Dislocated shoulder from bike fall

[JDelage]

A few days ago I had a bad fall while biking which resulted in a dislocated shoulder (not to mention chipped teeth & road abrasions). I was brought to the emergency room in ambulance, and they reset the shoulder. As of now, my pain is manageable, but my shoulder has very little mobility and no strength. Today I am going to meet with my regular doctor. I have a few questions for the people here:

1) What should I ask my doctor in terms of diagnostic, imaging or others? Is "classical" PT useful for this? In the ER I got no assessment of other potential damage to ligaments, etc.

2) What is the rehab protocol that have been successful for this kind of injury?

[JDelage]

So, MRI analysis is that there are a number of partial & full tears on tendons and ligaments, see below for details. The person i reviewed the MRI with strongly suggests surgery, but then he's a surgeon. I'm going to review the MRI with another surgeon for a 2nd opinion.

MRI results:

Impression

1. Evidence of recent anterior dislocation with Hill-Sachs and Bankart lesions.
2. At least partial avulsion at the humeral attachment of the inferior glenohumeral ligament associated with the above.
3. High-grade partial-thickness articular sided tearing at the distal supraspinatus tendon.
4. Tendinosis and low to moderate grade partial-thickness articular surface tearing at the distal infraspinatus tendon with overlying subacromial/subdeltoid bursitis.
5. Full-thickness longitudinal tear at the distal superior subscapularis tendon with high-grade partial-thickness tearing inferiorly.
6. Longitudinal tear at the superior labrum which could be posttraumatic or degenerative.
7. Moderately severe AC joint DJD.

Final Report Signed by: [redacted]
Inland Imaging, PS
Sign Date/Time: 01/07/2022 8:08 AM PST

Narrative
MRI UPPER EXTREMITY, JOINT; WITHOUT CONTRAST (CPT)

MRI RIGHT SHOULDER
CLINICAL INFORMATION:
Shoulder pain, rotator cuff disorder suspected, xray done

COMPARISON:
XR SHOULDER RIGHT (1/4/2022);

PROCEDURE:
Coronal oblique T1 and T2. Sagittal oblique T1 and T2. Axial T2 and PD.
Sedation: None

FINDINGS:
Bone Marrow: There is a mildly depressed impaction fracture (Hill-Sachs
lesion) at the posterolateral aspect of the superior humeral head.
There is contusion without definite fracture at the anterior/inferior
glenoid.
Joint Space/Capsule: There is a moderate-sized effusion. There is at
least partial avulsion at the humeral attachment of the inferior
glenohumeral ligament. There is thickening and increased signal of the
partially retracted fibers. There is no dislocation.

Acromion/Supraspinatus Outlet: Acromion process is Bigliani type 2.
Acromioclavicular Joint: Intact with moderately severe DJD.

Rotator Cuff:
*Supra/Infraspinatus: There is high-grade partial-thickness articular
sided tearing at the distal supraspinatus tendon. There is tendinosis
and low to moderate grade partial-thickness articular surface tearing
at the distal infraspinatus tendon. There is mild fluid signal in the
subacromial/subdeltoid space.
*Teres Minor: Intact
*Subscapularis: There is a full-thickness longitudinal tear at the
distal superior subscapularis tendon associated with partial medial
subluxation of the biceps. Tendinosis and high-grade partial-thickness
tearing are seen at the mid and inferior aspect of the subscapularis
tendon.

Biceps/Rotator Interval: Intact though demonstrating mild medial
subluxation at the level of the lesser tuberosity.
Glenoid Labrum: There is tearing and partial detachment at the
anterior/inferior labrum. Longitudinal tear is also seen at the
superior labrum.
Articular Cartilage: No focal defect or significant thinning is
identified.

Miscellaneous: Extensive edema is seen along the anterior aspect of the
subscapularis tendon.

[Will Morris]

So, MRI analysis is that there are a number of partial & full tears on tendons and ligaments, see below for details. The person i reviewed the MRI with strongly suggests surgery, but then he's a surgeon. I'm going to review the MRI with another surgeon for a 2nd opinion.

MRI results:

Impression

1. Evidence of recent anterior dislocation with Hill-Sachs and Bankart lesions.
2. At least partial avulsion at the humeral attachment of the inferior glenohumeral ligament associated with the above.
3. High-grade partial-thickness articular sided tearing at the distal supraspinatus tendon.
4. Tendinosis and low to moderate grade partial-thickness articular surface tearing at the distal infraspinatus tendon with overlying subacromial/subdeltoid bursitis.
5. Full-thickness longitudinal tear at the distal superior subscapularis tendon with high-grade partial-thickness tearing inferiorly.
6. Longitudinal tear at the superior labrum which could be posttraumatic or degenerative.
7. Moderately severe AC joint DJD.

Final Report Signed by: [redacted]
Inland Imaging, PS
Sign Date/Time: 01/07/2022 8:08 AM PST

Narrative
MRI UPPER EXTREMITY, JOINT; WITHOUT CONTRAST (CPT)

MRI RIGHT SHOULDER
CLINICAL INFORMATION:
Shoulder pain, rotator cuff disorder suspected, xray done

COMPARISON:
XR SHOULDER RIGHT (1/4/2022);

PROCEDURE:
Coronal oblique T1 and T2. Sagittal oblique T1 and T2. Axial T2 and PD.
Sedation: None

FINDINGS:
Bone Marrow: There is a mildly depressed impaction fracture (Hill-Sachs
lesion) at the posterolateral aspect of the superior humeral head.
There is contusion without definite fracture at the anterior/inferior
glenoid.
Joint Space/Capsule: There is a moderate-sized effusion. There is at
least partial avulsion at the humeral attachment of the inferior
glenohumeral ligament. There is thickening and increased signal of the
partially retracted fibers. There is no dislocation.

Acromion/Supraspinatus Outlet: Acromion process is Bigliani type 2.
Acromioclavicular Joint: Intact with moderately severe DJD.

Rotator Cuff:
*Supra/Infraspinatus: There is high-grade partial-thickness articular
sided tearing at the distal supraspinatus tendon. There is tendinosis
and low to moderate grade partial-thickness articular surface tearing
at the distal infraspinatus tendon. There is mild fluid signal in the
subacromial/subdeltoid space.
*Teres Minor: Intact
*Subscapularis: There is a full-thickness longitudinal tear at the
distal superior subscapularis tendon associated with partial medial
subluxation of the biceps. Tendinosis and high-grade partial-thickness
tearing are seen at the mid and inferior aspect of the subscapularis
tendon.

Biceps/Rotator Interval: Intact though demonstrating mild medial
subluxation at the level of the lesser tuberosity.
Glenoid Labrum: There is tearing and partial detachment at the
anterior/inferior labrum. Longitudinal tear is also seen at the
superior labrum.
Articular Cartilage: No focal defect or significant thinning is
identified.

Miscellaneous: Extensive edema is seen along the anterior aspect of the
subscapularis tendon.

Findings 1 and 2 are the ones the most strongly indicate surgery. With both a Hill-Sachs and a Bankhart lesion, your shoulder is going to be structurally unstable and your risk of repeat dislocation is extremely high. I would be quite shocked if they did not see an actual fracture at the anterior inferior glenoid during surgery.

If I were a betting man, I would bet on a Hill-Sachs and Bankhart repair, RTC repair, labral repair with anchor, biceps tenodesis, and Distal Clavicle Excision

[JDelage]

Thank you Will. I am meeting with another shoulder specialist in a couple weeks (earliest I could get him) to get a second opinion. One thing I have heard is that different specialist might disagree on the analysis of the MRI. I wish I could just upload it somewhere and get some solid analysis done that way (in addition, not instead of, one-on-one consultations).