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Shoulder

Shoulder Instability

What is shoulder instability?

Shoulder instability occurs when the ball of the upper arm (humerus) moves too much or slips out of the shoulder socket (glenoid). This can happen from injury or repetitive motion and leads to a feeling of looseness, weakness, or the shoulder “giving out.”

A shoulder subluxation is a partial dislocation where the ball of the shoulder briefly slips out of the socket and then returns on its own. It can cause pain, weakness, or a sensation that the shoulder is unstable.

A shoulder dislocation happens when the ball completely comes out of the socket. This often requires medical help to put it back in place. Dislocations stretch or tear stabilizing structures like the labrum, ligaments, and capsule, increasing the risk of future instability.

Symptoms include sudden pain, visible deformity, loss of shoulder movement, and a feeling that the joint is “out of place.” After reduction, patients may have ongoing pain, weakness, or fear of movement, especially with the arm out and back (abduction external rotation/ABER position).

Dislocations often occur from trauma, such as a fall or direct impact during sports. Repeated overhead motions (like throwing or swimming) can stretch shoulder ligaments over time, making the shoulder more prone to instability.

Diagnosis includes a detailed history and physical exam to assess joint stability and function. Imaging tests like X-rays confirm dislocation and rule out fractures. MRI or CT scans are used to check for soft tissue damage (like a torn labrum) or bone loss.

Initial treatment may include rest, immobilization, and physical therapy. Recurrent instability often requires surgery, especially in younger or athletic patients. Surgical options include labral repair, remplissage, or bone block procedures, depending on the injury pattern and bone loss.

A Bankart/anterior labral repair involves reattaching the torn labrum (the cartilage rim around the socket) to restore stability. This is usually done arthroscopically and is the most common procedure for anterior shoulder instability.

Remplissage is an additional procedure performed with labral repair when a bone defect called a Hill-Sachs lesion is present. It involves “filling in” the defect with part of the rotator cuff tendon to prevent the shoulder from engaging and dislocating again.

A bone block procedure adds bone to the front of the shoulder socket when there’s significant bone loss. The Latarjet uses a piece of the patient’s shoulder blade; a distal tibial allograft uses donor bone. These procedures provide stability when soft tissue repair alone isn’t enough.

Recovery takes about 4 to 6 months. Patients wear a sling for several weeks, then begin physical therapy to restore motion and strength. Athletes may return to sport after 5 to 6 months depending on progress and sport type.

Full recovery typically takes 6 to 9 months. Patients begin with a sling and gradually progress through therapy. Bone healing takes time, so return to high-demand sports is usually delayed until around 6 months or more post-op.

At a Glance

Sachin Allahabadi, MD

  • Board-Certified & Fellowship-Trained Sports Medicine Surgeon
  • Expertise in Minimally Invasive Knee & Shoulder Surgeries
  • Assistant Professor of Clinical Orthopaedic Surgery, Houston Methodist Hospital & Weill Cornell Medical College
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