Shoulder Stabilisation
Shoulder instability occurs when the shoulder joint is unable to stay centred in the socket. This may happen after a clear dislocation, a sporting injury, repetitive trauma or, in some patients, because of underlying looseness of the joint capsule.
Dr Ye treats both anterior and posterior shoulder instability in paediatric and adult patients, including adolescent athletes, contact sport injuries, recurrent dislocations and painful unstable shoulders.
When Does Shoulder Instability Need Surgery?
Not every shoulder dislocation requires surgery. Some patients can be managed with rest, physiotherapy, strengthening and activity modification, particularly if the risk of recurrence is low.
However, many young and active patients are at higher risk of further instability after a first dislocation. This is particularly true in teenagers, young adults, contact or collision athletes, overhead athletes and patients with bone loss around the shoulder socket or humeral head.
Repeated instability episodes can cause further damage to the labrum, capsule and bone. For this reason, early stabilisation may be recommended in higher-risk patients rather than waiting for multiple dislocations to occur.
Arthroscopic Shoulder Stabilisation
Arthroscopic, or keyhole, shoulder stabilisation is commonly used to treat shoulder instability. This usually involves repairing the torn labrum and tightening the stretched capsule through small incisions using anchors and sutures.
For appropriately selected patients without significant bone loss, arthroscopic stabilisation can provide excellent results, restore confidence in the shoulder and allow return to work, sport and activity.
Open Stabilisation and Latarjet Procedure
Some patients are better treated with open stabilisation. This is particularly the case when there is significant bone loss, recurrent anterior dislocation or high-risk collision sport involvement.
One important open procedure is the Latarjet procedure. This involves transferring a small piece of bone with attached tendons to the front of the shoulder socket to restore stability. It is a powerful operation for patients with bone loss or high-risk anterior instability.
Dr Ye will discuss whether arthroscopic stabilisation or open stabilisation is more appropriate based on the patient’s age, sport, activity level, number of dislocations, imaging findings and pattern of injury.
Posterior Shoulder Instability
Posterior instability is less common than anterior instability and can be more subtle. Patients may not always describe a clear dislocation. Instead, they may experience pain, weakness, clicking or a feeling that the shoulder is unreliable, particularly with pushing movements, bench press, contact sport or loaded forward elevation.
Posterior instability can often be missed because pain may be the main symptom. Careful assessment and appropriate imaging are important to identify labral injuries, capsular laxity, bone changes or associated pathology.
In selected patients, posterior shoulder instability can be treated arthroscopically with labral repair and capsular stabilisation.
Multidirectional Instability
Multidirectional instability is usually related to generalised looseness or hypermobility. It may affect both shoulders and is often associated with poor shoulder control rather than a single traumatic injury.
In many patients, multidirectional instability is best treated with a structured physiotherapy programme focusing on shoulder control, strength, coordination and scapular mechanics. Surgery is usually reserved for selected cases that do not improve with high-quality rehabilitation.
Imaging and Assessment
A careful assessment is important because treatment depends on the type of instability and the amount of soft tissue or bone injury.
X-rays are usually performed first. CT scans with 3D reconstruction can be helpful to assess bone loss, particularly in recurrent anterior instability. MRI may be useful to assess the labrum, capsule, rotator cuff and associated injuries, especially in painful shoulders, posterior instability or multidirectional instability.
Treatment approach
Shoulder instability treatment needs to be individualised. The best option depends on the patient’s age, sport, work demands, number of instability episodes, direction of instability, bone loss, soft tissue injury and goals.
Dr Ye offers the full range of treatment options for shoulder instability, from non-operative rehabilitation through to arthroscopic stabilisation, open stabilisation and Latarjet procedure. He treats both paediatric and adult shoulder instability and will discuss the most appropriate treatment based on each patient’s symptoms, imaging and functional goals.