Shoulder Instability/Dislocation

What is Shoulder Instability or Dislocation?

Shoulder instability can vary widely in severity, ranging from mild episodes of subluxation, which occurs when the ball of the shoulder slips out of the socket, to full dislocation, when the ball of the shoulder fully slips out and remains out of the socket. These can occur in contact or overhead sports and can also result from falls and other traumatic events.

Common Symptoms

• Repeated episodes of the shoulder “slipping” or “popping out”

• Apprehension or fear of overhead positions

• Weakness or fatigue in the shoulder

• Pain, soreness, or muscle fatigue after episodes of instability

Physical Therapist Diagnosis

A PT will assess shoulder stability, strength, and movement control. Special tests such as the apprehension and relocation tests are used. Past history of dislocations is also key to diagnosis.

Why it Happens

Instability may result from traumatic dislocation (often contact injury) or from looseness due to repetitive overhead stress without the proper control over stabilizing muscles.

Why it Doesn’t Always Heal on Its Own

Once instability develops, the surrounding muscles tend to compensate and provide less efficient and effective stability in the joint. Without retraining, recurrent episodes are common.

Ideal Physical Therapy Treatment

Rehab emphasizes restoring stability, strength, and control.

Key strategies include:

• Manual therapy to restore mobility

• Dry needling to resolve tightness and provide relief to protective muscles

• Strengthening of rotator cuff and scapular stabilizers

• Neuromuscular retraining for overhead and sport-specific positions

• Gradual progression to overhead activity

Expected Outcomes

Many athletes with instability improve with rehab and are able to resolve the issue through physical therapy treatment alone, though some require surgery if dislocations are frequent or there are other complicating factors involved. Rehab is essential in both cases for restoring stability, improving movement efficiency, and returning to full participation.