Shoulder Instability Repair Surgery
Shoulder instability is a condition in which the shoulder joint is unable to keep the humeral head (the ball of the upper arm bone) centered within the glenoid socket during movement — producing episodes of the shoulder slipping partially out of place (subluxation) or completely displacing from the socket (dislocation). Instability most commonly develops after one or more traumatic dislocations that tear the labrum and capsular ligaments, but it can also result from repetitive overhead activity that gradually stretches the capsule, or from congenital ligamentous laxity in patients who are naturally hypermobile. Regardless of the cause, shoulder instability produces a cycle of increasingly frequent episodes — each dislocation or subluxation damages the labrum, capsule, and bone surfaces further, lowering the threshold for the next event and increasing the risk of progressive cartilage damage and early-onset shoulder arthritis if the instability is not addressed.
Dr. Jonathan Glashow is a board-certified orthopedic surgeon and Clinical Associate Professor of Orthopedic Surgery at NYU Grossman School of Medicine, with a traveling shoulder fellowship under Dr. Charles Rockwood and Dr. Richard Hawkins — two surgeons whose contributions to the understanding and surgical management of shoulder instability are foundational to the field — and fellowship training in arthroscopic surgery at the Southern California Orthopedic Institute/UCLA. Shoulder instability surgery requires matching the procedure to the specific instability pattern: a soft tissue Bankart repair for labral tears without significant bone loss, a bone-grafting procedure such as a Latarjet for cases with critical glenoid bone loss, and a capsular shift or plication for patients with capsular laxity from repetitive microtrauma or connective tissue hypermobility. As Chief Medical Officer for the New Jersey Devils and Philadelphia 76ers — where shoulder instability from body checks, collisions, and falls is one of the most common season-limiting injuries — and a Castle Connolly Top Doctor every year since 2000, he performs shoulder instability repair at his Upper East Side practice in New York City.
Types of Shoulder Instability
Traumatic Instability: The most common type, resulting from one or more shoulder dislocations that tear the labrum (Bankart lesion) and stretch or rupture the capsular ligaments. The shoulder becomes progressively easier to dislocate with each episode as the stabilizing structures sustain cumulative damage.
Atraumatic Instability: Occurs without a specific traumatic dislocation event. Repetitive overhead activity — such as swimming, baseball, volleyball, or gymnastics — can gradually stretch the shoulder capsule over time, producing instability without a frank dislocation. Patients with congenital connective tissue conditions such as Ehlers-Danlos syndrome or Marfan syndrome, or those with naturally loose ligaments (generalized ligamentous laxity), are predisposed to this type.
Multidirectional Instability (MDI): The shoulder is unstable in more than one direction — typically anterior, posterior, and inferior. MDI is most commonly associated with capsular laxity rather than a specific labral tear and is more prevalent in young athletes involved in overhead and swimming sports.
Symptoms of Shoulder Instability
- Recurrent episodes of the shoulder slipping out of place or feeling like it will
- A sensation of looseness, deadness, or giving way in the shoulder
- Pain with overhead activity, reaching behind the back, or placing the arm in the cocking position
- Apprehension — a feeling of anxiety or guarding when the arm is placed in a vulnerable position
- Weakness and loss of confidence in the shoulder during sports or daily activities
- Clicking, catching, or popping within the joint
Surgical Options for Shoulder Instability
When physical therapy and rehabilitation have not provided adequate stability — or when the instability pattern involves structural damage that rehabilitation cannot address — Dr. Glashow offers several surgical approaches, selected based on the specific instability type, the direction of instability, and the presence or absence of bone loss.
Arthroscopic Bankart Repair: The most common procedure for traumatic anterior instability. The torn labrum is reattached to the glenoid rim using suture anchors through small arthroscopic portals, restoring the bumper effect that keeps the humeral head centered in the socket. Capsular tightening (plication) may be performed simultaneously to address any capsular stretching.
Latarjet Procedure: An open bone-grafting procedure recommended when significant glenoid bone loss has occurred — typically when more than 20 to 25 percent of the glenoid has been eroded by recurrent dislocations. A piece of the coracoid bone (with its attached muscle) is transferred to the front of the glenoid to extend the socket and provide both a bony buttress and a dynamic muscular sling that prevents future dislocation.
Capsular Shift / Plication: For patients with atraumatic instability or multidirectional instability caused by capsular laxity rather than a labral tear, the stretched capsule is tightened (plicated) arthroscopically or through an open approach to reduce the excess volume in the joint and restore stability.
Remplissage: An arthroscopic procedure that may be combined with a Bankart repair when a significant Hill-Sachs lesion (compression fracture on the humeral head) is present. The infraspinatus tendon and posterior capsule are attached into the Hill-Sachs defect to fill it and prevent it from engaging the glenoid rim during arm movement.
Recovery After Shoulder Instability Surgery
Patients wear a sling for four to six weeks after surgery to protect the repair while the labrum and capsule heal. Gentle passive range-of-motion exercises begin within the first few weeks under the guidance of a physical therapist, with active motion and strengthening introduced progressively over the following months. Most patients return to daily activities within six to eight weeks and to contact sports or overhead athletics between four and six months, depending on the procedure performed and the demands of the sport. Dr. Glashow uses functional testing and strength assessment to determine when each patient is ready to return safely.
Shoulder Instability Repair in New York City
If you are experiencing recurrent shoulder dislocations, subluxation episodes, a sensation of your shoulder slipping out of place, or a loss of confidence in your shoulder during sports or daily activities, Dr. Glashow provides comprehensive instability evaluation — including clinical examination, X-rays, MRI, and when needed CT imaging to assess bone loss — at his Upper East Side practice. Contact our office to schedule your consultation.
Frequently Asked Questions About Shoulder Instability Repair
What causes shoulder instability?
The most common cause is a traumatic shoulder dislocation that tears the labrum and capsular ligaments — once these stabilizing structures are damaged, the shoulder becomes progressively easier to dislocate with subsequent episodes. Shoulder instability can also develop from repetitive overhead activity that gradually stretches the capsule without a frank dislocation, or from congenital connective tissue conditions that produce generalized joint hypermobility. Dr. Glashow evaluates each patient’s history, injury pattern, and imaging to determine the specific cause and select the most effective treatment.
What is the difference between a subluxation and a dislocation?
A subluxation is a partial displacement — the humeral head shifts partially out of the socket and then returns on its own, often within a fraction of a second. A dislocation is a complete displacement — the humeral head exits the socket entirely and may require manual reduction to return it. Both indicate underlying instability, and both cause progressive damage to the labrum, capsule, and bone surfaces with each episode.
Can shoulder instability be treated without surgery?
Some patients — particularly those with atraumatic instability or first-time dislocations in older age groups — can achieve adequate stability through a structured physical therapy program focused on strengthening the rotator cuff and scapular stabilizers, which provide dynamic support to compensate for the damaged static stabilizers (labrum and capsular ligaments). However, patients with recurrent traumatic dislocations, significant labral tears, bone loss, or high-demand athletic requirements typically require surgical stabilization for a reliable result.
How does Dr. Glashow determine which surgical procedure is right for me?
The choice of procedure depends on the type and direction of instability, the condition of the labrum and capsule, and the presence or absence of bone loss. CT imaging is used to measure glenoid bone loss — if less than 20 percent, an arthroscopic Bankart repair is typically sufficient. If bone loss exceeds 20 to 25 percent, a Latarjet bone-grafting procedure provides a more durable result. For patients with capsular laxity or multidirectional instability, capsular plication or shift is the primary approach. If a significant Hill-Sachs lesion is present, a remplissage may be added to the Bankart repair. Dr. Glashow evaluates each patient’s complete clinical and imaging picture before recommending a surgical plan.
How successful is shoulder instability surgery?
Arthroscopic Bankart repair has a success rate of approximately 85 to 95 percent for preventing recurrent dislocation in appropriately selected patients. The Latarjet procedure has an even higher success rate — exceeding 95 percent — for patients with significant bone loss, though it is a more involved procedure with a slightly longer recovery. The key to success is matching the right procedure to the right patient based on the specific instability pattern and bone loss assessment.
Can I return to contact sports after shoulder instability surgery?
Yes — return to contact and collision sports is one of the primary goals of shoulder instability surgery. Most patients are cleared for non-contact sports at approximately three to four months and contact sports at four to six months after surgery, depending on the procedure performed and the demands of the sport. Dr. Glashow uses functional testing, strength assessment, and sport-specific drills to determine when each athlete is ready to compete safely.
