  I continue to do my PT exercises, I's and T's, Lightweight overhead presses in a neutral position, internal and external rotation stuff.  I was told I can continue to see strength gains and reduction in discomfort for 18 months or more.  I continue to improve - so far I don't wish I had surgery.

Other people's experience is clearly different.  It seems to all be dependent on various unique factors specific the individual and case.  That's my experience - the only rule I'd say is to get a second opinion and if the two opinions disagree widely get a third opinion too.