What is the proper treatment for first time shoulder dislocation?

This question comes to us from San Diego California:

“My 16 year-old son is a competitive baseball player who has recently dislocated his shoulder after a fall. I have had conflicting advice concerning the best way to go in terms of treatment. What do you think is the best course of action?”

Answer: The proper treatment for anterior shoulder dislocation has been long debated in the literature. The answer depends on several factors, the most important being the age of the patient when the first dislocation occurred. It may be surprising to hear that an increased recurrence rate of shoulder dislocation has been identified in younger patients. This means that the older you are when the dislocation occurs, the less chance you have of re-injury. It is also known that there is an increased incidence with participation in contact sports.

There are two main paths to take with managing this injury. The first is conservative treatment which consists of pain control and rehabilitation; the second is surgery. Recent literature states that the risk of recurrence of dislocation is 5 times greater when treated conservatively. It is also known that in young, highly active patients not treated with surgery initially, between 25 & 45% will require subsequent surgery. Therefore it would be safe to say that for a young, active/athletic person who wishes to continue sports participation, surgery is most likely the way to go. This of course must be a case by case decision between the athlete, guardian, therapist, and surgeon.