Shoulder instability and labral tears

What it is

Shoulder instability describes a shoulder that feels as though it slips, partially comes out of joint, or fully dislocates. Some people experience repeated dislocations, while others simply feel that the shoulder is unreliable, weak or painful in certain positions. The shoulder trades stability for movement, and that stability depends on the labrum (the rim of cartilage around the socket), the ligaments, the shape of the bone and the muscles that control the joint.

How it usually presents

• The shoulder slipping or partly coming out with certain movements
• A sense of dread or apprehension reaching overhead or behind you
• Full dislocations needing to be put back
• A shoulder that feels unreliable, weak or painful in certain positions
• Avoiding sports, swimming or sleeping with the arm above your head

Why does it happen?

Shoulder instability often starts after a significant injury such as a fall, sporting accident or collision, where the shoulder has been forced out of joint. This is known as traumatic instability. The damage may involve the cartilage rim (labrum), ligaments or the bone itself, and repeated dislocations can wear away bone over time. Not all instability follows a single injury, however. Some people have naturally lax, flexible tissues, and others develop symptoms because of changes in the way the muscles around the shoulder and shoulder blade work together to control the joint. Understanding the direction in which the shoulder becomes unstable — towards the front, the back or in more than one direction — is the most important part of deciding on the right treatment.

Do I need a scan or surgery?

Careful examination establishes the direction and type of instability. Simple X-rays are often the starting point, and an MR arthrogram or CT scan may be arranged where it will genuinely change the plan, particularly to assess the labrum and any bone loss. Where instability is driven by muscle control rather than structural damage, rehabilitation is the first line of treatment. Where there is a labral or bone injury, keyhole (arthroscopic) stabilisation or a bone-block procedure such as a Latarjet may be recommended.

Treatment options

• Specialist physiotherapy to build strength, coordination and shoulder blade control
• Rehabilitation before surgery, where an operation is likely to be needed
• Activity and technique modification for sport and work
• Imaging where it will genuinely change the plan, including assessment of bone loss
• Keyhole (arthroscopic) stabilisation of the labrum and ligaments
• Bone-block or other reconstructive procedures where there is significant bone loss

The first step is always a careful assessment. By understanding how your symptoms started, examining how your shoulder moves and functions, and arranging appropriate imaging where necessary, we can identify the underlying cause of your instability and decide together on the treatment that is most likely to restore confidence in your shoulder.