New Staff - Children's Hospital Boston

Shoulder Dislocations
Donald S. Bae, MD
Kickoff
The air has turned cooler, snow is starting to fall, and the New
England Patriots and Boston Celtics are back to their winning
ways…all sure signs that winter is here. With the change in seasons,
many children and adolescents are looking forward to the
return of winter sports. Sports participation continues to rise
both regionally and nationally. It is estimated that over 35 million
children and adolescents participate in organized sports, and the
majority of households will have at least one child participating
in athletic activities.
As sports participation continues to
rise, particularly in younger
children and adolescents at
higher levels of competition,
so too has our awareness
of sports related injuries,
including shoulder
dislocations.
More Than Just a Ball
and Socket
The shoulder is a complex
connection between the
arm and body, designed
to allow motion and
stability. One of the
main components
of the shoulder is
figure 1
the glenohumeral
joint, which links
the upper portion
of the humerus bone (humeral head) to the bony socket of the
scapula (the glenoid) (figure 1). While the glenohumeral joint has
often been described as a “ball and socket” joint, in truth, the connection
is more complex.
The glenoid is more shallow than the humeral head is round, and
thus the humeral head can shift out of the center of the glenoid
(subluxation) or completely move out of the glenoid (dislocation).
To prevent this, the joint is dependent upon the surrounding soft
tissue for stability. The glenoid is surrounded by a “bumper” or
rim of cartilage, called the labrum, which adds to glenohumeral
figure 2
joint stability (figures
2 and 3). This
labrum acts similar
to the chock
blocks that are
placed around
the wheels of
airplanes and figure 3
used to keep
the wheels from
moving (figure
4). In addition,
the labrum is
connected to
the shoulder joint
ligaments and capsule,
which provide additional stability.
In a shoulder dislocation from a fall or sports-related injury, there
may also be injury to the labrum, ligaments, and joint capsule
(figure 5). Though the humeral head may be placed back into the
glenoid, the injured labrum, ligaments, and/or capsule may not
heal in their original position, thus increasing the likelihood of repeated
shoulder dislocations.
Initial Care
Following a shoulder dislocation, treatment initially consists of
manipulating the humeral head back into the center of the glenoid.
While this can happen spontaneously, occasionally manipulation
needs to be done with a physician’s guidance with
sedation or anesthesia. After reduction of a shoulder dislocation,
patients are typically treated with sling immobilization, followed
by physical therapy to restore shoulder motion and strengthen
the muscles around the shoulder. Despite appropriate care of a
first-time shoulder dislocation, the likelihood of recurrent shoulder
instability episodes may be as high as 60 to 95 percent in adolescents
and young adults.
In patients involved in contact sports (e.g. football), specialized
braces have been designed to restrict the shoulder from being
placed in vulnerable positions and thus reduce the likelihood of
repeated instability events. continued on page 3
Welcome New Staff
Virginia Brunelle
The Department of Orthopaedic Surgery is
pleased to announce that Kimberly Bayliss, RN
and Erin Dawicki PA-C, have joined our clinical
support team.
The Orthopaedic clinical support team includes,
nurses, nurse practitioners, and physician assistants.
Each member of the clinical support
team contributes a fundamental role in providing
care to our patients and families with integrity,
compassion, and expertise.
Kimberly Bayliss, RN
Kimberly attended Northeastern University,
where she received a Bachelor of Science in
Shoulder Dislocations,
continued from page 2
These braces may be used to allow athletes
to return to sports participation for
the remainder of their season or indefinitely.
Surgical Treatment
In patients with recurrent shoulder dislocations
that do not improve with physical
therapy and activity modification, surgical
treatment is an option. Ultimately the
decision to pursue surgery is made by
the patient/parents and treating orthopaedic
surgeon after careful evaluation
and discussion.
Surgery for shoulder instability is designed
to repair and/or tighten the
labrum, ligaments, and joint capsule
around the shoulder. In most situations,
this may be performed using arthroscopy.
Small incisions are made around the
shoulder and an arthroscope (or pencilsized
camera) is used to look inside the
glenohumeral joint.
-2- -3-
Nursing. Prior to joining the Orthopedic Clinic,
Kimberly worked at Children’s on 10 Northwest,
an inpatient unit. She has also worked at
New England Medical Center, in the Pediatric
Intensive Care Unit, and Franciscan Hospital for
Children.
Erin Dawicki, PA-C
Erin attended the Medical University of South
Carolina where she received a Master of Science
in Physician Assistant Studies. Erin most recently
worked as an EMT on the Disaster Medical Assistance
Team at Rhode Island Hospital.
Specialized instruments are then used to
repair the injured labrum, ligaments, and
capsule.
There are some situations in which arthroscopic
techniques are not used.
figure 4
figure 5
Instead, the shoulder surgery is
performed using a longer incision
over the front of the shoulder joint.
This is often referred to as “open” surgery.
Your Home Team
The Department of Orthopaedic Surgery
at Children’s Hospital Boston has a number
of healthcare providers who are available
to help young athletes with shoulder
instability. Our team of orthopaedic surgeons,
physical therapists, nurses, and orthotists
is well trained and ready to assist
young athletes pursue successful, enjoyable,
and safe sports seasons. In this
game, we want everyone to be a winner.
1. Candy cane
2. Hockey
3. Superbowl
6. Patriots
Across Down
Kid’s Corner Answers
4. Penguin
5. Gingerbread
6. Plow
7. Salt
8. Ski
9. Snowflake