Jim, age 49, had just finished a great day of snowmobiling. Walking to his car on ice he found himself upside down in the parking lot with his shoulder completely out of socket, screaming in agony. Women always seem to tell us men how wimpy we are, comparing all pain to that of childbirth. At least with childbirth you get a baby in the end. This was just pain that wouldn't go away. X-rays in the emergency room revealed a completely dislocated shoulder. Jim's humeral head, the round ball, was perched painfully in front of the cup or glenoid. The ball was put back successfully in the socket by the in-call physician.

No age group grows out of the risk of shoulder dislocations. Athletes under 20 years of age with a first-time shoulder dislocation have greater than 90 percent chance of this happening again. People in their 20s and 30s have a reported risk of between 20 percent and 40 percent, with people over 40 having less than 10 percent chance of repeated dislocations.

Even though the risk of recurrent episodes decreases with advancing age, other risks go up. With our snowmobiling friend Jim, he completely tore all the tendons (rotator cuff) off the upper arm bone. This risk has been assessed at 30 percent in patients over 40 years of age; after age 60, it exceeds 80 percent. This type of injury requires early surgery to repair the torn tendons back to bone; otherwise, one could be left with little use of one's arm and shoulder.

Current treatment for first-time dislocations in the younger age group or for throwing athletes is trending toward earlier surgery. Most dislocations tear the ligaments off the cup in the front of the shoulder and these are repaired back to their normal position.

Several events have contributed to this shift towards surgery. The fact that more than 90 percent of young people with first time dislocations will have another event, thus having a higher risk of damage to the joint surfaces with resulting arthritis is one reason. The reality of less invasive surgery using the arthroscope and small incisions has also influenced this trend.

Chronic dislocators or repeated dislocations should be treated with surgery. Use of the arthroscope means that an operation that was exclusively performed through a large, open incision 15 years ago can now be performed through three small punctures. However, even though the surgery is done through small holes, the time required by the ligaments to heal back to bone is the same as with an open incision. Return to full sports and heavy work is usually allowed within four to six months.

Thus, shoulder dislocations can be very painful as well as potentially cause permanent damage; however, early, careful treatment can result in a shoulder with little if any limitation.