Recurring Anterior Shoulder Dislocations in a Professional Soccer Goalkeeper

Molly Kordsmeier, StudentSheila Klausner, PT

Kristen C. Schellhase, EdD, ATC, LAT, CSCS

PERSONAL DATA

24 year old, male, professional soccer goalkeeper, right arm dominant

PAST PERSONAL MEDICAL HISTORY

The athlete had a biceps repair surgery in 2002. Then he suffered two anterior shoulder dislocations causing him to have an arthroscopic Bankart repair in 2006.

CURRENT MEDICAL HISTORY

After his Bankhart surgery in 2006, he began to play professional soccer. In May of 2010 the athlete had another anterior dislocation. Four years later, he reached for a ball with outstretched arms while another player tried to kick the ball. This caused his shoulder to dislocate. Three weeks later the athlete had surgery to repair the anterior capsule and prevent further dislocations.

PHYSICAL SIGNS AND SYMPTOMS

The athlete reported that after the dislocation he had to go to the hospital to have it reduced. He kept it in a sling for a week, with very limited and painful motion until he had the MRI. During the surgery that followed his third dislocation, the doctor found no injury to the cartilage, but the anterior capsule was very damaged. The superior labrum, rotator cuff and biceps tendon were intact. Inferior to the biceps tendon however, the labrum was ruptured.

DIFFERENTIAL DIAGNOSISNone

RESULSTS OF DIAGNOSTIC IMAGING/LABORATORY TESTS

Prior to surgery, the patient’s MRI images showed a lot of excess fluid to the capsule.

 TREATMENT AND OUTCOME

With the patient’s position as a goalkeeper, and the need to have full range of motion at the shoulder, he had a Latarjet procedure performed. This surgery involves transferring the coracoid process to the anterior glenoid rim. This provides a bony block preventing further dislocation while allowing full external rotation. The inferior tendon sling is reinforced with the coracobrachialis muscle. This creates more stability. The surgeon fixes the capsule and inferior glenohumeral ligament to the origin of the coraroacromial ligament. This creates more stability and helps to repair the labrum. After surgery the athlete was placed in a sling that kept his shoulder at 0° abduction, and neutral internal and external rotation for four weeks. The patient was held in neutral for 4 weeks and started physical therapy 6 weeks post op. He is expected to resume full activity, and return to soccer after three to four months of rehabilitation.

DEVIATION FROM THE EXPECTED

The Latarjet procedure was created in 1954 in France. However, it has not become very widely used in North America until recently. The complexity of the surgery can keep surgeons from wanting to experiment with it, and there is not a very large population that needs such an extensive surgery to repair their glenoid rim, or stabilize the shoulder. The Latarjet procedure should be considered more often as treatment, especially in athletes because of the low recurrence rate of dislocations, the amount of motion and stability the patient will regain, and the short time that the athlete will take to recover.

FINAL DIAGNOSIS

Recurring anterior shoulder dislocations and anterior capsule damage were the final diagnosis.

Pre-surgery MRI Post-Latarjet procedure

Post-Latarjet Procedure

University of Central Florida