Shoulder Instability

Common Symptoms

Slipping, apprehension with overhead activity or recurrent dislocations.

How It Is Evaluated

Examination and imaging evaluate ligament, labral and bone damage.

Nonsurgical Management

After appropriate care for a dislocation, rehabilitation builds shoulder control. Activity changes can reduce repeat injury.

When Surgery May Help

Repeated instability may need labral repair or stabilization. Significant bone loss may require a bone-restoring procedure.

Remplissage For a Hill-Sachs Lesion

A shoulder dislocation can leave an indentation in the ball of the joint, called a Hill-Sachs lesion. If this defect can catch on the socket rim, a labral repair alone may not provide enough stability.

Remplissage is an arthroscopic procedure often combined with a Bankart labral repair. The surgeon secures part of the posterior capsule and infraspinatus tendon into the defect to help prevent it from catching. It does not replace the missing bone with a bone graft.

In a randomized trial of selected patients with recurrent anterior instability, a Hill-Sachs lesion and less than 15% glenoid bone loss, adding remplissage reduced recurrent instability compared with Bankart repair alone. The decision also considers shoulder rotation and the demands of throwing or overhead sports. Significant socket bone loss may instead require bone reconstruction.

Further reading: Randomized trial of Bankart repair with remplissage; Remplissage: indications and clinical outcomes.

Recovery & Return To Activity

Recovery depends on the injury, treatment and your activity goals. Rehabilitation progresses from motion and strength to functional tasks. Return to sport should be based on healing, function and your care team's assessment, rather than a date alone.

Further reading: AAOS OrthoInfo — Shoulder instability