What is the condition?

Shoulder instability occurs when the ball of the shoulder joint (humeral head) moves excessively or dislocates from the socket (glenoid). This may result from trauma, ligament laxity, or repetitive strain.

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What are the symptoms?

· Recurrent shoulder dislocations or subluxations (partial dislocations)

· A feeling of looseness or apprehension, especially during overhead or throwing movements

· Pain during activity or after episodes of instability

· Weakness or reduced confidence using the shoulder

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What is the natural history?

· Patients under 20 years of age have a high rate of recurrence after a first dislocation if left untreated (over 90%)

· Some patients experience increasing episodes of instability, leading to cartilage or labral damage over time

· Others may have infrequent episodes but develop shoulder arthritis in the long term due to repeated trauma

· Physiotherapy can improve shoulder control but may not prevent recurrent dislocations in all patients

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What are the risk factors for recurrent dislocation?​

· Younger age at the time of first dislocation (especially under 20 years)

· Participation in contact or overhead sports (e.g. rugby, basketball, swimming)

· Presence of a Bankart lesion (labral tear) or bone loss

· Generalised ligamentous laxity or connective tissue disorders

· Inadequate rehabilitation or premature return to high-risk activities

· Multiple prior dislocations or subluxation episodes

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How is it diagnosed?

· Clinical examination assessing shoulder movement, apprehension, and stability

· X-rays to assess for fractures or bony defects

· CT scan with 3D reconstruction looking for glenoid bone loss

· MRI to assess labral tears and capsular laxity in select cases

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What are the treatment options?

· Initial dislocations are often treated with a period of rest in a sling followed by physiotherapy. Imaging is performed and the risk of recurrent dislocation is stratified.

o For high-risk patients or those with substantial bone loss, surgery may be advisable even after a single episode

o For lower risk patients, observation and activity modification may be discussed

· Recurrent instability typically requires surgical stabilisation, particularly in young, active patients

· Surgical options include arthroscopic or open stabilisation, depending on injury pattern and bone loss

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When is surgery required?

· High-risk patients with substantial bone loss

· First time traumatic dislocations in young patients (age <25)

· Recurrent dislocations

· Associated rotator cuff tears or shoulder fractures

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What are the types of surgery?

Choice of surgery depends on patient age, sport, ligament quality, and presence of bone defects

· Arthroscopic stabilisation: Minimally invasive technique using keyhole surgery to repair the torn labrum and tighten the capsule with suture anchors. This is typically recommended in lower risk patients without bone loss

· Open stabillisation (e.g. Latarjet procedure): Required when there is significant bone loss or failed previous surgery. Involves transferring part of the coracoid bone to the front of the socket for added stability​

 

What happens if this condition is left untreated?

· Ongoing instability and risk of further dislocations

· Progressive damage to the labrum, cartilage, and joint surface

· Development of post-traumatic shoulder arthritis over time

· Reduced performance in sport or physical activity

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How long is the recovery following surgery?

· First 6 weeks: Wound healing and passive exercises

o A sling is worn full-time to protect the repair

o Physiotherapy focuses on pain control, posture, and passive range of motion

o Avoid lifting, pushing, or overhead movement

o Daily hand, wrist, and elbow mobility exercises are encouraged

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· 6 to 12 weeks: Gentle active motion but no lifting or strengthening

o Begin active-assisted shoulder range of motion under physiotherapist supervision

o Gradual improvement in movement and control

o Avoid strengthening or contact activities during this phase

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· 3 to 6 months: Commencement of gentle strengthening

o Progress to active range of motion and introduce strengthening exercises

o Focus on scapular control, rotator cuff strengthening, and functional movement patterns

o Most patients return to non-contact activities and desk-based work

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· 6 to 9 months: Return to sport

o Return to sport-specific drills, impact loading, and overhead activity as tolerated

o Contact sport or heavy labour is usually permitted after 5–6 months with surgeon clearance

o Ongoing strengthening and conditioning may continue for optimal performance

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What are the expected outcomes of surgery?

Surgical stabilisation is highly effective in preventing further dislocations, and most patients are able to return to sport and full activity. The risk of recurrence is lowest when surgery is combined with appropriate technique and structured rehabilitation. Recurrence rates can vary between individuals and depend on factors such as the type of sport and level of participation.

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In general, the recurrence rate for shoulder stabilisation varies depending on the procedure, your age, and the type of sport or activity you return to. In general, long term studies have shown the following:

· Arthroscopic stabilisation: 15% recurrence at 10–15 years

· Latarjet procedure: 2–5% recurrence

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What are the risks of surgery?

Shoulder stabilisation surgery is generally safe and effective, but as with all operations, there are potential risks. General surgical risks include infection, bleeding and wound issues.

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Specific to shoulder stabilisation, there is a risk of recurrence of instability or dislocation. Other potential risks include stiffness and loss of shoulder motion, persistent pain, or, rarely, injury to surrounding nerves. In the longer term, shoulder arthritis can develop in some patients.

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The Latarjet procedure carries additional risks related to the bone graft, including problems with screw fixation, graft position, or healing, which sometimes require further surgery. Very rare complications include blood clots, complex regional pain syndrome, or the need for revision stabilisation.

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What does the rehabilitation/recovery involve?

To find out more about rehabilitation and recovery after shoulder surgery please see our Rehabilitation Protocols here.