Scripps doctor shares expertise on shoulder subluxations

Dr. Heinz Hoenecke
(Courtesy )

Padres star Fernando Tatis Jr. has missed parts of this baseball season with shoulder issues, starting with a subluxation shortly after the season began. In a Q&A, Scripps orthopedic surgeon and sports medicine specialist Dr. Heinz Hoenecke discussed the different types of shoulder subluxations, how they are treated and potential side effects. As former Padres head physician, he has seen the physical trauma that can cause that particular injury in athletes.

Answers were lightly edited for clarity.

Q. How did you get your previous role as team physician of the Padres?

Hoenecke: The clinic that I’m with, Scripps, had taken care of the Padres for a long time, so when I joined them, I started helping out with the Padres in 1997 and then took over as the head physician in 2007, and then kept that until the end of 2016. My practice has a strong emphasis on shoulders, so I’ve seen shoulder problems and instability in multiple sports.

Q. Are Fernando Tatis Jr.’s shoulder injuries typical of the issues you see in your patients?

Hoenecke: I can’t speak to his specifics. But speaking about subluxations in general, for athletes we see them most commonly in contact or collision sports. Just talking about the general population in terms of subluxations, they come in two forms. We try to sort patients out depending on whether they have a history of a loose shoulder, whether it seems to slide in and out in different directions, no history of trauma, maybe even in both shoulders. Those patients are ones where we just try to rehab and do physical therapy to strengthen it. As they get older, they usually stabilize. But the kind that we see from sports involve a traumatic event where there’s often a torn labrum. If they had a traumatic event where it comes out and if they’re young, and this is most commonly in people in their late teens and 20s, they have a fair chance of it coming out again.

There’s always concern that with each subluxation or dislocation that they’re chipping away bone or cartilage that’s going to make it more likely to come out and decrease the potential success of the surgery.

Q: Is there a difference in the types of shoulder subluxations that you see in professional athletes versus non pro athletes?

Hoenecke: Not necessarily. If they’re both coming from a traumatic event such as falling, a recreational snowboarder may have the same report as a professional athlete. The biggest difference between the two usually is the timing of when to repair it. For an athlete who’s involved with a team, we try to pick that for a time that won’t impact his competitiveness, his ability to perform.

Q: What are the treatment options that patients would have to consider and what can they expect in recovery?

Hoenecke: That would depend on if it’s just a labral tear without a lot of bone or cartilage damage. Then we can do typically an arthroscopic repair, where we put little tacks with sutures in to repair the labrum and allow it to heal. Or if we find that they have more damage, then we have to actually open the shoulder, which might involve more aggressive procedures that potentially could cause the patient to lose range of motion. And then that gets into sport. If it’s a throwing arm, then you’re significantly concerned about any range of motion loss.

Q: Is there anything else people should know about shoulder subluxations?

Hoenecke: You have to individualize each of these. You need to know what the history is and you need to know exactly what the anatomy of the damage is to make the best decision.