Shoulder Instability & Dislocation

The ball and socket joint of the shoulder is a delicate balance of ligaments, cartilage, muscles and bones and when any of these tissues become injured or overstressed then the shoulder can become unstable and dislocate.

Shoulder instability means the joint moves more than it should or even dislocates totally, either at the front, back or bottom of the joint. Treatment will often depend on the cause of the shoulder instability and during your consultation with your London Shoulder Specialists consultant, they will try to identify the trigger event.

There are three broad categories that can cause instability and dislocation of the shoulder.

For more information on shoulder instability and dislocation and possible treatment options, call +44 (0) 203 195 2442 to arrange a consultation with the London Shoulder Specialists.

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First, there is traumatic dislocation, typically caused by a direct, forceful injury that may have torn the labrum which is the cartilage ring around the shoulder socket.

This would usually be of a nature to require medical attention at the time and you will usually have been advised to wear a sling and undergo physiotherapy, but often the resultant instability does not resolve.

The second cause is multidirectional instability where the shoulder dislocates with very little force and it can happen through the day, depending on your activities. People with hyper-extension or increased joint laxity can suffer from this. Physiotherapy may be initially recommended to ensure the shoulder is kept in correct balance when performing a range of movements.

The third cause is positional non-traumatic dislocations and is the result of ‘abnormal’ muscle movement that allows the patient to dislocate the shoulders, usually both, by performing a particular movement such as lifting the arm above the head.

Lifestyle adjustments and the use of a shoulder support may help, but if instability continues, surgical intervention may be required. X-rays and MRI scans will identify the extent of the problem and CT scans are also used to assess bone damage.

Depending on the underlying cause this may be an open or arthroscopic procedure. For positional non-traumatic dislocations, thermal capsular shrinkage or plication may be recommended.

Frequently Asked Questions on Shoulder Instability & Dislocation

When the humeral head, which is the ball of the shoulder joint, move too much in the socket and then slips out of the socket completely, it’s known as a dislocation. If it goes half in – half out, it is known as a subluxation.

The shoulder joint is designed to give an extensive range of motion, but it has the potential to become too loose and unstable. If the shoulder keeps dislocating, the nerves and tissues around the joint can become damaged, leaving you with long-term instability and weakness. There is also the potential increased risk of arthritis.

Some lifestyle modifications can prevent further dislocations, combined with physical therapy to strengthen the structures that support the shoulder joint. In some cases, shoulder surgery may be required to repair torn structures in the joint.

Typically, the first time a shoulder dislocates, it is due to a traumatic event such as a sports injury or a hard fall. You’ll be experiencing intense pain radiating down the shoulder and arm, and the shoulder may look sunken or pushed forward, and there may be swelling. The arm will not be functioning normally, and the muscles surrounding the shoulder may spasm.

With subsequent dislocations, pain is generally less extreme but the joint won’t function normally while the shoulder is dislocated.

The London Shoulder Specialists will diagnose a shoulder dislocation based on your symptoms, a physical examination and the results of diagnostic tests that may rule out other shoulder conditions.

X-rays may be ordered to establish if there’s been a fracture of one of the bones that make up the shoulder joint. MRI scans can reveal if the ligaments or tendons surrounding the shoulder joint have been injured or if there is a tear in the labrum.