Question
Hi there,

I have quite a bit of background, so here we go.

I was a competitive swimmer in my youth and trained year-round from ages 8-18.

Four years ago (at age 26) I sustained a traumatic anterior dislocation of my left shoulder. In the ER I was prepped for reduction, but before I was sedated I was told that I looked "more flexible" than average, and they were easily able to perform the reduction without sedation. Afterwards I went through two weeks of physical therapy, and because they found my strength and range of motion to be 'excellent', they sent me on my merry way.

Since then, I have experienced subluxation/partial dislocations on about a dozen occasions....during stretching, dressing, closing my car door, and even once when I sneezed (all reduced on their own within seconds). During this time I also started swimming again once per week but I would ease up or skip a week if I had a recent subluxation. I did not experience any pain while swimming, but I did have clicking during backstroke, so I avoided it.

About 8 months ago, I decided to join a Master's swim team and increased my workouts to 4 - 3500yd sessions per week. Things were going just fine (even the backstroke clicking had stopped) until my first competition (4 months ago), where I experienced a partial dislocation upon impact with the wall during a fast finish.  I decided to take this a bit more seriously this time?so restricted myself to kick-only workouts for a month, got a referral to an orthopedic surgeon, and went back to physical therapy (which ended fairly quickly and similarly to the first round).  The orthopedic surgeon ordered an MRI, and it showed:

1. Avulsion of the anterior inferior labrum with intact periosteum compatible with Perthes lesion
2. Linear labral tear involving the superior and posterior labrum.
3. Hill-sachs deformity.
4. Undersurface fraying of the supraspinatus tendon.

Surgery has been recommended, and I am currently in the process of figuring out if it is the best option for me.  Since the last partial dislocation, I have also begun to experience a new pain which feels like a huge knot and deep ache between my upper left shoulder blade and spine, accompanied by the dead-arm feeling (I usually get this feeling and pain in front/side of my shoulder for a week or two after a subluxation).  I have also begun seeing a chiropractor who specializes in ART, and she suspects the new pain to possibly be thoracic outlet syndrome as she found my scalene muscles on my left side to be 'complete bricks'.  (I must also note that since my dislocation, I heavily favor breathing on my left side rather than my right. Oh, and, I sit at a desk all day.)

So, I guess my question is, can shoulder instability cause TOS?  From what I know they are completely different problems which have the same symptoms. I'm also wondering if continuing to swim at my normal volume is having detrimental effects on my shoulder?the orthopedic surgeon said that I'm not creating more damage to the shoulder by swimming and that more damage only occurs when I actually re-dislocate.  But if is bringing on TOS in some way and I am having pain because of it, then that really does weigh in on my decision to have the surgery or not.  My swim coach thinks I shouldn't have the surgery and improving my stroke technique will help?.but I'm wondering if the damage might have already been done since my redislocations have mostly occured in non-swimming contexts.

Would love to hear your thoughts, thanks!

Answer
HI Vicky,

I've never seen literature to tie shoulder instability to TOS.    Nevertheless, you seem to have TOS regardless.    Try a provider of FAKTR.com or Grastontechnique.com, the former being the best.     Your shoulder is not great, and surgery may be in your future, however do the conservative care first and surgery last.   ART alone is not all that it's cracked up to be, and is highly dependent on the skills of the provider, e.g. some take the courses but still stink at it...  

'Hope this answers your question.   If not, let me know.

Dr. G