SHOULDER INSTABILITY
Shoulder Dislocations
And Instability
Shoulder instability occurs when the ball of the shoulder slips partially or completely out of the socket. Treatment depends on the injury pattern, age, sport, bone loss, labral damage, and risk of future dislocation.
First-Time Or Recurrent
Bankart & Labral Tears
Changes The Operation
Early Stabilization Often Matters
Start With Your Instability Pattern
First-Time Shoulder Dislocation
A first traumatic dislocation in a young active patient may carry a high risk of recurrence.
Recurrent Shoulder Dislocations
Repeated dislocations can cause progressive labral injury, glenoid bone loss, Hill-Sachs lesions, and cartilage damage.
Shoulder Instability Surgery
Surgical stabilization is designed to restore shoulder stability and reduce the risk of future dislocation.
Dr. Streit's Clinical Perspective
In young active patients, recurrent instability is not ideal because every instability episode can create more damage. Early stabilization is often recommended after a traumatic anterior dislocation in high-risk patients to avoid progressive bone loss, larger Hill-Sachs lesions, and more complex reconstruction later.
The goal is not simply to put the shoulder back in place. The goal is to preserve the shoulder and prevent repeated injury.
Common Instability Problems
Shoulder Labral Tears
The labrum helps stabilize the shoulder. Tears may cause pain, clicking, catching, or instability.
Bankart Repair
Arthroscopic labral repair for selected patients with limited bone loss and repairable soft tissue injury.
Latarjet Procedure
Bone-block stabilization for glenoid bone loss, failed Bankart repair, or selected contact athletes.
Hill-Sachs Lesion & Remplissage
A compression injury of the humeral head that may require remplissage when significant.
Glenoid Bone Loss
Bone loss of approximately 15% or more may shift treatment toward Latarjet reconstruction.
Revision Instability Surgery
Failed prior Bankart repair commonly leads to Latarjet as the next stabilizing operation.
How The Operation Is Chosen
Bankart Repair
- Minimal glenoid bone loss
- Good labral and capsular tissue
- First-time or limited recurrent instability
- No major structural bone defect
Latarjet Procedure
- Glenoid bone loss of approximately 15% or greater
- Flat anterior glenoid on imaging
- Failed prior Bankart repair
- Selected contact or collision athletes
Hill-Sachs Lesions And Remplissage
If a significant Hill-Sachs impaction fracture is present, remplissage may be added to arthroscopic Bankart repair. If Latarjet is performed, remplissage is generally not needed.
SLAP Tears And Biceps Treatment
SLAP Tears
SLAP repair may be considered in high school or college overhead athletes when the tear is truly the pain generator.
Biceps Tenodesis
For most adult non-throwers and many patients over 35, biceps tenodesis is generally favored over SLAP repair.
What About Multidirectional Instability?
Multidirectional instability and generalized laxity are usually treated first with a dedicated physical therapy program for at least 12 weeks. Surgery is not usually the first step unless there is a clear structural problem requiring repair.
Explore Shoulder Instability Resources
Has Your Shoulder Dislocated?
A focused shoulder instability evaluation can determine whether therapy, Bankart repair, remplissage, Latarjet reconstruction, or another treatment pathway is most appropriate.
Request Consultation