Conditions

Shoulder Instability

Shoulder instability means the ball at the top of your arm bone doesn’t stay firmly in the shoulder socket. It may:

Dislocate – come fully out of the socket
Subluxate – partly come out of the socket, but not fully dislocate

This can happen during movement, exercise, or even simple everyday tasks. Some people feel like their shoulder might “pop out” or slip. Shoulder instability may cause pain, usually around the front or upper part of the shoulder and arm. Symptoms often occur when reaching overhead, behind your back or into positions where your shoulder feels less secure.

Shoulder instability can develop after an injury, such as a shoulder dislocation, or without any obvious injury. An injury can damage the ligaments, the rim of cartilage around the socket (labrum), or the joint capsule. These structures help keep the shoulder stable. Damage to these structures can lead to the shoulder being unstable.

Some people develop shoulder instability without an injury. This is more common in people who have very flexible joints (hypermobility).

Treatment depends on the cause of your shoulder instability and how often it happens. Listed below is a list of treatments that may help.

Steps to take to recovery

Self-Management

Activity Modification

Avoid positions or movements that provoke instability. Avoid positions that make your shoulder feel as though it might slip out, particularly when reaching overhead or behind your back. Trying to avoid these positions will reduce the episodes of instability.

Pain Relief

Over-the-counter medicines: Over-the-counter pain relief may help you stay active. Always follow the advice provided with the medicine.

Topical creams: Some people find topical creams or gels helpful for short-term relief of pain and stiffness.

It is important to check whether you can take these medicines. If you are unsure whether you can take these medicines, speak to a pharmacist or another healthcare professional.

Exercises

Exercises are the main treatment for many people with shoulder instability. They help improve strength, control and stability around the shoulder. The BESS instability exercises provides a structured programme that may help support your recovery.

Further Treatment

Physiotherapy

Many people with shoulder instability improve with physiotherapy. Exercises that strengthen the muscles around the shoulder and improve movement control are often the most effective treatment and can reduce the chance of further episodes.

If your symptoms aren't improving or you feel you need more help, then please refer yourself to physiotherapy. We will work with you to develop a treatment plan. You can have one-to-one physiotherapy and have access to our gym classes. We can also refer you to other services to access other treatments listed below if appropriate.

Investigations

Many people do not need a scan. Further tests or scans are only needed for some people, particularly if the shoulder remains unstable despite rehabilitation. If your physiotherapist feels this may be needed they will discuss your options with you.

Surgery

Some patients may require surgery if they have a very unstable shoulder. There are different types of surgery depending on the cause of the instability. Your surgeon will discuss the most suitable operation for you. If your physiotherapist feels you may need a surgical opinion they will discuss your options with you.

Many people with shoulder instability improve with a structured exercise programme. Building strength and improving muscle control around the shoulder can reduce episodes of instability and help you return to your usual activities.

Lifestyle factors that influence health

Shoulder instability symptoms can be influenced by our overall health. Poor sleep, smoking, diabetes, and long-term stress can make pain feel worse and slow healing. Improving general health can help improve symptoms. More support with health and lifestyle factors can be found on our Your Musculoskeletal Health webpage.

When to seek further advice

Most shoulder pain can be managed safely with self-care. However, contact NHS 111 if you have any of the following:

A recent injury or fall that has caused severe pain or a sudden loss of movement.
You cannot move your shoulder after a fall, injury or seizure.
A shoulder that is hot, red or swollen, especially if you also have a fever or feel generally unwell.

These symptoms may need urgent assessment and are not typical of a shoulder instability.