A shoulder that has come out of its socket, or that feels like it is about to, is one problem — not five. The names attached to it describe different moments in the same injury.
The shoulder trades stability for range of motion. It is the most mobile joint in the body and it sits in the shallowest socket, held in place by a rim of cartilage called the labrum, by the capsule and ligaments around it, and by the muscles that keep the ball centred. Damage that system once and it can stop holding.
One injury, five names
- Dislocation — the ball came fully out of the socket and had to be put back.
- Subluxation — it came partly out and went back on its own. Often described as the shoulder "slipping" or the arm going dead for a moment.
- Labral tear — the damage the dislocation caused. When the shoulder goes out the front, the labrum is typically peeled off the front and lower rim of the socket. That specific lesion is called a Bankart tear.
- Shoulder ligament injury — the capsule and ligaments that were stretched or torn in the same event, because they are attached to the labrum and go with it.
- Shoulder instability — what you are left with when those structures no longer do their job, and the shoulder no longer feels trustworthy.
Read that list again and the picture is clear: the labral tear is not a separate condition from the instability. It is the reason for it. Being handed one of these names rather than another tells you very little about what should happen next.
The distinction that actually decides your treatment
There is one split that matters far more than the label, and it is the question of how the shoulder became unstable.
Traumatic instability. Something knocked the shoulder out — a tackle, a fall onto an outstretched arm, a wrestling hold. There is a real structural lesion: the labrum is off the rim, sometimes with a chip of bone attached. The shoulder was normal until the day it was not. This is the group where surgical repair is most often the right answer, particularly in young athletes.
Atraumatic instability. Nothing dramatic happened. The shoulder began slipping on ordinary movements, it may go out in more than one direction, and the other shoulder is often loose too. Frequently these people are generally flexible. Here the problem is the system rather than a single torn structure, and the treatment is a properly directed rehabilitation programme — muscular control of the shoulder blade and the cuff. Operating on this group without doing that work first produces disappointing results, and tightening a shoulder that was never torn tends to trade one problem for another.
Getting these two the wrong way round is the classic error in this diagnosis. It is also why "you have a labral tear" is not, on its own, a plan.
Age predicts more than almost anything else
Two things shift with age, and both change the conversation:
- How likely it is to happen again. A first traumatic dislocation in a teenager or young athlete has a high chance of recurring — the large majority do, and the risk falls steadily with each decade. That single fact is why early surgical stabilisation is discussed seriously in a nineteen-year-old contact athlete and much less so in someone in their fifties.
- What actually got damaged. Under about forty, a dislocation usually tears the labrum. Over about forty, the same dislocation is considerably more likely to tear the rotator cuff instead. This gets missed regularly. An older shoulder that dislocates, goes back in, and then stays weak is not simply slow to recover — it needs the cuff examined properly.
What it feels like when the shoulder is not fully dislocating
A full dislocation is unmistakable. Everything short of it is easier to dismiss:
- Apprehension. A specific dread in a specific position — usually arm up and rotated back, as if to throw. Not pain exactly. The sense that the shoulder is about to leave.
- Dead arm. A sudden loss of power for a few seconds, typically mid-throw or mid-serve.
- Slipping or clunking in certain positions, often reproducible on demand.
- Avoidance that has become habit. People stop reaching a certain way, or sleeping a certain way, long before they call it a symptom.
SLAP tears are a related but different problem
Not every labral tear comes from instability. A SLAP tear — superior labrum, anterior to posterior — sits at the top of the socket where the biceps tendon anchors, and it typically turns up in overhead athletes and in people who have fallen on an outstretched hand, without the shoulder ever coming out.
It matters that these are separated, because the treatment thresholds are different. There is a further reason to be careful here: a normal anatomic variant called the Buford complex reproduces the appearance of a detached labrum on imaging, and is regularly read as either a SLAP tear or a Bankart lesion when it is neither.
Both are covered in detail on the SLAP tear and Buford complex page — the variant was first described by Dr. Buford, and carries his name.
How the shoulder is examined here
History first, and in this diagnosis the history does most of the work: what position the arm was in, whether it needed reducing, whether it has happened since, and whether anything was required to cause it.
Then examination — including tests that reproduce the apprehension in a controlled way and confirm it settles when the shoulder is supported from the front.
On imaging, the honest position is that ultrasound is not the tool for the labrum. It is excellent for the rotator cuff and it earns its place in the over-forty shoulder for exactly that reason — but the labrum sits too deep and too far inside the joint to be assessed that way. For a suspected labral tear the study is an MRI, often with contrast placed inside the joint. Where the socket rim may have lost bone, a CT scan measures that far better than anything else, and bone loss is frequently the finding that decides which operation is appropriate.
What actually works
After a first dislocation
Reduction, a short period of protection, then early restoration of motion and a structured programme. Prolonged immobilisation does not reduce recurrence and costs range. The genuine decision point is not what to do in week one; it is whether to stabilise surgically at all, and that turns on age, activity, the imaging, and how much bone is involved.
Rehabilitation
The primary treatment in atraumatic and multidirectional instability, and a necessary part of recovery in everyone else. The targets are scapular control, cuff strength and the position sense that keeps the ball centred without conscious effort.
Where orthobiologics fit — and where they do not
An injection does not reattach a labrum that has come off the socket rim. No published evidence supports that, and any clinic implying otherwise is selling something the literature does not back. Detachment is a mechanical problem.
What orthobiologics can reasonably address in an unstable shoulder is the company the instability keeps: an associated rotator cuff injury, tendinopathy that developed while the shoulder was being guarded, or a partial capsular injury in a shoulder that is irritable rather than structurally detached. Biologic augmentation at the time of a stabilisation procedure is an active research question and should be described as one, not as a service.
Surgery
Arthroscopic repair reattaches the labrum and retensions the capsule, and in the right shoulder it works well. Once a meaningful amount of the socket rim has been lost, a soft-tissue repair alone carries a high failure rate, and a bone-transfer procedure becomes the better answer. That is why the bone assessment happens before the operation is chosen rather than during it.
Why a surgeon is the one saying this
Don Buford, M.D. is a board-certified orthopedic surgeon with more than 26 years in practice. He performs shoulder arthroscopy and he performs the ultrasound and injections personally.
On this diagnosis in particular that matters, because instability is a condition where the honest answer is often surgical and often not, and the split is decided by findings rather than by preference. A practice that only offers injections has an incentive to find the shoulder treatable without an operation. A practice that only operates has the opposite one. Being told plainly that an injection will not put your labrum back — and equally plainly that your loose, never-injured shoulder does not need an operation — requires somebody with nothing riding on the answer.
Common questions
Will my shoulder dislocate again?
Age is the strongest predictor. A first traumatic dislocation in a teenager or young athlete recurs in the large majority of cases, and that risk falls steadily with each decade of life. Contact and overhead sport raise it further, and so does bone loss from the rim of the socket. Someone who dislocates a shoulder in their fifties is in a very different risk category from someone who does it at nineteen, and the treatment conversation should reflect that rather than treating both the same way.
Do I need surgery after a first shoulder dislocation?
Not automatically, and not never. The decision turns on age, the sport or work you are going back to, what the imaging shows about the labrum, and how much bone has been lost from the rim of the socket. Early stabilisation is a serious conversation in a young contact athlete because the recurrence risk is so high. In an older or lower-demand shoulder, rehabilitation first is usually the right sequence. What decides it is findings, not a policy applied to everyone.
Can a shoulder labral tear heal without surgery?
A labrum that has been pulled off the rim of the socket does not reattach itself, in the same way a tendon does not bridge a gap. But that is not the same question as whether you need an operation. Plenty of people with a detached labrum have a shoulder that is comfortable and reliable for ordinary activity after rehabilitation, and never dislocate again. The reason to operate is recurrent instability or a shoulder that cannot do what you need it to do, not the existence of the tear on a scan.
Does PRP work for a shoulder labral tear?
An injection does not reattach a labrum that has come off the socket rim, and no published evidence supports that claim. Detachment is a mechanical problem. Where orthobiologics can reasonably help in an unstable shoulder is the company the instability keeps — an associated rotator cuff injury, tendinopathy that developed while the shoulder was being guarded, or a partial capsular injury in a shoulder that is irritable rather than structurally detached. Anything beyond that is being oversold.
What is a Bankart lesion?
It is the specific labral tear produced when the shoulder dislocates out the front. The labrum is peeled off the front and lower rim of the socket, taking the attached capsule and ligaments with it. When a fragment of bone comes off the rim along with it, that is called a bony Bankart, and it matters more, because lost bone changes which operation is appropriate. A Bankart lesion is not a different diagnosis from shoulder instability — it is the reason for it.
What is a SLAP tear, and is it the same as a Bankart tear?
No. A SLAP tear sits at the top of the socket where the biceps tendon anchors, and it typically occurs in overhead athletes or after a fall on an outstretched hand, without the shoulder ever coming out. A Bankart tear sits at the front and lower rim and is caused by dislocation. The distinction matters because the treatment thresholds differ, and because SLAP changes are commonly seen on scans of shoulders that do not hurt — in people over forty they are frequently a degenerative finding rather than an injury.
I dislocated my shoulder in my fifties. Is that different?
Meaningfully, yes, and it is regularly missed. Under about forty, a dislocation usually tears the labrum. Over about forty, the same dislocation is considerably more likely to tear the rotator cuff instead. An older shoulder that dislocates, is put back in, and then stays weak is often not simply slow to recover — it needs the rotator cuff examined properly, and that is something ultrasound assesses very well in the same visit.
