Shoulder pain

During baseball season, I saw a 17 year old male come to the office for right shoulder pain. He was playing summer ball as a pitcher and centerfielder. On one of the games, a ball was hit into the gap and he attempted to make a diving catch. Unfortunately, he did not make the catch and started writhing in pain. He was sent to the emergency room for evaluation. He explained how he could not move his arm and had to keep it braced. According to records, he had several xrays and underwent a shoulder reduction. He was told to follow-up in the office and obtain an orthopedic evaluation.

The patient was diagnosed with a shoulder dislocation and after months of treatment (including rest and then therapy), he was throwing again.

Shoulder dislocation (or glenohumeral dislocation) occurs when the head of the upper arm bone (humerus) is out of the socket of the scapula (glenoid). Typically, it is caused by direct trauma or sports injury (younger patients) or falls (older patients). In this patient, it was caused by a fall on an outstretched arm and also indirectly being a pitcher (possibly causing instability). About 90% of the time, the dislocation is anterior, where the head of the humerus is sitting in front of the shoulder blade. Posterior dislocations are rare and are seen after electrocutions or seizures.

The signs and symptoms of a dislocation include:

1. PAIN

2. Difficulty moving the arm

3. Cavity in the shoulder area

4. Arm locked in place

Diagnosis is made by examination, history, and radiographs.

Treatment includes:

1. Reduction or "popping" the shoulder back into place.

2. Immobilization for one to three weeks

3. Rehabilitation, improving range of motion and strengthening

4. Possible surgical intervention

Depending on the sport and severity, athletes can return to play 3-4 months after injury.

Here are some statistics regarding shoulder dislocations:

1. About 90% who experience a SD under 20 years of age will experience a second SD.

2. Patients (30 years or younger) who experience a SD have a 50% recurrence rate.

3. The shoulder is the most commonly dislocated joint in the body.

4. 95% of SDs occur due to a traumatic event.

Shoulder pain can be caused by other problems including rotator cuff injury, clavicular fractures, shoulder separation (injury of the acromioclavicular joint), humeral fractures, and non-orthopedic conditions such as pneumonia, heart disease, and peptic ulcer disease. The history and physical are the keys to determining the etiology of shoulder pain.

Contact your physician for more information. Thank you and have a nice day.