Sidelined by a Dislocated Shoulder

Medical Author: Benjamin C. Wedro, MD, FACEP, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD

According to Cubs third baseman Aramis Ramirez, he had dived for infield balls "3,000 times like that and didn't feel anything" but on May 8, 2009, he landed on his shoulder and it dislocated. It had been nine years since the last time it happened; the trainers tried to put it back in place on the field but failed. Team doctors relocated the joint in the locker room.

The shoulder is the most mobile and least stable joint in the body. Its ability to move in many directions makes it prone to dislocation and in younger people, sports injuries are a common reason. Throwing or reaching for a ball puts the shoulder at risk because there is little that stabilizes the shoulder joint. The glenoid fossa, the small cup that holds the humeral head (the end of the upper arm bone) in place is shallow and needs the help of the labrum, or cartilage, to deepen the receptacle for the arm bone. The rotator cuff, a group of four tendons, also helps keep the bones where they belong, but when those muscles are being stretched in a throwing or reaching motion, any excess force can pop the shoulder out of joint.

For regular people who dislocate their shoulder, it usually means a trip to the emergency room to get it put back in place. The injury causes muscle spasm relatively quickly, preventing the shoulder joint from easily relocating. Different techniques can been used to reduce the shoulder. Depending upon the cooperation and pain tolerance of the patient, medications to provide pain control, muscle relaxation, and sedation may be needed.

Elite athletes are a little different in that their injuries are often witnessed by medical personnel and the shoulder can be fixed on the field before the muscle spasm sets in.

Once the shoulder is relocated, more work needs to be done. The potential for the dislocation to recur is relatively high, and the shoulder needs to be immobilized in a sling to prevent that injury. The sling gets worn all the time, even to bed or in the shower. In the time just after the injury, a routine motion like lifting your arm to comb or wash your hair may be enough to dislocate the shoulder again. The volleyball spiking position puts the integrity of the shoulder in peril.

In younger people or those who need their arms to perform aggressive work, an operation may be needed to tighten the shoulder and prevent future injuries. In Ramirez's case, magnetic resonance imaging (MRI) showed some swelling, but there didn't appear to be a need for surgery, according to Associated Press (AP) reports.

Initial treatment with a sling for a shoulder dislocation must balance the risk of repeated dislocation with the loss of range of motion in the joint and the potential development of muscle weakness. With physical therapy, return to play may take six to eight weeks. But surgery is often required to return the shoulder to its pre-injury state. The question becomes, do you do the surgery now and lose the whole season or wait until the year is over and hope the shoulder survives? Either way, some time on the playing field will be lost.

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