SHOULDER INSTABILITY

Shoulder instability: causes, symptoms, and treatment of a dislocated shoulder

What does shoulder instability mean?

When the shoulder is dislocated, it is referred to as instability. The humeral head slips completely or partially out of the socket. This can be very painful and, if repeated, leaves a feeling that the shoulder is "not holding up."

Due to its enormous mobility, the shoulder is particularly susceptible to instability – significantly more so than other joints in the body.

Why is the shoulder so unstable?

The shoulder joint is designed for freedom of movement, not stability. Compared to the hip or knee, there is very little bony guidance . Instead, stability depends on an interplay of active stabilizers (muscles and tendons) and passive structures (ligaments, joint capsule, and labrum).

• Labrum glenoidale: cartilaginous ring that enlarges the socket and provides support

• Glenohumeral ligaments: important ligament structures that secure the humeral head

• Rotator cuff: Muscle group that dynamically stabilizes the shoulder

Shoulder instability occurs when one or more of these structures are damaged.

Causes: Why does the shoulder dislocate?

There are several reasons for instability:

• Sports accidents and falls : e.g. during handball, football, cycling or snowboarding

• Repeated dislocations : after a first dislocation, the risk of renewed instability increases significantly

• Congenital tissue weakness : some people have naturally loose ligaments

• Structural damage : e.g. capsular tears, labral lesions or bone defects

  
  

Symptoms: How do I recognize an unstable shoulder?

Symptoms can vary from person to person. Typical signs include:

• Acute pain after a dislocation

• Feeling of unsteadiness or instability , especially during overhead movements

• Feeling of blockage or rubbing in the joint

• Restricted movement or protective posture

• Recurrent dislocations or partial dislocations

What is shoulder instability?

Shoulder instability occurs when the humeral head is unstable in the socket and shifts forward, backward, or downward. It results from injury, overuse, or weak support structures and can cause pain, instability, and repetitive dislocations.

Diagnosis: How to detect shoulder instability

A precise diagnosis is crucial for choosing the right treatment. In our practice, we focus on:

• Anamnesis : Description of the complaints and the course of the accident

• Physical examination : special tests to check stability

• Imaging : X-ray, MRI or CT to visualize bone, capsule and labrum

  
  

What types of shoulder instability are there?

Similar to the AC joint (Rockwood classification), specialists also distinguish between different types of shoulder instability. These depend on the direction in which the humeral head slips out of the socket and how frequently this occurs.

1. Anterior shoulder instability

The most common form : The humeral head slips forward out of the socket. The cause is usually a sports accident or a fall on an outstretched arm .

• Typical: severe pain, immediate restriction of movement

• Risk: recurrent dislocations during overhead movements or sports

2. Posterior shoulder instability

Much less common. In this case, the humeral head slides backward out of the socket.

• Often occurs when falling forward onto the arm or during epileptic seizures

• Symptoms: Pain, “blockage” feeling when pressing or pushing

• Diagnosis is often more difficult because it is not immediately visible

3. Lower shoulder instability (inferior)

Very rare. The humeral head slips downward, for example, when carrying heavy loads overhead .

• Typical: Feeling of the arm being pulled out

• Often accompanied by overstretching of ligaments

4. Multidirectional shoulder instability (MDI)

Here the shoulder is unstable in several directions – usually due to congenital ligament weakness or overload.

• Those affected report repeated feelings of instability , even without trauma

• Therapy: primarily intensive muscle training and physiotherapy

• Surgery only in severe cases

Why is the classification important?

The classification helps physicians choose the appropriate form of treatment . While training is usually sufficient for functional instability , traumatic forms (e.g., after a fall or accident) often require surgical stabilization.

Treatment options: Conservative or surgical?

✅ Conservative therapy

Many cases of shoulder instability can be treated without surgery. These include:

• Targeted muscle training (especially the rotator cuff)

• Physiotherapy to improve joint control

• Coordination and stabilization exercises

• Use of orthopedic aids in the acute phase

For so-called functional shoulder instability, training is the most important treatment. In individual cases, a "shoulder pacemaker" that electrically stimulates muscles can also be used—although long-term results are still lacking.

✅ Surgical therapy

If the instability is caused by structural damage, conservative methods reach their limits. Reasons for surgery:

• Repeated dislocations despite training

• Capsule or labral tears

• Larger bone defects

Modern procedures such as arthroscopic stabilization or bone block techniques enable a lasting restoration of shoulder stability.

Rehabilitation and aftercare

Whether conservative or surgical, rehabilitation plays a central role. It includes:

1. Rest phase with gradual mobilization

2. Physiotherapeutic exercises to restore mobility

3. Muscle building , especially in the rotator cuff area

4. Sport-specific training for active patients

The healing process varies depending on the initial situation, but usually takes several months.

Prevention: How to prevent instability

• Strengthen shoulder muscles , especially the rotator cuff

• Perform overhead sports in a controlled and technically sound manner

• Avoid falls through proper training and protective equipment

• Seek early treatment if instability or pain occurs

Conclusion: Shoulder instability is treatable

A dislocated or unstable shoulder is painful and limiting—but it's easily treatable . Depending on the cause, targeted training, physical therapy, or modern surgical techniques can help restore the shoulder's stability and functionality.

👉 Make an appointment now – we will advise you individually and competently.