ACUTE SHOULDER DISLOCATION - FOOTBALL

Abstract

HISTORY A 20-year-old football player injured his non-dominant left shoulder after diving to catch a pass in practice. He landed on an abducted and externally rotated left arm as his body rotated towards the right. The patient reported that his shoulder had “popped out” and the trainer standing on the sideline was summoned. The trainer reached under the shoulder pads, reportedly felt a deformity, and immediately removed the patient's pads. PHYSICAL EXAM While his shoulder pads were being removed, the patient reported considerable discomfort with any movement of the left shoulder. The left arm was slightly abducted and internally rotated. There was no focal swelling or ecchymosis. The lateral aspect of the shoulder was flattened with an anterior prominence. Sensation and distal pulses were intact. Gentle traction was applied to the arm along its longitudinal axis by the athletic trainer. The arm was slowly abducted and the apparent shoulder dislocation was reduced. The patient was then taken to a local hospital for an evaluation and post-reduction radiographs. DIFFERENTIAL DIAGNOSIS Acute anterior glenohumeral dislocation Glenoid labrum tear Rotator cuff tear Fracture of the proximal humerus TEST AND RESULTS Left shoulder series including AP internal/external rotation views and an axillary view did not reveal an acute fracture or dislocation. FINAL/WORKING DIAGNOSIS Acute Anterior Dislocation of the Glenohumeral Joint TREATMENT The likelihood of recurrent dislocation was discussed. The patient decided that he would follow-up at the end of the season for surgical repair but he wanted to play as soon as possible. The patient was immobilized for only five days. Rehabilitation consisted of the following: Week 1 - range of motion, finger walking up wall, circumduction, Week 2 - the above exercises plus push-ups (sets of 25 to 50, 300 reps/day), 5 lb. hand weights forward flexion (15 reps/ 3 sets) and abduction (15 reps/3 sets), Week 3 - the above exercises plus internal and external rotation repetitions using extra heavy and heavy resistance theraband respectively (20 reps/ 4 sets each), a 12 lb medicine ball tossed against a mini trampoline and then caught (50 reps/ 2 sets). By week 3, the patient resumed non-contact wide receiver drills using a Grace International SAWA shoulder orthosis with abduction limited to 45 degrees for one week and then limited to 90 degrees thereafter. To note, the patient had regained full range of motion of the left shoulder by the end of week 3. Week 4 - the patient continued with all previously stated exercises and added 135 lb bench press (10 reps/3 sets), 35 lb dumb bell incline press (10 reps/3 sets), balance board push-ups (15 reps/ 2 sets), dips (15 reps/ 3 sets), wall throws (feet stay planted and patient is pushed against a wall where he catches himself and pushes himself away forcefully. The patient resumed full contact participation 4 weeks after his first shoulder dislocation. At the time of submission of this case, the patient had played 4 games without incident.