Shoulder instability
What is shoulder instability?
Shoulder instability occurs when the ball of the shoulder joint moves too far out of the glenoid ("socket"). This can range from a feeling that the shoulder slips or subluxes, through to a complete dislocation that needs to be put back into place.
Instability may follow a traumatic sporting injury, fall or collision. It can also occur in patients with ligament laxity, repetitive overhead loading, bone loss, or previous dislocations that have stretched or damaged the stabilising structures of the shoulder.
Common symptoms
Symptoms include recurrent dislocations, a sense of slipping or apprehension with the arm overhead or out to the side, pain, loss of confidence, weakness and difficulty returning to contact sport, gym training or overhead activity. Some patients mainly describe pain rather than obvious instability.
Shoulder pain
Diagnosis and imaging
Assessment includes a careful history, shoulder examination and imaging. X-rays help assess alignment and identify fractures or bone defects. MRI or MR arthrogram can assess the labrum, capsule and associated soft-tissue injuries. CT may be used when bone loss is suspected, particularly after recurrent dislocations or before surgery.
Non-surgical treatment
First-time dislocations and milder instability can sometimes be managed without surgery. Treatment may include a short period of protection, physiotherapy to restore movement and strengthen the rotator cuff and scapular stabilisers, and a structured return-to-sport program.
The right approach depends on age, sport, occupation, the number of instability episodes, imaging findings and the level of confidence the patient needs in the shoulder.
Surgical treatment
Surgery may be considered when instability recurs, when the shoulder remains unreliable despite rehabilitation, or when imaging shows injuries that carry a higher risk of further dislocation. Young contact athletes and high-demand patients often have a higher risk of recurrence after a traumatic dislocation.
The surgical plan is tailored to the pattern of instability. Options may include arthroscopic labral repair and capsular tightening, or bone-block procedures when there is significant glenoid bone loss or a high-risk instability pattern.
Recovery and follow-up
Recovery is staged and depends on the procedure performed. After stabilisation surgery, the shoulder is protected initially while the repair heals, then physiotherapy progresses movement, strength, control and sport-specific confidence.
Return to contact or overhead sport is usually gradual and criteria-based. The aim is not just to prevent another dislocation, but to restore trust in the shoulder for work, training and sport.
Shoulder instability FAQs
Does every shoulder dislocation need surgery?
No. Some first-time dislocations can be managed with a period of protection followed by structured physiotherapy. Surgery is more likely to be considered when instability recurs, when there is significant structural damage, or when the risk of recurrence is high because of age, sport or activity demands.
What imaging is needed for shoulder instability?
X-rays are used to assess alignment and look for fractures or bone defects. MRI or MR arthrogram can assess the labrum, capsule and soft tissues. CT may be used when glenoid bone loss or a more complex instability pattern is suspected.
Can physiotherapy fix shoulder instability?
Physiotherapy can be very effective for selected patients, especially when instability is non-traumatic, related to muscle control or a first-time event. Recurrent traumatic instability, significant labral injury or bone loss may be less likely to settle with physiotherapy alone.
When can I return to sport?
Return to sport depends on the type of instability, whether surgery is required and the demands of the sport. It is usually staged, with progression based on pain, movement, strength, control and confidence rather than time alone.
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