Dislocation: An Overview
Guest: Dr. David Geier – Orthopedic Surgery
Host: Dr. Linda Austin – Psychiatry
Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. David Geier, who is
Director of MUSC Sports Medicine Clinic.
Dr. Geier, a very common sports injury is shoulder dislocation. What happens when a shoulder is dislocated?
David Geier: It’s funny. It seems like it would be fairly
straightforward. But, in layman’s terms,
what happens is the ball pops out of the socket, typically, not so much from
getting hit right on the shoulder. It’s
due more to landing in a certain position or getting your arm pulled in a
certain way, where the arm almost pulls the humeral head, the ball, out of the
socket, most commonly to the front. So,
what happens is the arm often gets pulled behind the person, such as in
football, when they go to make a tackle, the arms gets pulled behind them or
they land on their outstretched hand and it forces the humeral head to pop out
of the glenoid, out of the socket.
Linda Austin: If that happens on a
sports field, what should one do?
David Geier: Well, initially, it needs
to go back in place. It’s excruciatingly
painful to have the shoulder dislocated.
The question becomes, if there’s appropriate medical care, physicians or
athletic trainers that feel comfortable reducing that on the field, in certain
circumstances, it’s appropriate to be done on the field. Most of the time though, that needs to be
done in an emergency room setting where x-rays can be taken to make sure
there’s no accompanying fracture and to verify a kind of before and after to
ensure that the shoulder is reduced.
Linda Austin: I think we’ve all seen in
the movies where that happens and another player will grab the arm and sort of
pull it out and reduce it, or put it back in place. Is that a bad idea, if you don’t really know
what you’re doing?
David Geier: I think it’s a bad idea if
you don’t know what you’re doing. You
could potentially, although not commonly, cause a fracture in addition to the
dislocation. But, more than anything, it
just might not work. You may not put it
back in place, and you put the athlete through a tremendous amount of pain
when, in an emergency room setting, not only do you have the capability to
x-ray, to verify the diagnosis, you can give the patient pain medicine and
sedation to make it more comfortable and much easier to reduce.
Linda Austin: So, in other words, if
you’re already in agony, you don’t want some linebacker kind of mauling you a
little bit more just for good measure?
David Geier: No, or some coach, or,
honestly, especially in the setting of a first-time dislocation, somebody
trying to pop it back in on their own.
Now, having said that, in a situation where somebody’s had this happen
over and over again, it does, sometimes, get very easy to pop in and out of
place. Some of those athletes can pop it
back in on their own. Now, the question,
obviously, is, should they get to that point?
That’s entirely another story.
But, some people can do it themselves.
Linda Austin: What is the treatment for
a shoulder dislocation, once the person comes to the ER?
David Geier: Well, the first concern is,
obviously, getting it back in place to minimize associated damage, to reduce
the shoulder so there’s no likelihood of any stretch injury to the nerve. Once the shoulder is reduced, likely, you’re
probably looking at two to three weeks in a sling, more for comfort than
anything else. The concern with a
shoulder dislocation is really based on the individual’s age when it
happens. Studies have shown that
athletes under age 21, especially under age 18, that dislocate their shoulder,
it’s very common for it to continue happening over and over again.
reason for that is that they’re very likely to tear the labrum, which is a
cartilage bumper along the socket, to tear that when their shoulder
dislocates. And, now, you lose the
protective effect of that bumper and it becomes very easy to pop the shoulder
out of place. Above age 35 to 40, that
doesn’t typically happen, and they’re very unlikely to dislocate their shoulder
again. But the concern with a true
shoulder dislocation in your adult population is the possibility of tearing a
rotator cuff tendon when they dislocate.
are actually potentially worrisome. I
know the old adage, everybody’s had their shoulder dislocate and popped back in
place. But, as sports medicine has
evolved, we’ve gotten much more in touch with the fact that these are serious
injuries and they very commonly progress to requiring surgical treatment.
Linda Austin: So, if the labrum has been
damaged, what is the remedy for that?
David Geier: Unfortunately, if you know
that’s the case, you’re looking at a surgical treatment. That’s not something you’re really going to
know by a physical examination, by a physician.
A lot of times you’re going to need a fancy test, an MRI, specifically,
an MR arthrogram, where a dye is injected into the shoulder before the MRI. If these studies show a labral tear, what
you’re usually looking at is a surgical procedure to repair the labrum and
stabilize the shoulder. That can be done
the way it’s been done historically, through a large open incision through the
front of the shoulder or, now, most people have gotten to a kind of cutting
edge technique doing it arthroscopically, through two or three little stab
incisions about the size to fit an ink pen through, through very small
incisions, and using suture anchors to repair the labrum and tighten the
Linda Austin: Dr. Geier, let’s talk
about rotator cuff injury repair in another podcast. Thanks so much for talking with us today.
David Geier: Absolutely. Thank you.
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