Long-Term Effects of Non-Surgical Treatment for Grade 2 Shoulder Dislocation

Is there any long-term consequence of a grade 2 acromioclavicular joint dislocation if it is not surgically treated?

Hello, Doctor.
I fell while running on March 27, 2024, and impacted my left shoulder, resulting in a Grade 2 acromioclavicular joint dislocation.
I am currently within the optimal surgical treatment window.
I have not provided X-rays for the water bucket but have included images of the X-rays for carrying a water bucket [https://imgur.com/a/w8JJbOd] and [https://imgur.com/a/G5aFrMf].
I have a keloid tendency [https://imgur.com/a/Kd9ZIB2].
Given my Grade 2 acromioclavicular joint dislocation and considering my keloid tendency, along with the fact that my right hand (the non-dominant hand) was injured and my work primarily involves office tasks that rarely require heavy lifting, I can opt for conservative treatment.
However, I would like to ask: 1.
At 34 years old, I am concerned about potential long-term sequelae or complications in 20 years, such as increased soreness, weakness, reduced range of motion, inability to sleep on my side, a higher likelihood of bone spurs, or increased risk of other shoulder joint degeneration, etc.? 2.
If financially feasible, would it be advisable to choose surgical intervention with the placement of a metal button for artificial ligament fixation, which may lead to fewer subsequent issues?

Wan Bei Yan, 30~39 year old female. Ask Date: 2024/03/29

Dr. Shi Guozheng reply Orthopedics

1.
Changes in twenty years are difficult to predict; even an uninjured shoulder joint may undergo degeneration.

2.
Grade II injuries may not require surgery.

3.
Choosing surgery does not guarantee complete recovery.

Reply Date: 2024/03/29

More Info

When considering the long-term effects of non-surgical treatment for a Grade 2 shoulder dislocation, it is essential to understand both the nature of the injury and the potential outcomes of conservative management versus surgical intervention.
A Grade 2 shoulder dislocation, which typically involves a partial dislocation of the shoulder joint, can lead to various complications if not treated appropriately. Non-surgical treatment often includes rest, physical therapy, and possibly the use of a sling to immobilize the shoulder during the healing process. While many individuals can recover well with conservative management, there are potential long-term effects to consider.

1. Long-term complications: After a Grade 2 shoulder dislocation, some patients may experience chronic pain, weakness, and a reduced range of motion in the shoulder joint. These symptoms can manifest years after the initial injury. The risk of developing shoulder stiffness, known as adhesive capsulitis or "frozen shoulder," may increase, particularly if the shoulder is not mobilized appropriately during recovery. Additionally, there is a possibility of developing osteoarthritis in the shoulder joint over time, which can lead to pain and decreased function.

2. Bone spurs and joint degeneration: Individuals who have suffered a shoulder dislocation may also be at risk for developing bone spurs (osteophytes) around the joint. These can contribute to pain and further restrict movement. Over time, repetitive stress on the shoulder joint, especially if there is a history of dislocation, can lead to degenerative changes in the joint, increasing the likelihood of conditions such as rotator cuff tears or shoulder impingement syndrome.

3. Impact on daily activities: Given your occupation involves office work and minimal heavy lifting, you may find that conservative treatment allows you to return to your daily activities without significant limitations. However, if you experience persistent pain or functional limitations, this could affect your quality of life and work performance.

4. Surgical intervention: If you are concerned about the long-term implications of a Grade 2 shoulder dislocation, surgical options, such as the placement of a metal button or artificial ligament, may provide a more definitive solution. Surgery can stabilize the joint and potentially reduce the risk of future dislocations, chronic pain, and degenerative changes. However, surgical procedures also come with their own risks, including infection, complications from anesthesia, and the need for rehabilitation post-surgery.

5. Personal factors: Your age (34 years) and the fact that you have a keloid tendency (蟹足腫) may influence your decision. Keloids can complicate surgical recovery and healing, leading to concerns about scarring and cosmetic outcomes. It is crucial to discuss these factors with your orthopedic surgeon, who can provide tailored advice based on your specific circumstances.

In conclusion, while non-surgical treatment for a Grade 2 shoulder dislocation can be effective, it is essential to weigh the potential long-term effects against the benefits of surgical intervention. Consulting with an orthopedic specialist who can assess your individual case, including your activity level, work requirements, and personal health history, will help you make an informed decision about the best course of action for your shoulder injury.

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