Repeated instability may injure the labrum or bone. Evaluation identifies the cause and whether rehabilitation or surgical stabilization is appropriate.
Why does a shoulder become unstable?
A traumatic dislocation can injure the labrum (a Bankart tear), stretch or tear the capsule and ligaments, or damage the glenoid or humeral head. Some patients have posterior or multidirectional instability rather than classic anterior dislocations. Your injury history and examination help distinguish these patterns.
Imaging and the role of bone loss
Examination, X-rays and selected MRI or CT scans help identify labral injury, a Hill–Sachs defect, glenoid bone loss and associated injuries. Because bone loss can influence the success of a soft-tissue-only repair, it is particularly important to evaluate in recurrent dislocations and contact athletes.
What are the treatment options?
- Rehabilitation: rotator-cuff and scapular strengthening, neuromuscular control, and a graduated return to demanding positions may be appropriate in selected patients.
- Arthroscopic labral repair and capsular stabilization: considered for certain patients with symptomatic instability and suitable soft-tissue and bone anatomy.
- Additional stabilization procedures: Significant bone loss from the shoulder socket may require bone augmentation. For selected defects in the upper-arm bone (Hill–Sachs lesions), remplissage uses nearby tendon and capsule to help prevent engagement with the socket; it does not replace missing bone. The choice depends on your anatomy and recurrence risk.
Recovery after labral repair for instability
Passive range of motion (PROM) means your shoulder is moved with help, without the shoulder muscles lifting the arm. Active range of motion (AROM) means you move the arm using your own muscles. Both follow the limits in your physical therapy protocol.
- First 4–6 weeks: wear the sling or shoulder immobilizer to protect the labral repair.
- Physical therapy may begin within 1 week: use passive shoulder motion only, within the limits of your repair.
- After the sling is removed: begin active shoulder motion and attend physical therapy twice a week, progressing according to your protocol.
- Return to sport: rebuild motion, control and strength before sport-specific progression. Clearance depends on healing, shoulder stability and the demands of your sport.
Bone procedures or other additional repairs may change these restrictions. Follow the protocol for your complete operation.
Preventing stiffness is a priority
Stiffness is a major concern after shoulder surgery. Physical therapy is essential to restoring motion and function while protecting healing tissue. Dr. Haber works with trusted therapists across the Front Range and recommends a therapist based on where you live.
Shoulder recovery guide: ice therapy, sleep and dressing tips →
Is every labral tear an instability problem?
No. SLAP tears involve the superior labrum and biceps attachment and may primarily cause pain or mechanical symptoms. Pain over the front of the shoulder can also arise from long-head biceps tendinitis.