What management options are available for a patient with recurrent shoulder dislocations who refuses to stop playing football?

Management Options for Recurrent Shoulder Dislocations in Football Players Who Refuse to Stop Playing

For patients with recurrent shoulder dislocations who refuse to stop playing football, surgical stabilization is strongly recommended as it provides the best outcomes for long-term shoulder function, significantly reduces recurrence rates, and allows for safer return to play.

Understanding the Risk

Recurrent shoulder dislocations in football players present a significant clinical challenge, particularly when the athlete refuses to modify their activity level. The management approach must balance:

• Risk of further injury and long-term joint damage
• Athlete's desire to continue participation
• Quality of life considerations
• Future shoulder function

Surgical vs. Non-Surgical Management

Surgical Management

• Primary recommendation: Arthroscopic shoulder stabilization surgery offers the best outcomes for athletes who wish to continue playing football 1, 2
• Benefits of surgical stabilization:
  • Significantly lower recurrence rates (26% vs 55%) compared to non-surgical management 2
  • Longer interval between recurrent instability events (14.7 vs 2.5 weeks) 2
  • 90% successful return-to-play rate in collegiate athletes following surgical repair 3
  • Athletes are 5.8 times more likely to complete a subsequent season without recurrent instability after surgical repair 3

Non-Surgical Management

• Only 40% of collegiate athletes successfully return to play without recurrence following non-surgical treatment 3
• High recurrence rate (55%) in NFL players managed non-surgically 2
• Median return to play:
  • 0 weeks for subluxation events
  • 3 weeks for dislocation events 2

Timing of Intervention

If the patient refuses to stop playing during the current season:

1. Short-term management (to complete current season):

   • Rehabilitation focusing on rotator cuff and periscapular strengthening
   • Protective bracing/taping during play
   • Pain management with NSAIDs and local cold therapy 1
   • Clear counseling about high risk (47%) of recurrent instability 2

2. Off-season intervention:

   • Schedule arthroscopic stabilization surgery immediately after season ends
   • Plan for approximately 39.3 weeks (median) recovery time before return to full contact 2
   • Implement phased rehabilitation protocol 1

Special Considerations

• Age factor: Younger players have significantly higher recurrence rates after both surgical and non-surgical management 1, 4
• Years of eligibility: Each additional year of play after surgery confers an additional 10% risk of reinjury 4
• Dislocation vs. subluxation: Players with primary dislocation (vs. subluxation) are 5 times more likely to experience recurrence 5
• Position played: Consider position-specific demands and tackle exposure

Counseling Points for Patient Discussion

1. Long-term implications: Discuss potential for permanent joint damage, early arthritis, and future functional limitations
2. Quality of life impact: Evidence shows 9.2% reduction in quality of life measures even after successful surgical repair 6
3. Recurrence statistics: Present clear data on recurrence rates with and without surgery
4. Career longevity: Explain how proper management now may extend playing career
5. Post-surgical expectations: Set realistic expectations about return timeline and potential limitations

Rehabilitation Protocol

If the patient chooses to continue playing before surgical intervention:

1. Phase 1 (Acute management):

   • Pain control with NSAIDs and cold therapy
   • Gentle range of motion exercises
   • Proper positioning education 1

2. Phase 2 (Progressive rehabilitation):

   • Progressive ROM exercises
   • Light strengthening of rotator cuff and periscapular muscles
   • Scapular stabilization exercises 1

3. Phase 3 (Return to play preparation):

   • Progressive resistance training
   • Advanced scapular stabilization
   • Sport-specific training with protective measures 1

Conclusion

While respecting patient autonomy is important, the evidence strongly supports surgical stabilization for football players with recurrent shoulder dislocations who wish to continue playing. The surgical approach significantly reduces recurrence rates and provides the best chance for continued participation with minimized risk of further injury.