What is shoulder instability?
The shoulder is the most mobile joint in the body, and the trade-off is stability. The ball of the arm bone is much larger than the shallow socket it sits in, and it is held there by a rim of cartilage called the labrum, strong ligaments, the rotator cuff and the surrounding muscles. Instability means the ball slips partly (subluxation) or completely (dislocation) out of the socket.
About 95% of dislocations go forward, usually after a fall on an outstretched arm or a collision. Some people are loose-jointed and have instability in more than one direction without a major injury.
What does it feel like?
A dislocation is painful and obvious. The shoulder looks squared off, and the arm cannot move. The ball is usually put back in place in an emergency room. After that, many people feel the shoulder is loose or about to slip, especially with the arm out to the side and rotated back, as in throwing or reaching behind. Some feel catching, clicking or a dead arm sensation.
Do I need surgery after a first dislocation?
It depends mainly on age and activity. Young, active people, especially athletes in contact and overhead sports, have a high chance of repeated dislocations. Older patients have a lower risk of recurrence but a higher risk of associated rotator cuff tears, which can be the bigger problem.
When is surgery recommended?
Dr. Stepanyan is more likely to recommend stabilization when:
- You have had more than one dislocation or the shoulder keeps feeling loose
- You are young and want to return to contact or overhead sports
- Imaging shows a torn labrum or bone loss from the socket or ball
- Therapy has not made the shoulder reliable
- There is an associated rotator cuff tear that needs repair
What happens in surgery?
Most stabilizations are done arthroscopically as an outpatient. The torn labrum is reattached to the rim of the socket with small anchors and sutures (a Bankart repair), and the loose capsule is tightened. When significant bone is missing from the socket or ball, a bone-grafting procedure may be needed instead. Dr. Stepanyan will go over which is right for you after reviewing your imaging.
Should I get a second opinion?
If you have been told to treat a recurrent dislocation with therapy alone, or have had a failed stabilization, a second opinion is reasonable. Request a visit and bring your MRI and X-rays.
Where can I see Dr. Stepanyan?
Dr. Stepanyan sees shoulder patients in Glendale, East LA and Santa Fe Springs. He completed a fellowship in sports medicine and arthroscopy at Congress Orthopedic Group in Pasadena.
What does recovery look like?
These are typical stages after arthroscopic shoulder stabilization. Your own plan may differ.
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Weeks 0–4
Protect the repair
You wear a sling and avoid rotating the arm outward. Elbow, wrist and hand motion and gentle pendulum swings help prevent stiffness.
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Weeks 4–12
Restore motion
The sling is weaned. Motion is gradually increased, within limits that protect the front of the repair, and strengthening around the shoulder blade begins.
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Months 3–5
Build strength
Resistance exercises for the rotator cuff and shoulder blade muscles build up. Running and cycling are fine, and light sport-specific drills begin.
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Months 5–6+
Return to sport
Throwing and contact sports resume in stages. Dr. Stepanyan clears you based on strength, motion and control, not just the calendar.
Returning to contact sport too soon is the most common reason for re-injury. Follow the plan written for you.