Shoulder Instability (Anterior Labral Tear)

The shoulder is a ball-and-socket joint formed by the humeral head (ball) and the glenoid (socket) of the shoulder blade. The glenoid is relatively shallow, so stability depends on several soft tissue structures:

• The labrum, a ring of cartilage that deepens the socket.
• The capsule and ligaments, which hold the ball in place.
• The rotator cuff and scapular muscles, which coordinate movement and dynamic control.

When a shoulder dislocates forward (anteriorly), these stabilizing tissues—especially the anterior labrum and capsule—can tear. This type of injury is often referred to as a Bankart lesion. In some cases, bone loss occurs on the front of the glenoid or back of the humeral head (Hill-Sachs lesion), increasing the risk of recurrent instability.

Anterior instability most commonly develops after a traumatic dislocation, such as falling on an outstretched arm or colliding with another athlete during contact sports like football or basketball. It can also result from repetitive overhead stress, particularly in throwing athletes.

Common causes include:

• A single, forceful event (e.g., football tackle, fall, or accident).
• Repeated overhead motions that stretch the capsule (e.g., baseball, swimming, volleyball).
• Generalized joint laxity or hypermobility.
• Incomplete healing after a previous dislocation.

Once the stabilizing tissues are torn or stretched, the shoulder becomes more prone to “slipping out,” sometimes even during simple movements like reaching behind or rolling over in bed.

Symptoms of anterior shoulder instability can vary depending on severity, but typically include:

• Pain in the front of the shoulder, especially in the days that follow an instability episode
• A feeling of looseness, slipping, or the shoulder being “out of place.”
• Weakness or loss of power during activity.
• Apprehension or fear of dislocation when the arm is moved into certain positions (like the “throwing” posture).
• In acute dislocations, visible deformity, often occurs.

Over time, repeated instability can cause secondary issues such as rotator cuff tears, labral degeneration, or cartilage damage.

Diagnosis begins with a detailed history and physical examination by Dr. José Vega, Cleveland’s trusted shoulder specialist.

Dr. Vega will evaluate:

• The mechanism of injury (traumatic vs. overuse).
• The number of dislocations or “slip” episodes.
• Shoulder strength, flexibility, and stability in various positions.

Special tests, such as the apprehension test, relocation test, and load-and-shift test, help determine the degree and direction of instability.

Imaging studies provide valuable insight into the extent of injury:

• X-rays identify bone loss or fractures.
• MRI or MR arthrogram shows labral tears, capsular damage, and soft tissue injury.
• CT scans may be used to measure glenoid bone loss, which is crucial for surgical planning.

Treatment depends on factors such as age, activity level, injury severity, and recurrence risk.

Nonsurgical Treatment

For first-time dislocations or mild instability, conservative care can often attempted first.

• Immobilization: Short-term use of a sling to allow pain and acute inflammation to resolve.
• Physical therapy: Focused on restoring motion, strengthening the rotator cuff and scapular stabilizers, and improving proprioception (joint position awareness).
• Activity modification: Avoiding positions that provoke instability (e.g., the arm externally rotated and abducted).

While physical therapy can be successful for some patients, younger athletes (under 25) or those in contact or overhead sports have a high recurrence rate—up to 70–90% after the first dislocation.

Surgical Treatment

Surgery is often recommended for patients with recurrent instability, significant labral tears, or glenoid bone loss.

Arthroscopic Bankart Repair

• The torn labrum and capsule are reattached to the glenoid rim using small anchors and sutures.
• This restores the anatomy and stabilizes the shoulder while preserving mobility.
• Performed arthroscopically through small incisions.
• Sometimes augmented with an additional procedure known as remplissage if there is a significant indentation on the back of the humeral head (Hill Sachs lesion) from the back of the ball hitting the front of the shoulder socket during the dislocation episode

Open or Bone-Augmentation Procedures

In cases with significant bone loss from the socket or certain high-demand athletes:

• A Latarjet procedure may be performed, transferring a small piece of bone from the coracoid process to the front of the glenoid to increase stability.
• This is especially useful for collision athletes or those with recurrent dislocations after prior repairs.