I’m often asked whether or not a patient requires surgery for a shoulder dislocation. There are a number of factors that are important. But perhaps the most important factor is the age of the patient in most settings. There are often reasons a shoulder dislocation should be fixed in all cases such as bone loss, other pathologies or issues seen inside the shoulder, or fractures. But most patients who dislocate their shoulder in the younger population tear their labrum, which is the lining of the joint.
Keyhole shoulder surgery is performed by most of the experienced shoulder surgeons in Melbourne. On occasion, a more complex procedure involving transport of bone may be required, but the majority of patients who dislocate their shoulder will undergo a simple arthroscopic or keyhole procedure.
The most important factor is age, and the younger the patient, the higher chance of re-dislocation. The problem with re-dislocating is every time a patient dislocates their shoulder, they do more serious damage. And the more serious the damage, the higher the chance of further dislocations and more frequent those dislocations. It is clearly seen in the orthopaedic literature that a patient undergoing a shoulder stabilisation procedure after one dislocation has a much lower recurrence rate of further dislocations than a patient having multiple dislocations. The evidence is quite clear on this. But does that mean that all patients should have an operation?
Certainly young patients have a much higher risk of re-dislocation than the older patients, and patients below the age of twenty have 95-98% percent chance of a further dislocation after just one incident.
At the age of forty, the chances are almost fifty percent. But the issue, of course, is that further dislocations often result in further bone damage and tears to the labrum, which is the primary problem in these patients. And the results of surgery decline with every dislocation.
I encourage all patients to get a specialist opinion from one of the shoulder surgeons in Melbourne before they undergo any form of conservative therapy. All patients who undergo a dislocation at the outset should have an MRI scan to look at the causes behind the dislocation and whether or not there’s any other issues that require urgent surgery.