Subluxation of the shoulder in athletes

Shoulder subluxation is an extremely common problem confronting the sports medicine physician and may present in a variety of ways, with the patient complaining of pain of a sense of instability. In throwing spots, tendinitis secondary to impingement is common, but it may also be secondary to instability as a result of traction or compression of the rotator cuff. In addition, subluxation may develop initially, then progress to dislocation, or the converse may occur. However, some patients may have subluxation over an extended period of time. The physician must consider the entity and take a careful history, followed by an examination that notes subtle losses of motion and strength and the presence of apprehension. The x-ray films may be helpful when the standard views are supplemented by the West Point and Stryker notch views. Examination under anesthesia and arthroscopy have played an increasingly significant role in the recognition and evaluation of these patients. At times, arthroscopy is helpful in the treatment of shoulder subluxation in patients who have partial labral detachment. This is mainly in throwers or tennis players in whom open surgery is likely to result in significant loss of athletic ability. Stretching and strengthening exercises are frequently helpful in managing subluxations and tendinitis associated with the microtrauma of repetitive use in contrast to traumatic subluxation. Operative procedures are indicated after the failure of conservative treatment. It is important to explore the joint to find loose bodies and to note any labral damage or detachment. Great care must be taken to avoid excessively tightening the capsule, which will limit athletic activity and may increase the instability in the opposite direction. Postoperatively, a well-directed exercise program to restore the patient's flexibility and strength is indicated prior to the resumption of any sporting activity.