Shoulder dislocation and instability

If the shoulder was broken in a fall, that has its own page: broken shoulders.

Why a shoulder comes out of joint

The shoulder trades stability for range of movement — it is the most mobile joint in the body and the one that dislocates most easily. A shoulder that has come out once often comes out again, particularly in younger and more active people.

After a dislocation

Each dislocation can damage the rim of the socket and the ring of tissue around it, and enough of that damage makes the next one easier. So the question after a dislocation is usually not only how to put it back, but whether it needs stabilizing so it stops happening.

What happens after a first dislocation

That depends a great deal on what you do. Contact athletes typically benefit from early surgical stabilization. The less violent the sport or recreational activity, and the older the patient, the less likely it is that surgery will be needed — unless there is major structural damage in the shoulder resulting in pain or recurrent instability.

First-time young dislocators who play a contact sport are a special group. Early intervention can allow the problem to be solved with an arthroscopic — minimally invasive — procedure. If the shoulder keeps dislocating, the problem frequently progresses from a soft tissue injury to a soft tissue and bony problem, and that needs a larger open incision.

Down time from surgery varies, but shoulder stabilization is usually a season-ending operation, not a career-ending one.

If you are dislocating in your sleep, you have probably waited too long and should have had your shoulder surgically stabilized earlier in the treatment window.Howard D. Routman, DO

Without fully coming out

Some shoulders are unstable without ever fully dislocating — they slip, catch, or feel like they are about to give way. That is worth having examined too.

How it is sorted out

X-rays first. A CT scan shows any bone loss around the socket, and an MRI shows the soft tissue. Which of those is needed depends on what the examination and the first X-ray suggest.

Common questions

If my shoulder has dislocated once, will it happen again?

It often does, particularly in younger and more active people. Each dislocation can damage the rim of the socket, which makes the next one easier, so a first dislocation is worth being assessed rather than simply put back.

I dislocated my shoulder once. Do I need surgery?

That depends a great deal on what you do. Contact athletes typically benefit from early surgical stabilization. The less violent the sport or recreational activity, and the older the patient, the less likely it is that surgery will be needed — unless there is major structural damage in the shoulder resulting in pain or recurrent instability.

How long will I be out after a shoulder stabilization?

Down time from surgery varies, but shoulder stabilization is usually a season-ending operation, not a career-ending one.

What is shoulder instability?

A shoulder that slips, catches, or feels like it is about to give way, whether or not it fully comes out of joint. It is worth examining, because the underlying damage is the same kind that leads to repeated dislocations.