Jude Bellingham’s shoulder problem presents Real Madrid and their top scorer with a big decision to make — one that could also have a bearing on England’s plans for the European Championship next summer.

Bellingham, who has scored 15 goals in his first 16 appearances since joining from Borussia Dortmund in the summer, dislocated his left shoulder in a 0-0 draw at home to Rayo Vallecano on November 5.

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He completed that match but did not feature in Madrid’s next two games. Against Braga in the Champions League, he was on the bench and at home to Valencia, he was not in the squad. He then joined up with England during the recent international break but did not play in either of their final two Euro 2024 qualifiers.

Last weekend, Bellingham returned to action by starting in Madrid’s trip to Cadiz and scored their third goal in a 3-0 win, but he was suffering. He played that game with shoulder protection in place and, on several occasions, you could see him trying to avoid exposing the area to contact.

Bellingham has made a spectacular start to life in Madrid and the plan seems to be that he will continue to play while protecting the shoulder.

“He had and has the problem,” said Madrid manager Carlo Ancelotti after the Cadiz fixture. “But with the protection, he is fine. So he played a very good game today.”

Before we continue, a quick note on this article and reporting on medical issues more generally. Everything reported here has been thoroughly sourced according to our standards on accuracy but the nature of football injuries and their treatment means that plans can change. For that reason, it isn’t possible to present a definitive version of how Bellingham’s shoulder injury will be treated.

However, sources at the club familiar with treating the kind of injury Bellingham suffered — who, like all those sources cited in this article, remain anonymous to protect relationships — suggest surgery is an option to completely resolve the issue.

A medical staff source said “conservative treatment” is usually the first response but “once a shoulder is out, the player will feel pain and this pain usually does not repair itself”.

The source also said that “sooner or later”, Bellingham would likely have surgery, but added that he could “wait a day, a week, a season or longer”. They continued: “You can live with it as long as you can deal with it. Then you have to operate.”

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Madrid sources have not confirmed any plans for Bellingham to have surgery. But, as you would expect for any club dealing with an injured player, the option has already been discussed. Time and further examination will determine what happens next.

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Dr Mikel Aramberri is CEO of the Alai Sports Medicine Clinic in Madrid. He says surgery is usually only recommended when a player has already suffered a dislocated shoulder previously — but not always.

“If the shoulder keeps popping out it is necessary to operate because then the player cannot be available for the coach,” he says. “But if it is an isolated episode one year and then after three years they have another isolated episode, and no instability is seen in the examination, it is not always usual to operate.”

Dr Santiago Arauz, who leads the shoulder unit at Clinica Cemtro, a Madrid hospital that specialises in surgical procedures, adds: “With a first dislocation, there may be debate. With two, if they are complete dislocations, most specialists agree that surgery is recommended. There is a lot of consensus on that.

“But anyone who has dislocated their shoulder once has a risk of recurrence that varies according to their age when they first dislocated it. The younger they are, the greater the risk of recurrence. If a 16-year-old dislocates his shoulder and has it repositioned, we know that there is a 90 per cent risk of it coming back. With each dislocation, the chances multiply.”

Dr Arauz predicts the recovery process for a footballer would likely take “at least two months”.

“In combat sports, we defer it to six months. In two months, the shoulder would not be healed but, in reality, the return to sport has to do with certain minimum requirements that have to be met; that you have good mobility, that you can move quickly, that you have no pain and that you have a minimum recovery of strength. And the advantage with football is that you can choose the time of the season to operate.”

It is not known whether Bellingham has suffered previous shoulder dislocations, but photos from his time at Dortmund do show him wearing shoulder support on two occasions when playing for the club in August 2022 and March 2023.

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Interestingly, Bellingham’s Madrid team-mate Brahim Diaz also dislocated a shoulder this season, in late September. The 24-year-old has continued to play despite the problem, even doing so (and scoring) just days after suffering the injury, on September 27.

The plan is for Brahim to have surgery once the season is over, giving him time to recover without missing game time.

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Bellingham’s situation is quite different. Unlike Brahim, he has an international competition to think of next summer — and he is just as crucial for England as he is for Real Madrid.

For now, the plan is for Bellingham to play on and he did so to great effect on Wednesday night against Napoli, scoring his 15th goal of the season in Madrid’s Champions League victory.

During last weekend’s fixture against Cadiz, at least one of his opponents attempted to target his shoulder in challenges that left Bellingham visibly frustrated.

Bellingham wore “protection” around his shoulder during that game, as Ancelotti said himself. Sources close to the club’s medical advisors indicate that this protection is commonly used in the NFL and has been imported from there, and sources in the Madrid dressing room say it has also been used by players in the Premier League. Its purpose is to help support the area during matches to alleviate pain, as well as reduce the risk of another dislocation.

In some set pieces against Cadiz, Bellingham attempted to keep his left arm behind his back when challenging for the ball. When he fell to the ground, he tried to get his arm up as quickly as possible to avoid too much contact.

Against Napoli, there were moments and small gestures that appeared to suggest he was still taking care not to further damage his shoulder — but he was once again the standout performer in Ancelotti’s side, also providing the assist for Joselu’s late goal in the 4-2 win.

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Sooner or later, it seems player and club will have to make a call on whether he might benefit from an operation on his shoulder — and when that might happen.

(Top photo: Manuel Reino/DeFodi Images via Getty Images)