Shoulder dislocation and instability

What it is

The shoulder trades stability for range: a large ball on a shallow socket, held by a rim of cartilage, the capsule and ligaments, and the muscles. A dislocation tears the rim and stretches the capsule, permanently reducing the passive restraint.

There are two distinct pictures. Traumatic instability follows a dislocation and has high recurrence rates in young athletes - very high under twenty. Atraumatic instability occurs in people with generalised laxity, without any injury, and responds much better to rehabilitation than to surgery. Telling them apart determines the treatment.

What it feels like

• A shoulder that has come out of joint, requiring reduction
• Apprehension - a strong sense the shoulder is about to come out in certain positions, typically arm out and rotated back
• A feeling of slipping, clunking or the shoulder moving too far
• Loss of confidence in overhead and throwing positions
• In laxity-driven cases, both shoulders and often other joints being unusually mobile

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Labral and capsular damage from a dislocation

A first dislocation typically tears the cartilage rim at the front of the socket and stretches the capsule. The passive restraint is permanently reduced, which is why recurrence is common.

Age at first dislocation

The single strongest predictor of recurrence. Under twenty the recurrence rate is very high; over forty it is much lower, though rotator cuff tears become more likely instead.

Generalised joint laxity

Some people have naturally more elastic connective tissue and unstable shoulders without any injury. This group does substantially better with rehabilitation than with surgery, which is why the distinction matters.

Rotator cuff weakness

The cuff centres the head of the humerus in the socket during movement. When the passive restraints are compromised, the cuff is the remaining defence - and it is trainable.

Scapular dyskinesis

A shoulder blade that does not position the socket correctly leaves the joint less congruent through range. Scapular control is a central part of rehabilitation.

Sport and activity

Contact sports, throwing, swimming and gymnastics all challenge the shoulder at end range. Return to contact sport is the main setting for recurrence.

Bone loss at the socket or the humeral head

Repeated dislocations wear away bone at the front of the socket and produce a divot in the humeral head. Beyond a threshold, soft tissue repair alone becomes unreliable and a bone procedure is needed.

Returning to sport too early

Return before strength and control are restored substantially raises the recurrence risk, and each recurrence causes more damage.

Posterior instability

Less common and frequently missed. It presents with pain and instability pushing forward with the arm in front, as in bench pressing, rather than with the classic apprehension position.

Who tends to get it

• Young athletes, particularly under twenty, after a first dislocation
• Contact sport players and throwing athletes
• Anyone with generalised joint hypermobility
• People who have dislocated more than once, in whom bone loss accumulates
• Anyone returning to sport before objective strength and control testing

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineShoulder Relief & Overhead Range

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

A first dislocation in someone under 25 has a very high recurrence rate and deserves early surgical discussion; numbness or a cold arm after dislocation is urgent

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Rehabilitation is the treatment of choice for atraumatic, laxity-driven instability and produces good results over three to six months. After a traumatic dislocation in a young athlete, recurrence rates with rehabilitation alone are high and early surgical stabilisation is often recommended - that is a discussion worth having with a shoulder surgeon rather than a decision to default. Either way, cuff and scapular strengthening is part of the answer.

Prevalence basis: Shoulder trauma epidemiology

Others the same routine covers

These share the Shoulder Relief & Overhead Range routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.