When somebody dislocates their shoulder, they tend to go to A&E to have it put back into the correct place (reduced). When their pain has settled, they then have physiotherapy to regain strength and movement in the joint.
What they don’t necessarily always realise is that this first dislocation hugely increases the probability of further dislocations in the future. Unfortunately, the statistics are very heavily set against you after you've dislocated your shoulder once on the rugby pitch; as a young man, if you returned to rugby after a shoulder dislocation you have a more than 90% risk of re-dislocation, and that's despite the best possible rehab and good physiotherapy.
The problem is that your first dislocation will have damaged the tissues and ligaments in the shoulder, and these will never fully heal themselves. Once the damage is done the first time you are then, unfortunately, very vulnerable to further problems in the future.
Usually, people come to me once they have dislocated their shoulder a few times, although occasionally they will see me after their first dislocation.
Diagnosis of shoulder dislocation itself is usually straightforward and is based on the medical history. In terms of determining the best way of fixing the underlying weakness in the joint, I tend to arrange an MRI scan to give detailed images of the joint itself. An MRI scan is excellent at showing the ligaments, tendons and muscles. Using the images from this scan, I will be able to see any problems within the joint that are contributing to the dislocations.
In certain cases, I may also arrange for you to have a CT scan to assess whether there's any associated bone injury (there is a lot of good research that shows that if you have significant bone loss there is quite a high failure rate from traditional keyhole surgery).
If you do not have significant bone loss, a straightforward keyhole operation, known as arthroscopic stabilization surgery, is very good. This is performed as a day case, meaning you will be able to go home the same day, and it is a very effective treatment.
If you have significant bone loss, and this happens in quite a lot of young rugby players, you're much better off having an operation called a Latarjet, which is named after a French surgeon. This is a more involved operation, yet paradoxically the recovery is slightly quicker and is very good at preventing further dislocations.
The Latarjet is also known as a bone block transfer, as the operation involves moving a bit of bone from your shoulder blade (scapula) and screwing it down in front of your shoulder socket. This prevents the joint from dislocating. The surgery is carried out as a day case, so you return home the same day. You will have a larger, more obvious cut at the front of your shoulder, whereas with the keyhole procedure only a few very small cuts are made. This procedure has a double benefit, in that it significantly reduces the failure rate of surgery while also allowing you to get back to playing rugby more quickly. The Latarjet is becoming a more popular choice as more evidence of its efficacy is coming in from places like Australia, France and America.
Recovery from any surgery takes time and varies for each person. As well as giving your body time to heal, physiotherapy plays an important role in helping you to regain strength, movement and function, and our Circle physiotherapy team will help you with this.
If you only have the arthroscopic keyhole surgery, you will be able to return to playing rugby again after 6 months. If you have the bone block transfer (Latarjet), we will get a CT scan three months after the surgery to assess your recovery and healing. If everything is looking okay at that stage, you will be able to return to rugby then. Many professional athletes are choosing the Latarjet as it allows them to get them back to playing much more quickly.
If you are experiencing recurrent shoulder dislocations, arrange a consultation with me. We will talk about your symptoms and I will carry out a full and detailed examination of your shoulder. If any treatments are indicated, I can talk you through them to give you all the information you need to make an informed decision. At Circle, you can see me without the need to join a waiting list, meaning we can get you treated and back to full strength and activity again. If you are a rugby player, I’ll be able to help you return to playing again as soon as possible.
I play rugby semi-professionally. During one match, I ended up dislocating my shoulder twice, and ended up having to go to hospital for an X-ray.
On the Monday, my rugby club contacted Harry and arranged for him to see me that afternoon. I talked with him about what had happened, and he arranged for me to have an MRI scan to show the extent of any damage. After Harry had talked me through the different treatment options, I decided to try rehab instead of surgery.
That was in the January, and I was able to start training properly again in August. However, I had a number of additional dislocations over the next few months and eventually it got to the stage that I knew I would need surgery to fix it properly. Harry explained everything to me thoroughly, and I was able to book things through the NHS ‘Choose and Book’ system.
I went in for my pre-op checks and tests the week before the surgery. They also gave me a book of things to do beforehand and explained the recovery process. On the day of the surgery, Harry went through everything with me again. He's always very calm and reassuring, a really nice bloke.
The operation went well, and my brother was able to pick me up at about 5pm the same day. I had the option to stay overnight at Circle if I wanted to, but I chose to go home. I had a check-up two weeks later and my sling was able to come off then. I had a few more checks at various stages and at three months after surgery I had a CT scan to make sure the bone formation had taken.
I had that operation in February and was able to start playing rugby properly again in August. I have not had any more dislocations, despite some pretty big hits. I have had one big scare though, when I took a really big hit and heard a bit of a crack in my shoulder. I contacted Harry straight away and explained what had happened. He suggested I go to Circle for an X-ray and a consultation with him. I called his receptionist and she booked me an appointment straight away! I had the X-ray then met with Harry, who looked at the X-ray and examined my shoulder very carefully. There was no sign of any damage - everything looked good and I was able to play rugby the following weekend without any worries.
Harry is always so helpful, I recommend him highly.
- Elbow arthroscopy
- Rotator cuff surgery
- Shoulder arthroscopic release
- Shoulder arthroscopic decompression
- Shoulder stabilisation (Bankart repair)
- Shoulder replacement surgery
- Tennis elbow treatment
- Ulnar nerve release surgery
- Diagnostic ultrasound
- Elbow open debridement (elbow arthritis)
- Elbow ligament injuries
- Biceps tendon pain
- Biceps tendon tear
- Biceps tendonitis
- AC joint repairs
- Labral tear in the shoulder
- Reverse shoulder replacement
- Shoulder dislocation
- Frozen shoulder