Shoulder Injuries | Q&A with Dr. Edward McFarland

Shoulder Injuries | Q&A with Dr. Edward McFarland

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[MUSIC] Dislocation of the shoulder is when
the ball comes completely out of the socket. The socket of the shoulder joint’s
a little bit smaller than the ball. So it’s about this size, and
the ball is much bigger. So that when the shoulder
is injured, the ball goes completely out of the socket,
and that’s called a dislocation. Which results in a fair amount
of damage to the tissues around the shoulder. A subluxation is where it
goes part of the way out, but then goes back in on its own. So it doesn’t completely
stay out of the joint, in goes back in and it’s reduced. But both of them can
be very painful, but usually dislocation’s much worse. [MUSIC] The most common causes
of a dislocated shoulder are sporting events. Particularly sports where the arm
can get pulled behind your body. The worst is American Football,
where people oftentimes gets their arms back, behind them like this and
it gets pulled. Or sometimes, they landed on
a outstretched arm like this and the shoulder The arm
will be pushed back, and the shoulder will come
out of the socket. The most common sport behind
that is probably basketball. There are some dislocations
in soccer and lacrosse, but really the most predominant
one is American football. The second most common cause,
though, is falls. People fall on their back porch,
or they fall and grab the banister,
it pulls their arm like this. And so, the two most common causes
would be sporting activities, and then just general activities or
daily activities where someone has a fall, or they slip,
or something like that. [MUSIC] Subluxation of the shoulder is where
it goes part of the way out of the socket, but doesn’t stay out. So what happens is it goes
out of the socket, but goes back in on its own. Sometimes that can cause as much
damage as if you have a dislocation. So the really critical thing in
determining whether you need an operation or not, is whether it
continues to sublux with activity, and how much pain and
disability you have. Some people can have a subluxation
and never have a problem again ever, depending on their activity. People that, during sports or
high-energy activities though, they generally, if they have
a subluxation, particularly if it continues to happen,
will end up with an operation. [MUSIC] Symptoms of dislocated shoulder
are primarily pain, and loss of function. So the ball is all the way
out of the socket, which tears the ligaments and
sometimes bruises the bone. And it’s pretty painful while
the ball is out of the socket. Once it’s reduced, generally the
pain goes almost away immediately, but people are left with some
soreness that usually lasts two to three weeks. [MUSIC] Dislocated shoulders
are treated primarily, initially by getting
the ball back in the socket. That sometimes requires
a trip to the emergency room. Because they are very painful. And it’s hard to get it back in
without some kind of pain medicine. The second thing is if it’s a long
standing dislocation in the sense that they’re recurrent, and
then it comes over and over again. And surgery is usually indicated
to stabilize the shoulder. [MUSIC] People who dislocate a shoulder
sometimes don’t have any further dislocations. So again,
it depends a lot on the age and activity level of the person. So we know that under the age of 25, that someone who’s athletically
active, they have about a 95% chance that it’ll come back out
again with sports activity. Over the age of 30 though, the chance of re-dislocation
is around 50%. Probably reflects the difference
in energy level, and what sports they’re doing. But it is age related and
activity related, in terms of whether you need to have
something done about it, surgically. [MUSIC] When you dislocate your shoulder, the ball actually goes out
of the socket, sort of say, usually towards the front,
sometimes it’ll go out the back. Around the socket is
a cartilage called labrum, that stabilizes the joint. So when the ball goes out
of the socket in the front, it knocks the labrum
off in the front. The labrum sort of acts like a chock block to keep the ball
from going out. So I always tell people it’s
like a golf ball on a tee. If you take away part of the tee, it’s gonna just continue to slide
out the part where it’s worn. The Hill-Sachs lesion is
when the ball goes out, it actually sort of gets
impaled on the socket itself. So, when the ball rotates back in, there’s usually a groove
on the back of the ball. It’s helpful because in
radiographs or MRIs, we can see the Hill-Sachs lesion or
the indentation of the bone. It’s a pretty good indicator
of what their injury was, and which direction
the shoulder dislocated. [MUSIC] But when people can
return to sports, depends a lot on their age and
their activity level. So we know that young people under
the age of 25, if they’re doing a contact sport, their chance
of re-dislocation’s about 95%. For football players who dislocate
a shoulder in season, we know that about 60 to 70% will re-dislocate
before the season is over, if they go back to sport. If they stay in the sport, then their re-dislocation
rate goes up to about 95%. Also depends upon the activity and
age of the person. We know that if you’re over the age
of 30, that the re-dislocation rate in about two to five years
is only about 40 to 50%. And as you get older,
the rate goes much lower. So over the age of 50, your change
of it re-dislocating is only 20%. Probably more relates to
your activity level and the sports you’re doing,
than it does to your age. [MUSIC] Physical therapy is almost always
needed after these operations to help the patient get back
their range of motion. Because the operation
tightens up the ligaments, we don’t want them too tight. So there’s sort of a double
edged sword there, in terms of making them too tight or
too loose. So the rehabilitation of the therapy
is actually helpful to regain range of motion and function. [MUSIC] The re-dislocation rate after
surgery depends a little bit upon how much was torn up before surgery,
and also on the age of the patient. We know that if you have a operation
done through an open incision about this long, the re-dislocation rate
at two years is around 3 to 4%. If you do have it done
arthroscopically, some reports say that the re-dislocation
rate’s as good as that. Other reports say it’s a little
higher, say around 8%. We know though, that for example, that there was a study done on
rugby players in Australia. And they found that their
re-dislocation rate, even with surgery,
at two years was around 15%. So it really depends on
the type of sports you do, what kind of repair you have,
and how you recover. [MUSIC]

7 thoughts on “Shoulder Injuries | Q&A with Dr. Edward McFarland”

  1. Thanks for the review. I just recently had this happen and I'm shocked how painful it is. And how long the pain is lasting (week two). I broke both my feet in a car accident and that was less painful than this. Differently not as easy to fix as in the movie Lethal Weapon.

  2. My doctor said i cannot repair it.. i have o accept that my shoulder dislocation will be part of my life now.. i have this recurrent shoulder dislocation in about 4-5 years now and it happening more than 100 time.. everytime it happen i will strecth it a little bit and put it back by myself.. lately it became worse.. sometimes it happens when im doing nothing.. multiple times it happen when im sleeping and it make me awake because of its pains..

  3. Thanks for the video. It has provided me some solace. I lift weights often and dislocated my shoulder running/falling with a dog. It was a bad dislocation, with my entire humerus below the actual area it was supposed to be attached to. I'm scared I'll never be able to use that shoulder to the full degree again. It makes me nervous when the doctor in the video says active people below 25 have a 95% of dislocation again. I'm 22 and still want to live an active lifestyle.

  4. People DO NOT GIVE UP ON FIGHTING If it's still hurting you and not feeling right! My dominant arm shoulder was totally dislocated on April 28th of 2019 and was never put back in right at the hospital, they told me to follow up with an ortho which i did but he read the hospital report that said "no evidence of a dislocation" so he put me in an arm immobilizer for 6 weeks and gave me 30 perk 5's. Come to find out after 7 weeks that there was actually now a subluxation the entire time of having it slung and immobilized… "I already assumed that tho from not being able to even take my shirt off and shower for 3 months!" I've seen 2 different hospitals and 3 orthopedic surgeons and every single one has strung me along.. Now i'm at a "Shoulder Specialist" which would have been nice to be at from the beginning cuz now It's now been 9 months and i'm still being told that in the beginning the shoulder was "totally jacked"/"a huge mess with a giant tear and that's why it feels like its gonna fall right back out" but they never did anything about it other then mentioning surgery. Now I just got off a 6 day z pack of steroids to try an loosen up the muscles in the area because i barely have any mobility or strength still from how long it was slung and then immobilized. Now it clicks and snaps and feels like there's severe nerve/muscle damage throughout my arm, up my neck and down my shoulder blade/back. I was also told that there was a huge tear in the beginning but now after 9 months, 4 MRI's about 10 x-rays and a CT scan they're telling me they can't see any tearing anymore so they're gonna be done with doing any more imaging. The new game plan is expecting me to do Physical Therapy on this damaged injured atrophied arm without even ever having a surgery done and then if I can't do it that's when they'll consider surgery!!! it's a joke, a never ending nightmare. I'm gonna end up in jail with this medical professionally neglected arm because I have a son that i have to pay child support for and haven't been able to work for almost a year now all because of what probably could have been a simple fix on a very common injury but now i'm permanently damaged!

  5. Yesterday i dislocated my shoulder luckily my friend put it back for me right away, one of the most painful things i have experienced…

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