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What is shoulder instability?
Shoulder instability is a condition in which the humeral head displaces from the glenoid cavity (subluxation or dislocation). After the first dislocation in young people, the risk of recurrence is 80-90%.
Types of instability:
- Traumatic — after dislocation, Bankart lesion
- Atraumatic — hypermobility, multidirectional
- Microninstability — subluxations without full dislocation
Injuries:
- Bankart — detachment of labrum
- Hill-Sachs — impression fracture of humeral head
- SLAP — detachment of superior labrum
- Capsule strain — volume increase
Facts
- ICD-10: M25.31
- Recurrence: 80-90% (up to 25 years)
- Age: 15-35 years
- After surgery: recurrence 5-15%
Symptoms of instability
Typical complaints
- Recurrent subluxations or dislocations
- Sensation of «head slipping out»
- Pain with abduction and external rotation
- Fear of recurrent dislocation
- Sports restriction
Consequences if left untreated
- Increased frequency of dislocations
- Progression of Bankart lesion
- Bone loss (glenoid bone loss)
- Development of shoulder osteoarthritis
- Inability to participate in sports
When regenerative treatment is particularly effective
- After first dislocation (recurrence prevention)
- Mild and moderate instability
- Microninstability in athletes
- Supplement to rehabilitation
Shoulder instability: treatment options and what is known about them
The treatment plan is made by the clinic doctor after an examination and a review of your images. The table shows the options usually discussed for this diagnosis and how well they have been studied.
| Option | What to expect | How well studied |
|---|---|---|
| Exercise therapy and physiotherapy | Reduces pain, strengthens muscles, improves function; the basis of treatment | Well studied, recommended |
| Painkillers and NSAIDs | Ease pain during flare-ups; long-term use is limited by side effects | Moderate evidence |
| PRP / CGF | — | Not usually used for this diagnosis |
| Stabilisation surgery | If conservative treatment does not help or there is an indication | When indicated — the doctor decides |
We send your request to several partner clinics. Some will suggest conservative treatment or injections, others surgery; each clinic quotes its own conditions and price. We help you compare the options.
Regenerative methods: realistic expectations
For mechanical joint problems — a labral tear, impingement, instability, ligament injury — targeted rehabilitation is the basis of treatment: muscle strengthening, coordination training and load management. Injections can reduce pain temporarily but do not remove the mechanical cause. There is little data on PRP for these diagnoses.
When surgery is discussed. Surgery is discussed for recurrent dislocations, a marked mechanical cause (bone shape, a large tear) or if pain and instability persist after 3–6 months of rehabilitation.
If an injection helps, the effect usually builds up over 6–12 weeks, and the result is assessed after 2–3 months. No clinic can guarantee a result.
Good to know: diagnosis, self-help, outlook
How to tell shoulder instability from similar conditions
Shoulder instability is the feeling that the joint “pops out” or partly dislocates, most often after a first dislocation in young athletes. Pain with the arm raised and turned outwards and fear of certain movements (apprehension test) are typical of anterior instability. A labral tear (SLAP) may cause clicking and pain when throwing, while a cuff tear causes weakness, especially in people over 40. MR arthrography shows the labrum and capsule best.
What you can do yourself
After a dislocation: a short period in a sling as prescribed, then exercises for the rotator cuff and shoulder-blade muscles and control of shoulder position. Avoid “risk” positions — arm raised and turned outwards — until strength returns. Return to contact sports only after the physician’s assessment and tests.
Outlook and timelines
In people over 30, exercise therapy after a first dislocation often gives good results. In young athletes the risk of further dislocations is high, so stabilising surgery (Bankart repair or a bone block) is discussed more often. The decision depends on the MRI, the number of dislocations and sporting goals.
Who it is not suitable for and possible risks
Contraindications
- Active infection — at the injection site or systemic, with fever.
- Active cancer or ongoing chemotherapy.
- Blood clotting disorders or a low platelet count. Anticoagulants are discussed with the physician.
- Pregnancy and breastfeeding — the procedure is usually postponed.
- A corticosteroid injection into the same area in recent weeks.
- A complete tendon or ligament rupture with loss of function — surgical repair is usually needed.
Possible risks
- Pain and swelling at the injection site for 1–3 days.
- Bruising where blood or fat tissue is taken.
- Rarely, infection. The procedure is therefore performed under sterile conditions with ultrasound or X-ray guidance.
- The effect may be absent or smaller than expected.
If any of these apply to you, mention it in your request. The coordinator will check with the clinic physician whether treatment is possible. Contact a coordinator.
Scientific evidence
Studies of regenerative methods show mixed results. Clinic physicians rely on research including the following:
- Karjalainen TV et al. Surgery for rotator cuff tears. Cochrane Database Syst Rev, 2019.
- Sheth U et al. Efficacy of autologous platelet-rich plasma use for orthopaedic indications: a meta-analysis. J Bone Joint Surg Am, 2012.
Next steps: Treatment methods · Treatment cost · How treatment in Germany is organised
Frequently Asked Questions about Treatment of Instability
RegenPAS is a patient service centre in Munich, not a clinic. We review your images and symptoms and send a request to several partner clinics at once. Clinics that can accept you send their own conditions and price; prices differ between clinics, and you choose the option that suits you. The coordinator replies within 24 hours, and a clinic physician’s preliminary opinion follows in 1–3 business days. We then arrange the appointment, visa invitation, interpreter, transfers and accommodation. Treatment decisions are made by the clinic physician. Contact a coordinator.
Your MRI (or CT, X-ray) report and the images if you have them, plus a short description of your symptoms and previous treatment. Send them via the form on the website — the assessment is free and without obligation: the coordinator replies within 24 hours, and the clinic physician’s preliminary opinion follows in 1–3 business days.
The cost depends on the method, the diagnostics needed and the clinic itself: prices differ between clinics. We request offers from several clinics and send you their conditions and quotes so you can compare. Price guidance is on the treatment cost page. For an outpatient procedure, 2–3 days in Munich are usually enough: examination, procedure and follow-up visit.
Clinic and method matching — free of charge
Describe your case and attach your MRI report. We will identify clinics that use the relevant methods and forward your request to them. No obligation; we reply within 24 hours.
Send a request