The shoulder joint has the greatest range of motion of any joint in an athlete’s body, and subsequently is particularly at risk to a dislocation injury.

This is an all too common story in high school football athletes. Research tells us that a high school athlete who has a first time shoulder dislocation injury, and is treated non-operatively with an immobilizer then physical therapy, has an 85-95% chance of suffering another dislocation injury within a year of returning to their sport. The good news is there are new treatment approaches available to significantly decrease this high risk.

What is a shoulder dislocation? A shoulder dislocation occurs when the head of the humerus (the “ball”) becomes detached from the scapula (the “socket”) due to a traumatic injury which tears the capsule and ligaments holding the ball in the socket.

Typically in high school football, the mechanisms of this injury are when a tackler uses poor form and “arm tackles”, or when a player falls on an outstretched arm, or a quarterback is in the throwing motion and gets their arm hit from the front. Ninety-five percent of shoulder dislocations occur when the "ball" comes out forward (anterior) to the socket.

Symptoms of a shoulder dislocation include: severe pain, inability to move the arm, self-splinting the arm by the side, loss of the contour of the deltoid musculature (due to the ball dropping down and forward), and complaints of a dead-arm feeling.

In some cases, the "ball" will spontaneously relocate back on the socket, relieving pain and in many cases lead the athlete to believe they suffered a minor injury.

If the "ball" is stuck in a dislocated position, the best medicine is to get appropriate medical help immediately to reduce the dislocation and prevent any long-term injury to the neurovascular tissues in the shoulder and arm. This includes x-rays to look for fractures (fractures of either the ball or socket as they collide when the shoulder dislocates) and may include an MRI if there is a high suspicion of internal derangement injury to the rotator cuff or labrum cartilage (which surrounds the socket).

Conservative Treatment Approach: This approach includes immobilizing the shoulder for a period of 2 to 6 weeks (depending on the severity of dislocation) to allow soft-tissue healing. Traditionally athletes use a sling, but recent research shows a 30 percent increase chance of recurrent dislocation when using a sling (arm at side turned into belly) versus the newer immobilizers with the arm at the side but slightly turned out.

Following sling removal, rehabilitation with a sports physical therapist will include restoring the normal range of motion and restoring the functional strength to the shoulder. Return to football should include consideration of a functional shoulder brace. Unfortunately, this treatment approach carries the high risk (85-95%) of the football athlete suffering a repeat dislocation when returning to the field.

Surgical Treatment Approach: This approach includes the use of surgical procedures to restore/repair the shoulder anatomy and stabilize the ball on the socket. This includes traditional open surgical procedures which take longer to heal, and newer arthroscopic surgical procedures with less healing time required. Following the procedures, the athlete may have a period of immobilization followed-up by rehabilitation with a sports physical therapist to restore motion and functional strength. The research has shown that with a surgical approach the risk of recurrent dislocation is about 5-10 percent.

So, a quandary occurs when the football athlete is face with an in-season dislocation. The best long-term approach for improving shoulder function and preventing a repeat dislocation is to have the shoulder surgically repaired. However, this will put the athlete on the sideline for the rest of the season in most cases (since the surgery and rehab will take up to 3-6 months). It’s by far the best decision for an underclassman, but a senior may choose the conservative approach so they can get back on the field, taking their chances on a repeat dislocation and delaying surgery until after the season.

Shoulder dislocation is a serious injury, and should not be brushed aside as a simple injury like a “jammed knuckle”. The risk of dislocation can be controlled well with surgical intervention and rehab, but these in-season medical decisions can be stressful when the win-at-all costs pressure looms for the high school football athlete.

To learn more about shoulder dislocations, here are two extremely valuable websites for you to visit:
http://shoulderdislocation.net/
http://www.shoulderdoc.co.uk/

(About the Author: John Tomberlin has worked with high school athletes in the Cedar Rapids Metro area since 1995. He was a four-sport athlete in high school and a high school coach for two years in Illinois. John has more than 25 years of experience working with athletes as a physical therapist and a certified strength and conditioning specialist. He has worked with professional athletes in the NFL, MLB, and on the PGA and LPGA tours. John also has worked with elite amateur athletes in alpine skiing, figure skating, and track and field.)