Shoulder Disorders

Shoulder Instability and Dislocation

Anterior Dislocations/Initial Dislocation

LEOs 40 years of age or older:

1. Non-surgical – Those treated by closed reduction, who have demonstrated a successful return to full-training activities should be able to return to unrestricted duty 6 months after injury.3,4,5
2. Surgical – Those treated with surgical repair, who have then demonstrated successful return to full-training activities, should be able to return to unrestricted duty in 6 months post-surgery.

LEOs under 40 years of age:

1. Non-Surgical – Those treated by closed reduction should be restricted from full duty for at least 3 years.3,6,7,8,9,10,11
2. Surgical – Those who at the time of surgical repair, were determined to have a Baker Type 1 (capsular tears with no labral lesions, stable under anesthesia, and had no or minimal hemarthrosis) injury and who demonstrated a successful return to full-training activities should be able to return to unrestricted duty 6 months post-surgery.
3. Surgical – Those who at the time of surgical repair were determined to have a Baker Type 2 or 3 injury (Type 2: capsular tears, partial labral detachments, mildly unstable and mild to moderate hemarthrosis; Type 3: capsular tears with labral detachments grossly unstable and large hemarthrosis, and complete capsular/labral detachments) and who have successfully returned to full-training activities should not be cleared to full duty until at least 2 years following surgery.

Posterior Dislocations
When dealing with a posterior shoulder dislocation, it is important to remember that this condition is often associated with a seizure disorder. Therefore, the examiner is advised to review the LEO’s medical history when treating this condition.

LEOs with a posterior dislocation from trauma, without evidence of instability in rehabilitation and who have demonstrated a successful return to full-training activities should be able to return to unrestricted duty in 6 months.

LEOs with a posterior dislocation due to the following mechanisms will require surgery in order to return to unrestricted duty:

• Related to seizure
• Traumatic with persistent instability
• Recurrent posterior shoulder dislocation

LEOs who have demonstrated a successful return to full-training activities should be able to return to unrestricted duty in 6-9 months post-surgery.12,13,14

Inferior Shoulder Dislocation
LEOs can be treated non-surgically if reduction is easily obtained. LEOs who have demonstrated a successful return to full-training activities should be able to return to unrestricted duty. These dislocations are so rare that a timeframe for return to full duty is unclear.

If reduction is not successful, surgical treatment is required.15 LEOs who have demonstrated a successful return to full-training activities should be able to return to unrestricted duty in 6 months.

Posterior Shoulder Instability Without Prior Dislocation
LEOs with posterior shoulder instability can be treated conservatively. Those who have demonstrated a successful return to full-training activities should be able to return to unrestricted duty.

Those who fail conservative treatment are candidates for surgery.12 Following surgery, those who have demonstrated a successful return to full-training activities should be able to return to unrestricted duty in 6 months.