Recurrent Shoulder Dislocation

Why is the shoulder prone to dislocation?

The shoulder is a ball-and-socket joint that allows the arm to move in almost every direction. The ball at the top of the arm is quite large, while the socket is relatively small and shallow—rather like a golf ball sitting on a tee. This design gives the shoulder great freedom of movement, but also means that it needs several tissues around the joint to keep the ball in place.

These supporting tissues act like a combination of a rim (known as labrum), straps (ligaments) and muscles that help hold the ball in the socket while the arm moves. When the shoulder dislocates, some of these supports can be stretched or torn. If they do not heal properly, the shoulder may become loose and dislocate again.

What are the symptoms of recurrent shoulder dislocation?

You may experience:

• Repeated dislocations

• A feeling that the shoulder is slipping out

• Fear during certain movements

• Pain

• Reduced confidence using the arm

• Difficulty with sports or overhead activities

How is recurrent shoulder dislocation assessed?

Assessment includes the history and examination, particularly understanding how and when instability occurs.

X-rays help assess the bones. CT may be useful for measuring bone loss, while MRI or MR arthrogram can assess the labrum and other soft tissues.

What are the treatment options?

Treatment depends on age, activity, number of dislocations, bone loss, soft-tissue injuries and sporting demands.

Physiotherapy can improve shoulder strength and control, particularly in patients with less severe instability.

Surgery may be recommended when instability is recurrent or when there are structural injuries that make further dislocation likely.

Depending on the pattern of bone and soft-tissue damage, procedures may include arthroscopic stabilisation or operations designed to address significant bone loss.

What type of surgery may be recommended for recurrent shoulder dislocation?

The type of surgery depends on the damage to the shoulder and the amount of bone loss. Arthroscopic shoulder stabilisation may be suitable when the main problem is damage to the soft tissues that help keep the shoulder stable. When there is significant bone loss, a bone-block procedure such as the Latarjet procedure may be recommended.

What happens if surgery is not done?

Some patients can manage instability through rehabilitation and activity modification. However, recurrent dislocations may continue and can progressively damage the bone and cartilage of the shoulder.

For young, active patients with recurrent instability, especially those participating in contact or overhead sports, the risk of further instability is an important part of the decision.

When can I return to normal activity?

Recovery after shoulder stabilisation surgery is gradual. The arm is usually protected during the early weeks while the repaired tissues begin to heal. As a general guide, patients can expect to resume light daily activities progressively during the first 4–6 weeks. Desk-based work may be possible within 2–4 weeks, depending on the arm used and the nature of the job, while work involving lifting, pushing, pulling or overhead activity may require around 8–12 weeks or longer. Most routine activities are usually comfortable by about 2–3 months, although strength and confidence continue to improve for several months.

When can I return to sports?

Returning to sports takes longer than returning to everyday activities. Running and lower-body exercise can usually be introduced progressively during rehabilitation, while activities that place greater demands on the shoulder are introduced later. As a general guide, return to unrestricted sports is usually considered around 6 months after surgery, provided that shoulder movement, strength, stability and confidence have adequately recovered. Contact, collision and overhead sports may require a longer and more cautious progression.

The decision to return to sport should not be based on time alone. The shoulder should have good movement, adequate strength and stability, and the patient should be able to perform sport-specific activities without pain or apprehension.

When should I see an orthopaedic surgeon?

If your shoulder has dislocated, you should have it assessed by an orthopaedic surgeon, particularly if you are young, active or have experienced a significant injury. If the shoulder has dislocated more than once, specialist assessment is especially important because repeated dislocations can damage the structures that help keep the shoulder stable and may increase the risk of further instability.

You should also seek assessment if you have a persistent feeling that the shoulder is slipping out, pain or apprehension with certain movements, or difficulty returning to your usual activities or sports. An assessment can determine why the shoulder is unstable and whether physiotherapy, activity modification or stabilisation surgery is the more appropriate option.

If your shoulder is currently dislocated and has not been put back into place, seek urgent medical attention rather than trying to relocate it yourself.