Shoulder condition

Shoulder instability

The shoulder has more motion than any other major joint, so it depends on the labrum, capsule, ligaments, and surrounding muscles for stability. Instability occurs when the ball of the shoulder moves partly or completely out of the socket. Many patients are helped without surgery. This page explains what instability is, how it's evaluated, and how a treatment decision is approached.

General orthopedic education — not medical advice. Decisions about your care should be made with a qualified clinician.

How the shoulder stays stable, and what instability is

The shoulder has more motion than any other major joint, which makes it dependent on the labrum, capsule, ligaments, and surrounding muscles for stability. Instability occurs when the ball of the shoulder moves partly or completely out of the socket.

Dislocation and subluxation

A dislocation occurs when the ball comes completely out of the socket. A subluxation is a partial or temporary loss of alignment that may slide back into place on its own. Both can injure the structures that stabilize the shoulder.

Traumatic and atraumatic instability

Some instability begins with a traumatic injury, while other patients develop instability related to joint laxity, repetitive activity, muscle-control problems, or a combination of factors. These patterns are evaluated and treated differently.

A first-time dislocation

A first-time shoulder dislocation requires prompt evaluation to confirm that the joint is reduced and to assess for fracture, nerve injury, rotator cuff injury, labral injury, or other damage. Treatment afterward is individualized according to the injury and the patient.

Common symptoms

Symptoms may include repeated dislocations or subluxations, a sense that the shoulder may slip out, pain, weakness, apprehension in certain positions, or difficulty returning to sports and activities.

Repeated dislocations or subluxations
A sense that the shoulder may slip out
Pain or weakness
Apprehension in certain positions
Difficulty returning to sports and activities

How shoulder instability is evaluated

Evaluation begins with the injury history and physical examination. X-rays assess alignment, fractures, and bony changes. MRI is sometimes used to evaluate the labrum, capsule, rotator cuff, and other soft tissues. CT may be used when more detailed assessment of bone loss is needed.

Nonsurgical treatment

Some patients regain dependable stability without surgery.

Nonsurgical treatment commonly includes rehabilitation to restore motion, strength, coordination, and control of the shoulder. Activity modification may be used while the shoulder recovers. Some patients regain dependable stability without surgery.

Recurrence and treatment decisions

The likelihood of recurrent instability is influenced by factors including age, activity level, sport, number of instability events, tissue injury, bone loss, and the direction and pattern of instability. No single factor determines treatment.

Preparing for your visit

Questions worth discussing at your evaluation

Bringing a few questions can make the first conversation more useful. You might ask:

Was this a full dislocation or a partial slip, and was anything injured when it happened?
Given my age, activity, and history, how likely is my shoulder to become unstable again?
What are my nonsurgical and surgical options, and what are the trade-offs of each?
If we try rehabilitation first, how will we know whether it's working?
How do the sports or activities I want to return to affect the decision?

Common questions