What is shoulder instability?

The main joint in the shoulder is the glenohumeral joint. It is naturally an unstable joint as the socket is relatively shallow and it relies on a mixture of bony and soft tissue constraints to prevent dislocation. Shoulders can dislocate secondary to natural joint laxity, but the predominant cause is related to trauma from either accidents or sport. Some patients dislocate secondary to a combination of causes. Dislocations lead to damage to the shoulder stabilising structures, such as the shoulder labrum which is a cartilage rim of the shoulder socket. These anatomic injuries mean that the patient is at a higher risk of recurrence of their dislocation, particularly when this happens below 30 years of age.

What are the symptoms of shoulder instability?

Although recurrent dislocation is a clear symptom, shoulder instability symptoms can sometimes be subtle to diagnose and should always be considered in a young patient. Patients may feel apprehensive in certain positions of the shoulder and certain activities may be uncomfortable. Recurrent instability can also lead to achy pain and patients can develop arthritis over time.

How is it diagnosed?

It is diagnosed by taking a careful history and performing a detailed examination. Posterior instability can be often missed and we pay special attention to assessing for it. The underlying structural injuries in the shoulder can be assessed by shoulder X-ray, and further information for operative planning can be gained by performing a CT scan and MRI scan when surgery is needed. These can help to determine whether there is a significant bone injury associated with the trauma and recurrent dislocations.

How is it treated?

Treatment can begin with symptomatic management with pain killers and physiotherapy to maintain movement and muscle strength in the acute phase.

Stability exercises addressing scapula control and muscle imbalance can be important, particularly in less traumatic shoulder instability, and a close relationship with the physiotherapy team is vital.

When surgical intervention is required, shoulder stabilisation can be performed both by an arthroscopic route and through an open procedure. Depending on the patient’s function, sporting needs and the degree of anatomic injury different procedures will be required to lead to the highest chance of success. These decisions are made following a joint informed discussion with the patient and surgeon. These operations can lead to a significant improvement in a patient’s quality of life and prevent further anatomical change and potentially arthritis.

If you or someone you know has suffered an injury or is experiencing pain in their shoulder or difficulty with moving the shoulder, arm or elbow and would like a consultant-led review, please contact us. Grosvenor Orthopaedics have extensive experience in the treatment of ACJ injuries with excellent patient outcomes.


Grosvenor Orthopaedics have extensive experience in the treatment of should & elbow -related injuries with excellent patient outcomes.


If you would like to learn about other shoulder & elbow conditions click the button below to find out more


If you would like to learn about other shoulder & elbow treatments click the button below to find out more

our specialist shoulder and elbow consultants

Shoulder and Elbow care at Grosvenor Orthopaedics is led by our consultant surgeons Mr W James White and Mr David Butt, both graduates of London medical colleges. They bring extensive experience to Grosvenor Orthopaedics having worked across Guys NHS Trust and the world renowned Royal National Orthopaedic Hospital.

Our team have broad experience in the successful treatment of a range of shoulder and elbow problems, addressing both young and sports related injuries as well as those relating to trauma, disease process and genetics.

Patients who choose Grosvenor Orthopaedic Partners for their treatment will receive some of the best care available in the UK. Our team are leading consultants across London’s shoulder and elbow clinics and offer specialist care to our private patients through King Edward’s Hospital, HCA Lister and other major private hospitals in central London.

Our team are well placed to manage and treat a diverse range of shoulder and elbow problems utilising cutting edge diagnostic technology and treatment approaches, both surgical and conservative. Below is an overview of some of the conditions we treat but for a more thorough understanding please contact our team here


Consultant Shoulder and Elbow Surgeon

FRCS(Tr&Orth), MBBS, BSc(Hons)
James is a Consultant Shoulder and Elbow Surgeon, practising at Guy’s and St Thomas’ Hospital NHS Foundation Trust, King Edward VII’s, The Lister Hospital Chelsea and HCA Chiswick Outpatient Clinic. His practice encompasses all aspects of shoulder and elbow surgery including arthroscopy, arthroplasty and trauma. He has a reputation as a thorough clinician, effective communicator and skilled surgeon. Through joint decision-making with the patient and utilising non-operative techniques where possible, he achieves the best possible outcomes for patients. When surgery is required, James has excellent outcomes based on his precise and prepared approach to operating.


Consultant Shoulder and Elbow Surgeon

FRCS(Tr&Orth), MSc, MBBS, BSc(Hons)
David is a Consultant Shoulder and Elbow Surgeon, practising at the world-renowned Royal National Orthopaedic Hospital Stanmore, King Edward VII’s Hospital and One Hatfield. His practice involves all aspects of shoulder and elbow surgery, from minor injuries to complex reconstructive procedures. He strongly believes in shared decision making and a patient-centred approach to treatment. He is a meticulous surgeon using up to date and evidence-based techniques to treat every patient’s individual needs.

What some of our patients say

Miss NN

Thank you and please accept my gratitude for a successful knee surgery and overall a very positive experience. This gold medal is for you!