Shoulder instability

Shoulder instability refers to a shoulder joint that dislocates, partially dislocates (subluxes) or feels loose and unreliable. It most commonly results from a traumatic dislocation that tears the labrum (the soft tissue rim of the shoulder socket), but can also arise from ligamentous laxity or repetitive overhead activity.

Symptoms

• A history of shoulder dislocation requiring manipulation to relocate
• A sensation of the shoulder slipping or giving way
• Apprehension when raising the arm in certain positions
• Pain and a sense of looseness with overhead or throwing activities

Diagnosis

Clinical examination is central to diagnosis. Imaging with X-ray (to assess bone loss) and MRI (to evaluate the labrum and ligaments) is typically arranged. CT scan may be required if significant bone loss is suspected.

Non-surgical management

For first-time dislocations in older, less active patients, or where instability is mild, physiotherapy to strengthen the rotator cuff and periscapular muscles may reduce the risk of re-dislocation.

Surgical options

Arthroscopic Bankart repair

This keyhole procedure reattaches the torn labrum back to the glenoid (socket) rim using suture anchors. It aims to restore the normal anatomy of the shoulder with minimal tissue disruption. Results depend on factors including whether the glenoid bone is intact.

Latarjet procedure

The Latarjet procedure transfers the coracoid process (a bony projection of the shoulder blade) to the front of the glenoid socket. This creates a bony buttress that prevents the humeral head from dislocating anteriorly. It is particularly indicated when there is significant bone loss from the glenoid or in cases of failed arthroscopic repair.

Recovery

Following surgery, a sling is worn for 4–6 weeks. Physiotherapy commences early to restore movement and strength. Return to contact sports typically occurs at 6–9 months for arthroscopic repair, though recovery varies between people.