In order to arrive at a precise treatment, it is necessary to establish an exact diagnosis as to which direction the shoulder is going out of place. This can sometimes be done on the basis of your history (your account of your injury and the symptoms which you have described to me), as well as by examination and plain x-rays.
Occasionally, a test called an MRI (Magnetic Resonance Imaging) is used to help establish a diagnosis. This is a test done in a special machine as an outpatient procedure which does not involve the use of x-rays, but rather uses a magnetic field. It gives us a fairly accurate picture of the status of rotator cuff tendons, ligaments, and other structures in and around the shoulder. Often, to establish with precision the exact direction of the dislocation or subluxation and other problems, it is necessary to examine the patient under anesthesia and arthroscope the shoulder. An arthroscope is a small telescope inserted through a small incision which allows us to see inside the joint.
I have mentioned earlier the initial treatment for the first-time dislocator or subluxor. In addition to immobilization, appropriate strengthening exercises are recommended after removal of the immobilization. Resumption of athletic activities can be taken up on an individual basis, but 6-8 weeks after injury is minimum and 3 months is probably a safer time course.
Some high school and collegiate athletes may want to consider surgical reconstruction of the shoulder after the first dislocation because of the high incidence of redislocation. A second reason to consider is if the athlete is going to continue athletic participation, then often the second dislocation can occur during an event and risk further injury. A second dislocation necessitates more time out of athletics. This matter can be discussed further with those of you who wish to consider this on an individual basis.
As mentioned previously, after a second dislocation or subluxation, recurrence is even more likely. Exercises to strengthen the muscles are important in the overall rehabilitation of the shoulder. Unfortunately, strong muscles will not prevent a recurrent dislocation or subluxation. This is due to the earlier discussion regarding the role of the ligaments in furnishing stability to the joint. The muscles and tendons do not have this as their primary responsibility.
The symptoms of recurrent dislocation or subluxation can be controlled to some degree by activity modification. This means avoiding certain arm positions and athletic activities which require the arm to be placed in these positions. Some football players, such as offensive linemen, can wear a device called a ‘chain and cuff’ which limits motion in order to continue participation. Other positions on the football team generally do not lend themselves to use of this device. It is not applicable in other sports such as basketball and baseball.