Back Pain Doctor
Shoulder Dislocation and Instability
Written by Dr Joshua Hatch, Musculoskeletal GP, RACGP Fellow, Diploma in Musculoskeletal Medicine (FSEM UK).
Shoulder instability covers a spectrum. At one end is the shoulder that comes fully out of joint (a dislocation), usually forwards, in a tackle, a fall onto an outstretched arm or a heavy overhead lift. At the other end is a shoulder that slips partly out and back again (a subluxation), or one that simply feels unreliable. A first dislocation often tears the labrum, the rim of cartilage around the socket, and that is part of why it can recur.
The first visit after a dislocation
A shoulder that is still out of joint is an emergency department problem, not a clinic one. Once it has been put back, assessment looks at how it happened, how many times it has happened, the person’s age and sport, checks the nerves around the shoulder and the strength of the rotator cuff, and decides what imaging is needed. X-rays look for a fracture. An MRI, sometimes with contrast injected into the joint, shows the labrum and any bone loss from the socket or the back of the humeral head, which matters when surgery is being considered.
How likely it is to happen again
The risk is not the same for everyone. A review of ten studies and 1,324 adults found that 39% had further instability after a first traumatic dislocation, with higher risk at 40 and under, in men and in people with hyperlaxity, and lower risk after a greater tuberosity fracture (Olds, Br J Sports Med 2015). In adolescents the pooled recurrence rate was 73%, and 14 to 18 year olds were at far higher risk than younger children, although those studies were small and of modest quality (Olds, Br J Sports Med 2015).
Rehabilitation or surgery
Rehabilitation comes first for most people: a short period of comfort in a sling, then restoring movement, then progressive strengthening of the rotator cuff and the muscles around the shoulder blade, finishing with sport-specific work. Return to sport is decided on strength, control and confidence, not on the calendar.
For younger athletes the trials favour early surgery. In a randomised trial of 40 people under 30, the redislocation rate at two years was 47% with sling and rehabilitation against 16% after arthroscopic stabilisation (Kirkley, Arthroscopy 1999). At about six years the gap in redislocation remained, but general shoulder function scores were similar, and the authors recommended early surgery mainly for higher-level athletes in risky sports (Kirkley, Arthroscopy 2005). A 2025 meta-analysis of 11 comparative studies and 694 patients found arthroscopic repair after a first dislocation markedly reduced redislocation and later stabilisation surgery (Abdel Khalik, Orthop J Sports Med 2025).
So not every first dislocation is treated the same way. For a 19-year-old rugby player, a surgical opinion is usually raised early. For a 45-year-old who fell while bushwalking, rehabilitation and a check of the rotator cuff are the priority.
After 40
The pattern of injury changes with age. Labral tears dominate in younger people, while rotator cuff tears become common with age, around 70% in one series of patients over 60 (Loew, Unfallchirurg 2001). A shoulder that stays weak after it has been put back needs the cuff assessed promptly, because a large traumatic tear may need a surgical opinion.
Loose shoulders without an injury
Multidirectional instability is different. It usually develops without a dislocation, often in people with generally flexible joints, and the first treatment is a structured program aimed at control of the shoulder blade and the ball in the socket. In an Australian randomised trial of 41 people, a specific instability program produced better shoulder scores at 12 and 24 weeks than a general one (Warby, Am J Sports Med 2017). See also the guide to hypermobility.
A shoulder that hurts at the top after a fall onto the point of the shoulder may be an AC joint injury rather than a dislocation, and a clicking, painful shoulder without instability may be a labral tear.
Common symptoms
- The shoulder coming out of joint, or a sense that it is about to (apprehension)
- Pain and weakness after an episode, often worst with the arm raised and turned outwards
- Clicking, catching or a dead-arm feeling with overhead or throwing movements
- Avoiding tackles, bench pressing or reaching overhead because the shoulder feels unreliable
Commonly seen in
Evidence for twelve treatment options in shoulder dislocation and instability
This is not a fixed ladder or a package of treatments. Every option is assessed independently against this diagnosis, including treatments with limited direct research that may still be reasonable for a clearly defined tissue target. The evidence level, likely benefit, risks, cost and alternatives are weighed at consultation.
Foundation: diagnosis, education and rehabilitation
The part of care with the broadest relevance. For many people it is enough on its own; other options are judged against it, not automatically added after it.
Diagnosis, education and progressive rehabilitation Working out what is driving the pain, explaining what your imaging does and does not mean, and building a graded loading plan you can actually follow. Core care
What it involves
Assessment to identify the likely pain source, an explanation of what the diagnosis means, adjustment of the loads that aggravate it, and a progressive strength and conditioning plan, with weight management where that is clinically relevant.
What the evidence shows
Rehabilitation is the starting point for most people, and the trials show where it falls short. In a randomised trial of 40 people under 30 after a first traumatic dislocation, redislocation at two years was 47% after sling and rehabilitation against 16% after arthroscopic stabilisation (Kirkley, Arthroscopy 1999); at about six years redislocation still differed but general shoulder function scores did not (Kirkley, Arthroscopy 2005). A 2025 meta-analysis of 11 comparative studies and 694 patients found arthroscopic repair markedly reduced redislocation and later stabilisation surgery (Abdel Khalik, Orthop J Sports Med 2025). For atraumatic multidirectional instability, a randomised trial of 41 people found a specific instability program gave better shoulder scores than a general one at 12 and 24 weeks (Warby, Am J Sports Med 2017).
Pairing reviewed 2026-10-30.
Where it fits
The usual starting point for most people: restoring movement, then rotator cuff and shoulder blade strength and control, then sport-specific work, with return to sport decided on criteria. For a young athlete in a collision or overhead sport an early surgical opinion is raised, because that is where the trials favour stabilisation. Over 40, the rotator cuff is checked early.
Muscle and symptom-modifying options
Useful only when the examination identifies the tissue they target or when short-term pain control creates a useful rehabilitation window.
Wet needling and trigger point injection (trigger point injection) A fine needle into a tender band of muscle, with a small volume of dilute glucose solution injected through it. Only if relevant
What it involves
The needle is placed into the tender muscle band and a small volume of 5% glucose with a very dilute local anaesthetic (0.02-0.08%) is injected. Often done in the same visit as your assessment, and usable where the tender area sits deeper. Dry needling (the same technique with nothing injected) is not offered here.
What the evidence shows
No study of trigger point needling or injection as a treatment for shoulder instability was found. A PubMed search on 30 October 2026 pairing shoulder dislocation, shoulder instability and glenohumeral instability with needling, trigger point, perineural, hydrodissection, corticosteroid and hyaluronic acid terms returned nine records; the only needling trial was after surgery, adding dry needling to rehabilitation following a stabilisation repair (Halle, Int J Sports Phys Ther 2020).
Pairing reviewed 2026-10-30.
Where it fits
Only where a tender band in the shoulder girdle muscles is adding to pain during rehabilitation. It does nothing for the instability.
Ultrasound-guided injections Guidance means the needle can be seen reaching the target. What goes into the needle depends on the diagnosis. Only for a separate problem
What it involves
The injection is performed under ultrasound so the needle can be watched into the target structure. What is injected is decided by the diagnosis, and corticosteroid is used sparingly, for the reasons set out below.
What the evidence shows
No trial of a guided injection as a treatment for shoulder instability was found. A PubMed search on 30 October 2026 pairing shoulder dislocation, shoulder instability and glenohumeral instability with needling, trigger point, perineural, hydrodissection, corticosteroid and hyaluronic acid terms returned nine records, none testing an injection for an unstable shoulder.
Pairing reviewed 2026-10-30.
Where it fits
Not a treatment for instability. Considered only for a separate problem in the same shoulder, such as an irritated subacromial bursa, on that problem's evidence.
V-ACTOR vibration therapy (vibration therapy) Low-frequency vibration applied over tender muscle. Not a shockwave, despite sharing the machine. Plausible: no studies
What it involves
A vibration handpiece is moved over the tender muscle and fascia for a few minutes. It runs from the same STORZ MASTERPULS icon console as radial shockwave but is a separate handpiece delivering a different, gentler form of energy. No needles, no anaesthetic, no downtime.
What the evidence shows
No published clinical trial of this device in this condition. It is a vibration handpiece delivered from the same console as radial shockwave, and the rationale is myofascial rather than tendon- or bone-directed.
Pairing reviewed 2026-10-30.
Where it fits
A comfort measure used within a session where muscular tightness is limiting movement. Never the reason for the appointment, and not a substitute for the treatments that do have evidence.
Energy-based treatment options
Radial pressure wave, focused shockwave and EMTT have different targets and different evidence. They are assessed separately rather than treated as one category.
Radial or focused shockwave? Read the overviewRadial shockwave (radial pressure wave) Broad treatment across tender muscle and fascia, close to the surface. Only if relevant
What it involves
A handpiece is moved over the tender tissue while ballistic pressure pulses are delivered, using a transmitter head chosen for the tissue, including heads shaped for fascia and for the muscle either side of the spine. The pulse is strongest at the skin and weakens with depth, so this is mainly a myofascial treatment, though it can reach deeper in some areas. No anaesthetic, no downtime, usually a course of sessions about a week apart.
What the evidence shows
Radial shockwave has not been studied in shoulder instability. A PubMed search on 30 October 2026 pairing shoulder dislocation and shoulder instability with shockwave, platelet-rich plasma, prolotherapy and dextrose terms returned 22 records, none testing shockwave in this condition.
Pairing reviewed 2026-10-30.
Where it fits
May ease tender muscles around the shoulder blade during the strengthening program. It does not stabilise the joint.
Focused shockwave (ESWT) A true shock wave converging at depth: for tendon, joint, ligament and bone. Only if relevant
What it involves
A focused system generates an acoustic shock wave that converges at a focal point set at a defined depth, concentrating the energy where the target is. This is the form used for tendon, joint, ligament and bone. Typically four to six sessions about a week apart, no anaesthetic and no formal downtime.
What the evidence shows
No study has tested focused shockwave in shoulder instability. A PubMed search on 30 October 2026 pairing shoulder dislocation and shoulder instability with shockwave, platelet-rich plasma, prolotherapy and dextrose terms returned 22 records, none testing shockwave in this condition.
Pairing reviewed 2026-10-30.
Where it fits
Not a treatment for an unstable shoulder. Considered only for a coexisting rotator cuff or calcific tendon problem, on that problem's evidence.
EMTT (magnetotransduction therapy) High-energy magnetic pulses applied over the area. Usually painless, no contact. Plausible: no studies
What it involves
You sit with the applicator positioned over the area for a short session. It is usually painless and needs no gel or skin contact. It is usually given as a course, commonly alongside shockwave.
What the evidence shows
There are no published randomised trials of EMTT in this condition, or in any musculoskeletal condition, that could be identified. The supporting work is laboratory work: EMTT increased tenocyte proliferation, migration and collagen expression in cultured human tendon cells (Mancini, Int J Mol Sci 2025). The nearest human evidence for a related electromagnetic therapy is negative. A randomised trial of pulsed electromagnetic field therapy added to eccentric exercise for Achilles tendinopathy found no improvement in outcome scores or tendon neovascularity over eccentric exercise alone (Ko, Orthop J Sports Med 2024).
Pairing reviewed 2026-10-30.
Where it fits
Offered only as an adjunct alongside treatment that does have evidence, never as the plan itself, and only after that gap is explained. Much of the EMTT literature is manufacturer-affiliated, which is part of why it is described this way.
Biologic and joint injection options
Each injection is assessed independently for the named diagnosis. Cost, uncertainty, likely benefit, risks and alternatives are part of the decision.
Platelet-rich plasma (PRP) Your own blood, concentrated and injected under ultrasound guidance. Only for a separate problem
What it involves
Blood is taken from your arm, spun to concentrate the platelets, and injected into the target under ultrasound guidance in the same appointment.
What the evidence shows
No study of platelet-rich plasma as a non-operative treatment for shoulder instability was found. A PubMed search on 30 October 2026 pairing shoulder dislocation and shoulder instability with shockwave, platelet-rich plasma, prolotherapy and dextrose terms returned 22 records. The one clinical PRP study in this area injected it during arthroscopic labral repair, as a surgical adjunct, in a case-control design (Azharuddin, Shoulder Elbow 2025).
Pairing reviewed 2026-10-30.
Where it fits
Not offered for the instability, which is a matter of the labrum, the bony socket and muscle control. Considered only for a separate problem in the same shoulder, such as a rotator cuff tendon, on that problem's evidence.
Prolotherapy (dextrose) A course of dextrose injections into and around the structure and its attachments. Not offered for this
What it involves
Hypertonic dextrose is injected at the tender ligament and tendon attachments, and into the joint where relevant, usually as a series of treatments a few weeks apart.
What the evidence shows
No study of prolotherapy or dextrose injection for shoulder instability was found. A PubMed search on 30 October 2026 pairing shoulder dislocation and shoulder instability with shockwave, platelet-rich plasma, prolotherapy and dextrose terms returned 22 records, none testing prolotherapy in this condition.
Pairing reviewed 2026-10-30.
Where it fits
Not offered for a dislocated or unstable shoulder. A torn labrum or bone lost from the socket is not something an injection repairs, and the routes with evidence are rehabilitation and, where warranted, surgical stabilisation.
Viscosupplementation (hyaluronic acid) A gel-like injection into an arthritic joint. Widely used, and genuinely contested. Not offered for this
What it involves
One or a short series of hyaluronic acid injections into the joint under ultrasound guidance.
What the evidence shows
No study of hyaluronic acid injection for shoulder instability was found. A PubMed search on 30 October 2026 pairing shoulder dislocation, shoulder instability and glenohumeral instability with needling, trigger point, perineural, hydrodissection, corticosteroid and hyaluronic acid terms returned nine records.
Pairing reviewed 2026-10-30.
Where it fits
Not offered. Hyaluronic acid is considered only for arthritis inside a joint, and instability is not arthritis.
Nerve-targeted options
Relevant when examination identifies a superficial neuropathic pattern or a compressed peripheral nerve, not simply because pain is present.
Lyftogt perineural therapy (perineural injection therapy) A series of small dilute dextrose injections just under the skin, over tender superficial nerves. Only if relevant
What it involves
Small injections of low-concentration dextrose, usually 5%, placed just beneath the skin along tender superficial nerves. Given as a series of short sessions.
What the evidence shows
No study of perineural injection in shoulder instability was found. A PubMed search on 30 October 2026 pairing shoulder dislocation, shoulder instability and glenohumeral instability with needling, trigger point, perineural, hydrodissection, corticosteroid and hyaluronic acid terms returned nine records, none testing it in this condition.
Pairing reviewed 2026-10-30.
Where it fits
Not a treatment for instability, or for a nerve injured by the dislocation, which needs assessment and time. Considered only where a superficial nerve is separately part of the pain.
Ultrasound-guided nerve hydrodissection Fluid placed around a nerve to free it from the surrounding tissue. Only if relevant
What it involves
Under ultrasound, fluid is placed in the plane around the nerve to separate it from the tissue that is tethering or compressing it.
What the evidence shows
No study of nerve hydrodissection in shoulder instability was found. A PubMed search on 30 October 2026 pairing shoulder dislocation, shoulder instability and glenohumeral instability with needling, trigger point, perineural, hydrodissection, corticosteroid and hyaluronic acid terms returned nine records, none testing it in this condition.
Pairing reviewed 2026-10-30.
Where it fits
Not a treatment for instability. Considered only where examination and ultrasound find a nerve entrapped separately from the joint problem.
This is general information only and suitability is assessed individually. Treatments with limited or condition-dependent evidence may still be discussed, but only with clear explanation of the uncertainty, the expected benefit, risks, cost and alternatives. Red flags, progressive neurological symptoms or suspected serious pathology require a different pathway.
Every treatment above is described in full on the non-surgical treatments page, including what each one is used for and what the evidence supports. Ratings apply to the named diagnosis; an adjacent muscle, tendon, joint or nerve problem is assessed as a separate target. The method behind the ratings, and the treatments not offered, are set out on the evidence page.
Corticosteroid injection is reviewed separately for each diagnosis.
Cortisone reliably reduces pain in the short term, and that can be genuinely useful when pain is stopping you sleeping or moving enough to rehabilitate. Beyond that window the picture changes. A systematic review of 41 randomised trials and 2,672 participants found that corticosteroid injection reduced pain in the short term but that the effect reversed at intermediate and long term; in pooled analysis for lateral epicondylalgia the short-term effect was large (SMD 1.44, 95% CI 1.17 to 1.71) while no intervention was favoured at 26 weeks (-0.40, -0.67 to -0.14) and at 52 weeks (-0.31, -0.61 to -0.01) (Coombes, Lancet 2010). In a randomised trial in lateral epicondylalgia, 83 per cent of the corticosteroid group had completely recovered or much improved at one year against 96 per cent given a placebo injection, and recurrence ran at 54 per cent against 12 per cent; adding physiotherapy made no significant difference at one year (Coombes, JAMA 2013). In joints, repeated corticosteroid injections have been associated with cartilage loss. It does not repair anything.
So treatment plans are not built around it. Where an injection is the right call, the specific diagnosis and target are reviewed, what is being injected and why is discussed, the number is kept low, and it is paired with the loading work that changes the longer-term course.
When it might still be considered
- Pain severe enough to block rehabilitation
- A clear inflammatory or bursal target on imaging
- A specific short-term goal: a trip, a procedure, a return to work
- Diagnostic use, where the response shows where the pain is coming from
When a cortisone injection is worth doing, and when it is not
Other shoulder conditions
Pain in the same area can come from more than one source, and the label matters less than what the examination and history point to. These are the other guides for this region.
Frequently asked questions
My shoulder is still out of joint. Should I come to the clinic?
Will it dislocate again?
Do I need surgery after a first dislocation?
I am over 40 and dislocated my shoulder. Is that different?
My shoulders feel loose but I have never injured them. Is that instability?
Ready for a clearer plan for your back or musculoskeletal pain?
Book an assessment with Dr Joshua Hatch.
Your assessment focuses on understanding the likely source of your pain and the most appropriate non-surgical options for your diagnosis, with the aim of reducing pain and improving function.
You must have your own regular GP before booking. This service works alongside your GP for focused care. Booking requirements.
Book an appointment