My 19-year-old son dislocated his shoulder for the second time while windsurfing. He was advised to have surgery. His father dislocated his shoulder five years ago while skiing. He has not had any subsequent problems. What treatment would you advise for my son?

The term dislocation of the shoulder is used to describe the disruption and displacement of the normal contact between the head of the humerus (ball) and the glenoid (socket) of the shoulder joint. Both your son and your husband had to have had sustained a significant trauma to dislocate a shoulder if they have had no prior history of instability. The age at which a person dislocates his or her shoulder becomes an important factor when considering treatment. The potential for recurrent dislocation episodes is high in individuals under 20 years of age. Some studies report as high as 90 percent recurrent dislocations in those individuals under 20 years of age who are athletic. Your husband, on the other hand, has had no subsequent dislocations of his shoulder over the past five years. This history is consistent with studies that have evaluated and followed individuals over 40 who have had a dislocation. Since the likelihood of recurrent dislocation occurring in people over 40 is low, nonoperative treatment is indicated. Thus, one would expect your husband to respond well to a brief period of immobilization with a shoulder sling followed by physical therapy and rehabilitation. Because your son's initial dislocation occurred under age 20, the likelihood is high for subsequent dislocations. Nonoperative treatment has a high failure rate in this age group. With each subsequent dislocation, further damage to the shoulder can occur as well as injury to the nerves around the shoulder joint. Surgery to restore stability to the shoulder joint should be considered in your son's case.