Video Case Reports: Options for Managing Shoulder Instability

    When faced with a particularly difficult case, why and how do orthopaedic surgeons make some of the decisions they do?

    At ICJR’s Shoulder Course in Las Vegas, Brian J. Cole, MD, MBA, from Rush University Medical Center in Chicago, gave attendees a glimpse at the thought processes of shoulder specialists as he guided an expert panel through discussion and debate on management options for 7 tough, real-life cases involving patients with shoulder instability.

    Panel members who shared their thoughts on these cases included James Esch, MD; Tom Norris, MD; Timothy Reish, MD; and Anthony Romeo, MD.

    The cases they reviewed included the following:

    • A 24-year-old NBA player who was in the last year of his contract and who sustained his first shoulder dislocation 24 games into an 82-game season. His shoulder was reduced in the training room during the game, with minimal pain.
    • A 16-year-old high school lacrosse player with a right shoulder injury. He was unable to throw or catch, and he experienced pain and weakness in the affected shoulder.
    • A 25-year-old pitcher who had experienced his first dislocation 2 years earlier. He’d gone on to four anterior dislocations, each occurring with less force and each reduced in the emergency department. He is unable to pitch due to pain and instability.
    • A 25-year-old recreational basketball player who has have five dislocations that were reduced in the emergency department. He has had two arthroscopic stabilization procedures, and 2 years later, he dislocates again during mid-abduction.
    • A 28-year-old lawyer who is an avid snowboarder. He has sustained his sixth shoulder dislocation during a snowboarding fall; the five prior dislocations were reduced in the emergency department.
    • A 38-year-old male who sustained his first dislocation while playing high school football in 1990 and who underwent an arthroscopic procedure in 1991 due to recurrent instability. He has had multiple dislocations and subluxations since then, with relocation in the emergency department.
    • A 14-year-old wrestler and football player who sustained a subluxation during a wrestling match that did not require reduction. However, he has painful instability despite physical therapy and bracing.

    Watch the presentation here to find out what the panel members said about these cases. Do you agree with their treatment recommendations?