Surgical fix may be best for dislocated shoulder

NEW YORK (Reuters Health) - Surgery should be considered in adolescent athletes who sustain a traumatic dislocation of the shoulder, the authors of a research review on shoulder injuries in young people conclude.

While skipping surgery and using a sling to immobilize the shoulder is also "an acceptable option," they add, athletes and their families should be informed that repeat dislocations are more likely with this approach.

More and more young athletes are choosing a single sport and sticking with it, at increasingly younger ages, Drs. Dean C. Taylor of Duke Sports Medicine in Durham, North Carolina, and Kevin L. Krasinski of St. Elizabeth's Medical Center in Boston note in their report. These athletes often play their sport of choice year-round, putting them at increased risk of overuse injuries.

Taylor and Krasinski review the evidence for and against various treatments for these overuse injuries, as well as shoulder injuries due to trauma, in the February issue of The Journal of Bone & Joint Surgery.

For fractures of the clavicle, the authors say, athletes who are younger than 12 or 13 who are still experiencing major bone growth can be treated successfully by immobilizing the shoulder with a sling. But for older athletes whose bones have less growing to do, surgery to repair displaced clavicle fractures may be a better option.

Rest is the best way to treat overuse injuries such as "Little Leaguer's shoulder," which is thought to be caused by stress fractures, Taylor and Krasinski say. Also, they add, stretching and strengthening exercises -- especially workouts that train the athlete to recruit muscles throughout the body for throwing, thus distributing force more evenly throughout the body -- are important for prevention.

In cases of shoulder dislocation, the authors say, understanding the source of the injury is crucial, because while exercise is the best treatment for instability of the shoulder not due to trauma, dislocation caused by traumatic injury often recurs, and surgical treatment has been shown to reduce the risk of repeat injury. And research now shows that arthroscopic surgery -- in which the joint is operated on with special instruments through tiny incisions in the skin -- is just as effective as traditional open surgery.

"Young throwers should be discouraged from pitching while they have pain, as shoulder deconditioning and persistent improper mechanics may cause injury," Taylor and Krasinski warn. "Once structural damage has occurred, the treatment becomes surgical. Fortunately, structural damage is rare in adolescent pitchers."

SOURCE: The Journal of Bone & Joint Surgery, February 2009.