Shoulder Dislocation in a Young Athlete: What Happens Next?

A shoulder dislocation during football, wrestling, basketball or another sport can be alarming for both a young athlete and their parents. Once the shoulder is put back in place and the initial pain begins to improve, however, it's easy to assume the worst is over. For young athletes, that's not always the case.

A first-time shoulder dislocation can damage structures that keep the joint stable, and adolescents and young adults are at higher risk of another episode of instability. That's why the question after a shoulder dislocation isn't simply, "When can I play again?" It's also important to understand what was injured, how likely the shoulder is to remain stable and which treatment approach gives the athlete the best chance of returning safely to the activities that matter to them.

What Actually Happens When a Shoulder Dislocates?

The shoulder is a ball-and-socket joint, but unlike the hip, its socket is relatively shallow. This gives the shoulder the tremendous range of motion athletes need to throw, reach and perform overhead movements, but it also means the joint depends heavily on surrounding soft tissues for stability.

Most traumatic shoulder dislocations in young athletes are anterior dislocations, meaning the ball at the top of the upper arm bone, or humerus, moves forward out of the socket. When this happens, the injury may stretch or tear the ligaments and labrum. A first dislocation can also cause injuries to the bone or other structures in and around the shoulder.

Once the shoulder is reduced, or returned to its normal position, the athlete may feel significantly better. But reduction doesn't repair the tissues that may have been damaged during the injury. An appropriate evaluation after a dislocation can help determine the extent of that damage and what should happen next.

Why Can the Shoulder Dislocate Again?

Recurrent instability is one of the biggest concerns following a shoulder dislocation in a young athlete. This doesn't always mean another complete dislocation. An athlete may instead experience a partial slipping of the joint, called a subluxation, or feel that the shoulder is loose, unstable or about to "give out" in certain positions.

Age is an important factor. Research has consistently found that adolescents and young adults are among the groups at highest risk for recurrent instability after a first traumatic anterior shoulder dislocation. Athletes who participate in collision and contact sports may face additional demands because their shoulders are repeatedly exposed to tackles, falls and forceful positions.

Each athlete's risk is different, however. Age, sport, position, level of competition, previous injuries, physical examination and imaging findings can all help guide the discussion. This is also why treatment after a first dislocation isn't necessarily the same for a recreational athlete, a high school quarterback, a wrestler and a competitive swimmer. However, a second dislocation dramatically increases the risk of ongoing instability and further shoulder damage, so a surgeon specializing in shoulder instability should evaluate it quickly.

Does a First Shoulder Dislocation Require Surgery?

Historically, first-time shoulder dislocations were often treated without surgery, using a period of protection followed by physical therapy and a gradual return to activity. Rehabilitation remains an appropriate option for many patients. Physical therapy may focus on restoring pain-free motion and strengthening the muscles around the shoulder, including the rotator cuff and muscles that control the shoulder blade. As rehabilitation progresses, exercises can become more specific to the movements and demands of the athlete's sport.

At the same time, research has improved our understanding of how often instability recurs in younger athletes. For some patients, particularly young athletes with a high risk of recurrence, surgical stabilization may be considered after the first dislocation rather than waiting for the shoulder to come out of place again. However, that does not mean every young athlete should have surgery after one dislocation. The decision should be individualized.

A recent discussion published by the American Orthopaedic Society for Sports Medicine illustrates why. Using the example of a 16-year-old competitive football player with a first-time anterior shoulder dislocation, sports medicine specialists presented reasonable arguments for both early surgical stabilization and structured rehabilitation. The athlete's age, collision sport, imaging, competitive goals and desire to return during the season all factored into the decision.

What About Returning to Sports?

Feeling better isn't the same as being ready. Before returning to sport after a shoulder dislocation, an athlete should regain appropriate motion, strength and shoulder function. The shoulder also needs to tolerate the movements and demands of the athlete's particular sport without significant pain or feelings of instability.

Return-to-play decisions are especially important in collision and contact sports because returning too soon can expose an incompletely recovered shoulder to another instability episode. An athlete treated nonsurgically may be able to return in the same season in some circumstances, while an athlete who undergoes stabilization surgery will need a longer healing and rehabilitation period before returning to competition.

The goal isn't simply to get an athlete back onto the field or court as quickly as possible. It's to help them return with a shoulder that can meet the demands of their sport while balancing immediate goals with long-term joint health.

Treat the Athlete, Not Just the Injury

A first shoulder dislocation raises important questions for young athletes and their families, including the following:

• How much damage occurred?
• How likely is the shoulder to dislocate again?
• Can physical therapy restore sufficient stability?
• Would early stabilization provide a better long-term option?
• How does the athlete's sport, season and future goals affect the decision?

Those questions are best answered through an individualized evaluation, not a one-size-fits-all approach. At North Florida Bone & Joint Specialists, board-certified Orthopaedic Surgeon Dr. Chris O’Grady is a nationally recognized shoulder specialist with a Certificate of Added Qualifications in Sports Medicine. He specializes in complex shoulder problems and works with athletes and families to evaluate sports-related injuries, understand treatment options and develop an appropriate recovery and return-to-activity plan. Visit Dr. O’Grady’s Physician Page to learn more or submit our Online Appointment Request Form to schedule a visit.