Question
Dear Dr. Leatherman,

I am a 23 year old male of medium build and currently active in the gym and tennis. I have suffered from neck pain for a few years now and have seen a chiropracter in boston for treatment, and now see one in manila (where i am now living). I would also like to mention that I am flat-footed.

Here is a slight summary and background of my problems.
- Random Neck pains and strains since age of 19.
- believed to be from a hit i took in rugby in highschool.
- Started seeing a chiropracter in boston a session a week for back and neck alignment.
- feb 24 2007: Was a pedestrian involved in a car accident.
   hit by decelerating pickup going at 50mph(ran red light)
   reacted and shielded body with left arm and left leg
   while jumping away from point of impact.
   Flung into the air, rolled body on landing to spread
   shock and stress of hit. suffered minor injuries.
   MRI/CT/X-ray all showed negative at the ER.
   Sent back home same day with minor bruises and scratches
- Neck pain back with a vengeance started seeing chiro again
- started feeling better till pain was almost gone.
- Feb 2008: skateboard accident. slammed top left shoulder
           into grass ground. no dislocation. but
           excruciating pain. iced it asap and saw a chiro.
- September 9th 2008: went surfing and dislocated shoulder while paddling. chiro believed skateboard incident to have weakened my left joint.
- MRI revealed bankart lesion on left shoulder.
- Singapore MRI revelead similar was advised to continue
 chiro and muscle building exercises by the ortho.
- neck and left shoulder pain persisted but was getting better
- April 2009 consulted with ortho and chiro if i could go surfing again. got the go ahead. Went surfing april 12th 2009. again dislocated while paddling. popped it back in and started swimming back to shore, while swimming back i realized left shoulder kept dislocating on the freestyle stroke (at the motion moving arm from the water to the back and than out of water). Switched to breathstroke and got back to shore.
- Neck pain a lot worse now
- upper left back and shoulder discomfort.
- at the area of the upper left back scapula towards the neck, I feel as if something is pressuring the area behind the scapula. I have to snap my neck to the right in order to relieve the pain momentarily.

What should I do now?
Should i attempt an athroscopic surgery?
Advise would be much appreciated.
Thank you very much for reading.

Cheers,
Miko Tan

Answer
Dear Miko,

WOW, you have such and injurious history...much more so than normal patients with neck and shoulder problems.  At this point Miko, I would recommend that you pursue the surgical options because a Bankhart lesion is not going to get better with physical rehabilitation protocols.  And...the fact that you are so active will only make this issue worse over time...surfers are notorious for the continuation of sport even after injury and your shoulder in integral for the sport.

I would recommend that you seek out a few surgical opinions and pursue the surgical correction at this point to correct the avulsed ligament and repair the labrum (cartilage surface) of the joint if needed.  I can only assume that you have damage to both at this point and possibly a bone fragment in there too.  You will definitely need to go through 4-6 weeks of post-surgical rehabilitation after the surgery though, and this can be performed either by a chiropractor or physical therapist.

Good luck Miko...here is to a speedy recovery!

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net