By Dr. Jeff Daniels EBS Medical Columnist
How do I convince a 20 year old, who just dislocated his shoulder, to hang up his snowboard for the remainder of his vacation in Big Sky? He arrived here after a 20-hour bus ride from California, and proceeded to land on his shoulder during his first run.
And now that his shoulder dislocation is reduced and doesn’t hurt anymore, what’s stopping him from throwing himself down the mountain once again?
His friends—unhurt and seemingly unconcerned about the consequences of re-injury—are egging him on. We’ve got his injured arm tethered to his body in a shoulder immobilizer, something that would make it very difficult to snowboard because you really need both arms to move freely and easily. This contrasts with a decent skier who might be able to at least ski the groomers with only one arm.
So I try to explain the anatomy to this guy who seems to disregard anything I tell him. When the shoulder dislocates, a big ball of bone called the humeral head—attached by nothing but soft tissue—travels about 4 inches from its original location against the glenoid, taking all of that soft tissue with it.
The rotator cuff tendons are a big player in keeping the shoulder bones in place, and they emanate from the back of the shoulder. Here you have an injury that is stretching them forward, because that’s where the ball of the humerus ends up in an anterior shoulder dislocation.
I ask them, “Do you have any friends whose shoulders constantly dislocate?” When they say “Yes,” I explain that not letting the shoulder rest in an immobilized position—and risking another dislocation by landing on that arm or shoulder too soon after the initial injury—is why they have that problem. Then I demonstrate how waving goodbye or rolling over in your sleep can cause dislocations in “loose” shoulders.
And yet, I couldn’t convince this young man that he was risking a chronic problem by ignoring my warning, removing his immobilizer, and going right back onto the slopes. At least he didn’t do what one skier did a couple of years ago: When we left him alone in the exam room, he decided to get dressed after the reduction, and when he raised his injured arm upward, we heard a pop and a scream. He had re-dislocated the shoulder 10 minutes after we had fixed him!
There’s no exact consensus on how to treat a first time anterior-dislocated shoulder. How long should it stay in strict immobilization? We tell people that it should be held in the immobilizer for at least a week. After the week of immobilization, we recommend seeing a physical therapist.
Rehab for anterior shoulder dislocations is a common therapy, and most physical therapists are very good at guiding the healing process—allowing everything to tighten up so that it would require a similar accident to cause another dislocation.
I’ve learned here over the years, dealing with so many acute injuries, that there are several ways to “skin a cat.” My best advice, particularly to people visiting Big Sky, is to see a physical therapist or orthopedist as soon as they get home, and see what their approach is to rehabbing a first-time dislocation.
For those with a shoulder that won’t stop dislocating, hurting or feeling unstable, there are procedures that can tighten up the soft-tissue structures. The Bankart technique seems to be the most common procedure, where either bone anchors or sutures are used to secure the torn labrum, which is the tough, cartilage-like ring of soft tissue that emanates from the glenoid of the scapula and is a major stabilizing factor.
I’ve reduced approximately 1,000 dislocated shoulders over the past 22 ski seasons in Big Sky, and there have been two already this winter. Have a happy and safe holiday season.
Dr. Jeff Daniels was the recipient of the 2016 Big Sky Chamber of Commerce Chet Huntley Lifetime Achievement Award and has been practicing medicine in Big Sky since 1994, when he and his family moved here from New York City. A unique program he implements has attracted more than 700 medical students and young doctors to train with the Medical Clinic of Big Sky.