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Shoulder Dislocation – Surgery a Better Option?

A recent article in the Washington Post highlights the difficult decision making process Paul Casey (professional golfer) faced to determine the best course of treatment after he dislocated his shoulder recently. Although there are many factors to consider in determining the best course of treatment following an initial shoulder dislocation, one of most important factors in determining the likelihood of recurrent instability or dislocation is age at the time of injury. More information here about unstable shoulder. So without taking any other factors into account, knowing that Paul Casey is over 30 years in age at the time of his first shoulder dislocation, puts him at a lower risk of having another dislocation.

DORAL, Fla. — Paul Casey already has missed five tournaments this year after dislocating his shoulder while snowboarding over the holidays. It’s a bad time for an injury, especially in a Ryder Cup year, though Casey has a good reason to feel optimistic.

It could have been worse.shoulder dislocation

One of the doctors he saw in the aftermath of his injury said that surgery was a possibility, and he would be out four to six months.

“That was a little bit worrying,” Casey said Wednesday.

After getting more opinions, he was convinced that surgery was not needed. It was the first time he had dislocated the shoulder, the labrum was in good shape and there was every reason to believe he could return to 100 percent health.

Casey figures he’s at about 90 percent at the Cadillac Championship at Doral, which has a 74-man field with no cut.

“It’s feeling strong,” he said. “All that work I’ve been putting into the shoulder, now I have to do a lot of work on the golf game.”

Casey said he heard a sound coming from his shoulder when he fell, felt pain and within minutes could not move his arm. When he got down the mountain and had an X-ray, he was told it was dislocated. Then, the shoulder was put back in the socket and the pain went away.

“I thought it was great,” Casey said. “I thought maybe I can be ready for Abu Dhabi or Qatar or something like that. I had absolutely no clue how long a dislocation takes to repair. Finding out that I didn’t need surgery was a relief because the surgery … basically would have wiped out the whole season.”

Now, he has some catching up to do.

Casey is at No. 41 in the European points list (based on European Tour earnings) and No. 19 in the European ranking list. The top five players are taken from each list.

At least it didn’t cost him any of the four majors, which offer the most ranking points. Casey is playing the next two weeks in Florida, taking a week off, then playing Houston and the Masters.

“I think I’ll throw in some events as the golf game gets stronger and as the year goes on,” he said.

Of course, the decision for surgery isn’t simple either. Some of the worse shoulder problems we see are patients that have had poorly conceived or executed shoulder surgery for an unstable shoulder. Here is more information about shoulder surgery complications. Here are some tips on how to choose a shoulder specialist. Another tip is to make sure the surgeon you choose is able to comfortably tie arthroscopic knots and uses only surgical techniques that require knot tying. Although the vast majority of surgeons that perform shoulder surgery do not tie knots routinely and use so call knotless implants, the failure rates with these types of implants has been reported to be as much as five times greater. So do your homework, and like Paul Casey, don’t be afraid to get a second, third, fourth, or even fifth opinion until you have a clear understanding of your unique circumstances and the best treatment option for you personally.

Vivek Agrawal, MD

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