Shoulder Dislocation and Instability

The shoulder is the body’s most mobile joint, which also makes it the joint that most often dislocates. After a first shoulder dislocation, especially in young and active people, the shoulder can become unstable and keep slipping partly (subluxation) or fully out of place. Dr. Andrew Dold, a board-certified, fellowship-trained sports medicine surgeon in Frisco, Texas, treats shoulder instability in athletes at every level, including as team physician and surgical consultant to Rugby Canada, and performs arthroscopic stabilization, remplissage and the Latarjet procedure.

What happens when a shoulder dislocates?

When the ball (humeral head) is forced out of the socket (glenoid), it usually tears the labrum, the rim of cartilage around the socket, and the ligaments attached to it. This is called a Bankart lesion. The ball can also be dented as it slides over the edge of the socket (a Hill-Sachs lesion), and repeat dislocations can wear away bone from the front of the socket. Most dislocations go out the front; shoulders that slip out the back are covered on the posterior shoulder instability page.

Will it happen again?

It depends mostly on your age, sex and activity. In a meta-analysis of 10 studies with 1,324 adults, recurrent instability after a first traumatic anterior dislocation was 39%, and people aged 40 or younger had about 13 times the odds of recurrence compared with older people.¹ In a national study of more than 21,000 people, ages 20 to 29 and male sex were the strongest risk factors for another dislocation.³

Symptoms

• A shoulder that “pops out” or feels loose
• Apprehension with the arm overhead or out to the side
• Pain, clicking or weakness with throwing, lifting or tackling
• Numbness or tingling down the arm after a dislocation, which should be checked promptly

Diagnosis

Dr. Dold examines the shoulder’s stability and orders X-rays and an MRI or MR arthrogram to look at the labrum and ligaments. A CT scan may be used to measure bone loss on the socket or the ball, which guides the choice of surgery. He also checks for related injuries such as a SLAP tear or, in older patients, a rotator cuff tear.

After a first dislocation: therapy or surgery?

Non-surgical care means a short period in a sling for comfort, then physical therapy to restore motion and strengthen the rotator cuff and shoulder-blade muscles. Many people, especially older adults, never dislocate again.

For young, active people, research favors surgery for preventing another dislocation. A 2025 meta-analysis found redislocation in about 6% after arthroscopic Bankart repair compared with about 51% after non-surgical care, and patients who had surgery were more likely to return to sport at their previous level.² In a randomized trial, recurrence at 2 years was 2.3% after arthroscopic stabilization and 19.1% after bracing, although shoulder function scores were similar between the groups.⁴ Dr. Dold weighs your age, sport, season and goals with you.

Surgery options

The right operation depends largely on how much bone has been lost. In a classic study, arthroscopic Bankart repair failed in about 4% of shoulders without significant bone defects but in about 67% of those with them.⁵ Dr. Dold measures bone loss carefully before choosing an operation:

• Arthroscopic Bankart repair: reattaches the torn labrum and ligaments to the socket with small anchors, through small incisions.
• Remplissage: an arthroscopic procedure that fills the Hill-Sachs dent with the back of the rotator cuff so it no longer catches on the socket, often combined with a Bankart repair. In a meta-analysis in athletes, adding remplissage was linked to lower recurrence and higher return to sport.⁶
• Latarjet procedure: transfers a small piece of bone to the front of the socket, used when there is significant bone loss or after a failed prior repair. A 2025 review of long-term studies found lower recurrent instability and revision rates after the open Latarjet than after arthroscopic Bankart repair at about 10 years.⁷
• Posterior and multidirectional stabilization: for shoulders that slip out the back or in more than one direction.⁸

For more detail, see Shoulder Dislocation and Labral Tears: 38 Questions Patients Ask.

Recovery

Most patients wear a sling for about 4 to 6 weeks after stabilization surgery, followed by a structured physical therapy program. Return to contact and collision sports is usually about 5 to 6 months after surgery, once strength and motion have returned. In a review of collision athletes after arthroscopic Bankart repair, about 90% returned to sport and about 81% returned to their previous level, at an average of about 5 months.⁹ Timelines vary, and Dr. Dold will give you a specific plan.

Watch Dr. Dold: Bankart repair

These videos show real surgery, so some viewers may prefer not to watch.

More videos on Dr. Dold’s YouTube channel.

What the research shows

Shoulder instability has been studied in many randomized trials. Here is what they add.

After a first dislocation

For young, active patients, randomized trials and long-term meta-analyses show that arthroscopic stabilization lowers the chance of another dislocation and improves return to play compared with non-surgical care. About half of patients treated with therapy alone do not dislocate again, so non-surgical care remains reasonable for many people, particularly older or less active patients. Bracing the arm in outward rotation did not reduce recurrence in a randomized trial.

Choosing the right operation

Bone loss and the size and position of the Hill-Sachs dent are among the strongest predictors of failure after arthroscopic Bankart repair, and collision athletes are at higher risk. Adding remplissage to a Bankart repair lowers recurrence and improves return to sport in patients with a Hill-Sachs lesion and limited bone loss. The Latarjet procedure has lower recurrence over longer follow-up and is a reliable option after a failed repair, although it carries its own complication profile.

Return to sport

Most athletes return to sport after stabilization, but about a third do not return to their previous level, which is worth discussing when planning treatment.

Why see Dr. Dold

• Board certified by the American Board of Orthopaedic Surgery, with subspecialty certification in Sports Medicine
• Sports medicine and arthroscopy fellowship at NYU Langone / Hospital for Joint Diseases; orthopedic residency at the University of Toronto
• Fellow of the American College of Surgeons (FACS), the American Academy of Orthopaedic Surgeons (FAAOS), the American Orthopaedic Association (FAOA) and the Royal College of Surgeons of Canada (FRCSC)
• Author of a SLAP repair book chapter (Springer, 2017) and research on shoulder suture anchors (KSSTA, 2013)
• Team physician and surgical consultant to Rugby Canada; has cared for professional athletes from the NFL, NBA, NHL, MLS, PGA Tour and Major League Rugby
• D Magazine Best Doctors (Collin County), 2019–2026 · Rated 4.9 on Google

Frequently asked questions

Research cited on this page

1. Olds M, Ellis R, Donaldson K, et al. Risk factors which predispose first-time traumatic anterior shoulder dislocations to recurrent instability in adults: a systematic review and meta-analysis. Br J Sports Med. 2015;49(14):913-922. PubMed
2. Abdel Khalik H, Dagher D, Lameire DL, et al. Management of first-time anterior shoulder dislocation: a systematic review and meta-analysis: Arthroscopy Association of Canada position statement. Orthop J Sports Med. 2025;13(2):23259671251316893. PubMed
3. Szyluk K, Jasiński A, Niemiec P, et al. Male gender and age range 20-29 years are the most important non-modifiable risk factors for recurrence after primary post-traumatic shoulder dislocation. Knee Surg Sports Traumatol Arthrosc. 2018;26(8):2454-2464. PubMed
4. Minkus M, Königshausen M, Pauly S, et al. Immobilization in external rotation and abduction versus arthroscopic stabilization after first-time anterior shoulder dislocation: a multicenter randomized controlled trial. Am J Sports Med. 2021;49(4):857-865. PubMed
5. Burkhart SS, De Beer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy. 2000;16(7):677-694. PubMed
6. Davis WH, DiPasquale JA, Patel RK, et al. Arthroscopic remplissage combined with Bankart repair results in a higher rate of return to sport in athletes compared with Bankart repair alone or the Latarjet procedure: a systematic review and meta-analysis. Am J Sports Med. 2023;51(12):3304-3312. PubMed
7. Meyer AM, Lorentz SG, Klifto CS, et al. Open Latarjet results in lower recurrent instability and revision rates than arthroscopic Bankart repair at a 10-year follow-up: a systematic review. Arthroscopy. 2025;41(9):3693-3705. PubMed
8. Ralph JE, Hurley ET, Lunn K, et al. Outcomes of arthroscopic stabilization for posterior shoulder instability: a systematic review. J Shoulder Elbow Surg. 2024;33(11):2530-2538. PubMed
9. Pasqualini I, Turan OA, Hurley ET, et al. Return to sports following arthroscopic Bankart repair in collision athletes: a systematic review. Shoulder Elbow. 2025;17(3):288-297. PubMed
10. van Spanning SH, Verweij LPE, Priester-Vink S, et al. Operative Versus Nonoperative Treatment Following First-Time Anterior Shoulder Dislocation: A Systematic Review and Meta-Analysis. JBJS Rev. 2021;9(9). PubMed
    A meta-analysis found high-quality evidence that surgical stabilization after a first dislocation lowers recurrence over more than 10 years in young patients.
11. Belk JW, Wharton BR, Houck DA, et al. Shoulder Stabilization Versus Immobilization for First-Time Anterior Shoulder Dislocation: A Systematic Review and Meta-analysis of Level 1 Randomized Controlled Trials. Am J Sports Med. 2023;51(6):1634-1643. PubMed
    Stabilization surgery after a first dislocation, especially in active men in their 20s and 30s, led to significantly lower recurrence than non-surgical care.
12. Pougès C, Hardy A, Vervoort T, et al. Arthroscopic Bankart Repair Versus Immobilization for First Episode of Anterior Shoulder Dislocation Before the Age of 25: A Randomized Controlled Trial. Am J Sports Med. 2021;49(5):1166-1174. PubMed
    A randomized trial found arthroscopic Bankart repair after a first dislocation reduced re-dislocation and improved function at 2 years.
13. Hu B, Hong J, Zhu H, et al. Arthroscopic Bankart repair versus conservative treatment for first-time traumatic anterior shoulder dislocation: a systematic review and meta-analysis. Eur J Med Res. 2023;28(1):260. PubMed
    Arthroscopic Bankart repair outperformed non-surgical care for recurrence, return to play and later surgery in young active patients.
14. Kavaja L, Lähdeoja T, Malmivaara A, et al. Treatment after traumatic shoulder dislocation: a systematic review with a network meta-analysis. Br J Sports Med. 2018;52(23):1498-1506. PubMed
    About half of patients treated with physiotherapy after a first dislocation did not dislocate again; surgery helps those who develop chronic instability.
15. Kearney R, Ellard D, Parsons H, et al. Advice only versus advice and a physiotherapy programme for acute traumatic anterior shoulder dislocation: the ARTISAN RCT. Health Technol Assess. 2024;28(22):1-94. PubMed
    The UK ARTISAN trial found adding physiotherapy sessions to advice gave little extra benefit after a first dislocation treated without surgery.
16. Whelan DB, Litchfield R, Wambolt E, et al. External rotation immobilization for primary shoulder dislocation: a randomized controlled trial. Clin Orthop Relat Res. 2014;472(8):2380-6. PubMed
    A randomized trial found immobilization in external rotation did not lower recurrence compared with a standard sling.
17. Rutgers C, Verweij LPE, Priester-Vink S, et al. Recurrence in traumatic anterior shoulder dislocations increases the prevalence of Hill-Sachs and Bankart lesions: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2022;30(6):2130-2140. PubMed
    Hill-Sachs and Bankart lesions were more common after repeat dislocations than after a first one.
18. Trasolini NA, Dandu N, Azua EN, et al. Inconsistencies in Controlling for Risk Factors for Recurrent Shoulder Instability After Primary Arthroscopic Bankart Repair: A Systematic Review. Am J Sports Med. 2022;50(13):3705-3713. PubMed
    Off-track Hill-Sachs lesions and bone loss were among the most consistent risk factors for failure of arthroscopic Bankart repair.
19. Alkaduhimi H, van der Linde JA, Willigenburg NW, et al. Redislocation risk after an arthroscopic Bankart procedure in collision athletes: a systematic review. J Shoulder Elbow Surg. 2016;25(9):1549-58. PubMed
    Collision athletes had a higher re-dislocation risk after arthroscopic Bankart repair, without a difference in return to sport.
20. Memon M, Kay J, Cadet ER, et al. Return to sport following arthroscopic Bankart repair: a systematic review. J Shoulder Elbow Surg. 2018;27(7):1342-1347. PubMed
    Most athletes returned to sport after arthroscopic Bankart repair, but about a third did not return to their previous level.
21. Hurley ET, Toale JP, Davey MS, et al. Remplissage for anterior shoulder instability with Hill-Sachs lesions: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2020;29(12):2487-2494. PubMed
    Adding remplissage to Bankart repair lowered recurrence in patients with Hill-Sachs lesions and limited bone loss.
22. Ahmed AF, Polisetty TS, Wang C, et al. Higher return to sport and lower revision rates when performing arthroscopic Bankart repair with remplissage for anterior shoulder instability with a Hill-Sachs lesion: a meta-analysis. J Shoulder Elbow Surg. 2024;33(8):1836-1846. PubMed
    Remplissage with Bankart repair led to lower recurrence, fewer revisions and higher return to sport.
23. Gonzalez-Morgado D, Ardebol J, Noble MB, et al. No Difference in External Rotation Loss After Isolated Bankart Repair, Remplissage, or Latarjet: A Systematic Review and Meta-analysis. Am J Sports Med. 2025;53(2):493-500. PubMed
    A 2025 review found remplissage lowered recurrence without a significant loss of outward rotation, and may need fewer reoperations than Latarjet.
24. Imam MA, Shehata MSA, Martin A, et al. Bankart Repair Versus Latarjet Procedure for Recurrent Anterior Shoulder Instability: A Systematic Review and Meta-analysis of 3275 Shoulders. Am J Sports Med. 2021;49(7):1945-1953. PubMed
    A meta-analysis found the Latarjet procedure had a lower risk of recurrence than Bankart repair with longer follow-up.
25. Lho T, Lee J, Oh KS, et al. Latarjet procedure for failed Bankart repair provides better stability and return to sports, but worse postoperative pain and external rotation limitations with more complications, compared to revision Bankart repair: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2023;31(8):3541-3558. PubMed
    For failed Bankart repair, Latarjet gave better stability and return to sport than a revision Bankart repair.
26. Karavan MP, Hurley ET, Mills FB, et al. Primary Latarjet procedure versus Latarjet in the setting of previously failed Bankart repair: a systematic review. J ISAKOS. 2023;8(6):490-496. PubMed
    Latarjet performed after a failed Bankart repair had more complications and recurrence than Latarjet performed as the first operation.

Medically reviewed by Andrew P. Dold, MD, FAOA, FAAOS, FACS, FRCSC. Last reviewed October 2026. This page is general information, not medical advice. Individual results vary.