Shoulder stabilization
Instability surgery
Arthroscopic or open reconstruction selected according to soft-tissue injury, bone loss, and recurrence risk.
Surgery is considered when the shoulder remains unstable despite appropriate rehabilitation, when recurrent episodes cause progressive damage, or when the injury pattern carries a high risk of recurrence. The operation must match the anatomy; no single stabilization procedure fits every shoulder.
See the anatomy and imaging
What must be reconstructed
Instability surgery addresses the structures that no longer keep the humeral head centered: the detached labrum, stretched capsule, and—when present—loss of glenoid or humeral-head bone. Accurate treatment begins by identifying the direction of instability and whether the main problem is soft tissue, bone, or both.
Preoperative imaging
X-rays look for fractures and chronic bone changes. MRI or MR arthrography can define labral, capsule, cartilage, and cuff injury. CT with three-dimensional reconstruction may be used when bone loss is suspected because the amount and location of missing bone influence procedure selection.
Arthroscopic stabilization
Through small incisions, the labrum can be repaired to the socket rim and the stretched capsule tightened. This is often used when instability is primarily a soft-tissue problem and bone loss is limited.
Latarjet procedure
The Latarjet transfers a segment of the coracoid with its attached tendons to the front of the socket. It may be selected for significant glenoid bone loss, an engaging humeral defect, contact-sport demands, or certain failed prior repairs.
Other strategies
Remplissage may be added to a Bankart repair for selected Hill-Sachs defects by securing the posterior capsule and infraspinatus into the defect. Distal tibial allograft or other bone-block reconstruction may be considered in selected complex or revision cases. Each option has distinct benefits, motion tradeoffs, and risks.
Recovery
Wear the sling and bolster at all times, including during sleep, unless Dr. Ramirez gives different instructions; most repairs require 4–6 weeks. Before the first postoperative visit, perform elbow, wrist, finger, and scapular motion only, with pendulums if permitted. Formal therapy usually starts after the 14-day visit with directed passive motion. Active motion generally begins during weeks 6–12, followed later by strengthening and sport- or work-specific rehabilitation. Do not drive while taking narcotics or wearing the sling.
Risks
- Recurrent instability, stiffness, or persistent apprehension
- Nerve injury, infection, fracture, or hardware problems
- Nonunion or graft position problems after bone-restoring surgery
- Development or progression of arthritis
Evidence and further reading
- AAOS OrthoInfo: Chronic Shoulder Instability
- Peer-reviewed review: Recurrent Anterior Shoulder Instability
- OrthoBullets: Traumatic Anterior Shoulder Instability
Educational content is reviewed for patient clarity and is not a substitute for an examination or individualized medical advice.
PIA Shoulder MD