Question 1

Why does my shoulder keep coming out of place?

Accepted Answer

Recurrent instability usually occurs because the structures that normally stabilize the shoulder were stretched or torn during a previous dislocation. Once these structures are damaged, the shoulder can become easier to dislocate again.

Question 2

Does a first-time shoulder dislocation require surgery?

Accepted Answer

Usually not. I generally recommend waiting until a second or third dislocation before considering surgery. However, surgery may occasionally be appropriate after a first dislocation in athletes or patients involved in high-risk activities who cannot afford the disruption of another dislocation.

Question 3

What makes a shoulder likely to dislocate again?

Accepted Answer

Age is the most significant factor. The risk of recurrence is inversely related to age, with younger patients having a much higher risk of another dislocation. Men also have a higher risk of recurrence.

Question 4

Can physical therapy prevent recurrent shoulder instability?

Accepted Answer

Physical therapy can improve symptoms, strength, and function, but it is usually not very effective at reducing the risk of another dislocation. Recurrence is more closely related to age, activity type, and the extent of the initial injury.

Question 5

When is surgery recommended for shoulder instability?

Accepted Answer

I generally tell patients that if they have a second dislocation, they are very likely to have a third, and once they have had three, additional dislocations are almost guaranteed. Therefore, after the second or third dislocation, we usually begin considering surgical stabilization.

Question 6

Are there special considerations for shoulder dislocations in older patients?

Accepted Answer

Yes. Older patients are less likely to develop recurrent instability but are much more prone to traumatic rotator cuff tears with a dislocation. For this reason, I generally obtain an MRI in older patients after a shoulder dislocation to evaluate the rotator cuff.

Shoulder Instability