Who Treats Shoulder Instability and Dislocations in Bethesda?

Overview

Shoulder instability means the ball of the shoulder slips, subluxates, or fully dislocates — forward (anterior), backward (posterior), or in multiple directions at once (multidirectional). Treatment depends on which pattern is present, how much bone has been lost, and what the shoulder needs to do for work or sport. Treating shoulder instability is a regular part of Dr. Raffo's practice.

Who this is for

This page is a starting point for patients who have had a shoulder dislocate, subluxate, or repeatedly "give way," and for referring physicians and athletic trainers trying to route a patient to the right sub-type page. It applies to:

• Anyone who has had a traumatic shoulder dislocation, whether it was reduced in an emergency room or on the field.
• Athletes and patients with recurrent subluxation events — the shoulder feels like it is "slipping" without a full dislocation.
• Patients with deep, activity-related shoulder pain and no dislocation history, which is the more common presentation of posterior instability.
• Patients, often younger and more flexible, whose shoulders feel loose in more than one direction and who may have a positive sulcus sign.

It is not the right page for labral tears without instability symptoms (see the SLAP and labral repair page) or for stiffness and impingement without a sense of the joint moving out of place.

How I approach it

I start every instability evaluation with direction and mechanism, not with an assumption that this is a straightforward anterior Bankart problem. A patient who describes deep posterior pain with bench press or blocking, and no clear dislocation event, is a different diagnosis than a patient who dislocated skiing and has obvious apprehension. I also want to know how many episodes there have been and what the bone looks like on imaging before I talk about surgery at all, because the number of prior dislocations and the amount of bone loss both change the recommendation substantially. For a patient with true multidirectional laxity, my first move is usually not an operation — it's a structured strengthening program, because a large share of atraumatic multidirectional instability responds to rehab alone.

The operation

The specific operation depends on the instability pattern:

• Anterior instability is most often addressed with arthroscopic Bankart repair, sometimes combined with remplissage when there is an off-track Hill-Sachs lesion, or with a bone-block procedure such as Latarjet when glenoid bone loss is the dominant problem. Details are on the Bankart repair and remplissage page.
• Posterior instability is addressed with arthroscopic posterior labral repair and capsulorrhaphy. Details are on the posterior shoulder instability page.
• Multidirectional instability is treated with a structured rehabilitation program first, and arthroscopic capsular plication only in patients who fail a genuine trial of physical therapy. Details are on the multidirectional instability page.

All three are performed arthroscopically through small portal incisions, using suture anchors placed in the glenoid or humeral bone to re-tension the torn labrum and capsule.

Risks and honest tradeoffs

Risks vary by which procedure is performed and are detailed on each sub-type page. In general terms across arthroscopic stabilization procedures, recurrence is the central tradeoff patients weigh: arthroscopic Bankart repair carries roughly a 14.2% recurrence rate in meta-analysis, rising to 17.4% once adjusted for publication bias (meta-analysis), and recurrence risk is meaningfully higher in patients under 20 and in contact or collision athletes (Bulleit, JSES 2024). Every instability operation also carries the general arthroscopic risks of stiffness, infection, and, rarely, nerve injury.

Recovery and rehabilitation

Recovery timelines differ by procedure and are covered in depth on the sub-type pages, but all instability repairs start with a period of sling immobilization to protect the healing labrum and capsule, followed by a graduated return of motion, then strengthening, before a return to full activity or contact sport.

• 0–4 to 6 weeks: Sling immobilization, gentle passive motion as directed.
• 6–12 weeks: Progressive active motion and early strengthening.
• 3–6 months: Sport-specific and functional strengthening.
• 6–9+ months: Return to contact sport or heavy overhead work, timing dependent on the specific procedure performed.

1. 0–4 to 6 weeks

   Sling immobilization, gentle passive motion as directed.

2. 6–12 weeks

   Progressive active motion and early strengthening.

3. 3–6 months

   Sport-specific and functional strengthening.

4. 6–9+ months

   Return to contact sport or heavy overhead work, timing dependent on the specific procedure performed.