Shoulder Instability / Dislocation

What Is It

The shoulder joint has the greatest range of motion in the body, which makes it dependent on soft tissue — the capsule, ligaments and muscles — for stability, unlike the hip, where the bony architecture itself provides most of the stability. Instability occurs when the head of the humerus partially (subluxation) or completely (dislocation) exits the joint socket, most often anteriorly.

Signs & Symptoms

• Sudden, severe pain at the moment of dislocation, with a visible shoulder deformity
• A feeling that the shoulder "slips out" or "gives way" when raising the arm overhead, particularly in external rotation
• Weakness and apprehension during throwing motions after the first episode
• Swelling and restricted range of motion in the days following the injury
• With repeated episodes, progressively less force required to dislocate the shoulder again

Cause & Mechanism

The most common mechanism is a fall onto an outstretched arm or an impact while the arm is raised and externally rotated — a frequent scenario in handball, wrestling and contact sports. A first episode in younger athletes carries a high recurrence risk because the front rim of the joint socket is almost always damaged during dislocation (Bankart lesion).

Diagnosis

Clinical tests (apprehension test, relocation test) assess the direction and degree of instability. MRI, preferably with arthrography, shows labral and capsular damage and any bony lesion of the humeral head (Hill-Sachs) — findings that determine whether surgery is needed.

Treatment With Us

After a first episode in younger athletes returning to contact sport, surgical stabilisation (arthroscopic Bankart repair) significantly reduces the risk of re-dislocation compared with rehabilitation alone. In older patients or those with lower activity demands, a structured rotator cuff and scapular strengthening programme often provides a stable, functional result without surgery.