Shoulder Instability & Labral Repair
What Is Shoulder Instability & a Labral Tear?
The labrum is a ring of cartilage lining your shoulder socket (glenoid) that serves as the critical connection point between your shoulder ligaments and the bone of the socket itself. It deepens the socket and anchors the ligaments that hold the ball of your shoulder joint centered. A labral tear damages this connection, and when the surrounding ligaments are also stretched or torn, the joint becomes unstable, meaning it can partially slip out of place (subluxation) or fully dislocate. Instability can be traumatic, from a dislocation, or atraumatic, from repetitive stress or naturally loose ligaments.
This is you if:
- You've had one or more shoulder dislocations
- Your shoulder feels like it's going to “pop out” during certain movements, especially overhead or behind your back
- You play a contact or overhead sport and have ongoing shoulder looseness or apprehension
- You've already been told you have a labral tear (SLAP tear or Bankart lesion) and want an honest read on your real options
- Physical therapy hasn't resolved your instability and you want to know what's next
Symptoms
- A feeling that your shoulder is loose, slipping, or about to give out
- Pain with overhead motion or when your arm is positioned away from your body
- A visible or felt dislocation, followed by looseness afterward
- Reduced confidence or apprehension using the arm overhead or behind the back
- Clicking, catching, or popping sensations
Causes & Risk Factors
- Traumatic dislocation — often from a fall, a contact sport injury, or a forceful pull on the arm
- Repetitive overhead motion — common in throwing and swimming athletes
- Naturally loose ligaments (hypermobility) — increases risk of instability without a specific injury
- Prior dislocation — each dislocation increases the risk of another, and each one can cause additional damage to the shoulder, whether that's further tearing of the labrum or chipping of bone in the socket or the ball of the joint (known as “bone loss”), which can make the shoulder progressively harder to stabilize over time
Non-surgical first.
A first-time dislocation, especially in a lower-demand patient, often responds well to physical therapy focused on strengthening the muscles around the shoulder. Depending on your specific risk factors for repeat injury, we'll often recommend non-operative treatment after a first-time dislocation. After a second, third, or fourth dislocation, we'll often recommend surgery instead, since more damage tends to occur with each dislocation. Activity modification and bracing during sport can also help reduce the risk of another dislocation.
Understanding “bone loss.”
Every time your shoulder dislocates, the ball and socket can strike each other hard enough to chip away small amounts of bone — this is called bone loss. It's an important factor in deciding which surgical option is right for you: more bone loss generally calls for a different, more involved procedure than a straightforward labral repair.
Surgical options, matched to severity:
- Arthroscopic Bankart Repair — A minimally invasive, arthroscopic procedure that repairs the torn labrum and capsule. Best suited to small-to-moderate tears with minimal bone loss.
- Arthroscopic Remplissage — Often paired with a Bankart repair, this addresses a specific bone defect on the ball of the joint (a Hill-Sachs lesion) that can otherwise keep causing instability, even after the labrum itself is repaired.
- Distal Clavicle Bone Transfer — Uses a small piece of your own collarbone to rebuild the socket when there's moderate bone loss, combining an arthroscopic labral repair with a small open incision.
- Latarjet Coracoid Transfer — For patients with multiple prior dislocations and more significant bone loss, this transfers a bone block to rebuild the socket. It has a strong track record for stopping recurrent instability, especially in contact-sport athletes.
- Distal Tibial Allograft — Reserved for the most severe bone loss, or when a prior stabilization surgery hasn't held. Uses donor bone to reconstruct the socket.
The right procedure depends on your specific tear, your bone loss, your sport, and your prior surgical history — Dr. Thon will walk you through exactly which option fits your case and why.
Recovery & What to Expect
Recovery depends on the extent of your instability and the procedure performed, but here's the general path:
- Sling: 6 weeks, worn at all times except during physical therapy, showering, changing, and while awake at complete rest.
- Physical therapy: Begins within 1–2 weeks after surgery, at least once weekly for the first 6 weeks.
- Follow-up visits: You'll be seen 6 times after surgery, spaced out with gradually increasing time between visits over the following year.
- Overall timeline: Recovery is gradual — expect roughly 20% of your improvement in the first 2 months, up to 80% between 2–4 months, and the final stretch through 4–6 months. Contact athletes should expect the full 6 months before returning to sport. Some stiffness, especially with rotation, is normal for up to 6 months.
Every recovery is different. Dr. Thon will walk you through your personal timeline in detail before and after surgery.
Why Choose Orchard Orthopedics for This
You'll always see Dr. Thon personally for your instability evaluation and surgery, not a resident or rotating provider. Recurrent instability is easy to under- or over-treat; you'll get an honest, personalized read on whether your shoulder actually needs surgery or whether targeted rehab is the smarter first step, paired with the direct access and unhurried follow-up care Orchard Orthopedics is built around.
Frequently Asked Questions
Understanding Your Injury
Not necessarily. A first-time dislocation, especially in an older or lower-demand patient, often responds well to physical therapy alone. Your risk of needing surgery goes up with repeat dislocations or in younger, more active patients.
Each dislocation makes the next one more likely, and repeat dislocations can cause more cartilage and bone damage over time — what we call bone loss, which can make future treatment more complex. An evaluation gives you an honest picture of your actual risk.
That's a common and important signal. It usually means the labrum itself needs to be repaired rather than just supported by stronger muscles around it.
Occasionally the extent of ligament or bone damage is only fully clear during surgery. If that happens, Dr. Thon will address what's actually there and explain exactly what changed and why, before, during, and after your procedure.
Deciding on Treatment
Yes, especially before surgery. A second opinion isn't a lack of trust in your first doctor. It's a normal, expected step, and many patients return to their original surgeon with more confidence in the plan either way.
I have no insurance panel dictating my decisions and no quota to hit. I'll tell you when physical therapy is a realistic path for your shoulder as readily as when surgery is the better call.
No surgery can promise zero risk of recurrence, but the right procedure, matched to your degree of bone loss, significantly reduces your risk compared to leaving an unstable shoulder untreated. Dr. Thon will walk you through your specific odds based on your case.
That's a completely normal reaction. Your visit is the place to ask every question you have, including ones about anesthesia, risk, and what the day of surgery actually looks like, until you feel genuinely informed, not just signed up.
Age alone doesn't rule surgery in or out. What matters more is your activity level, how many times you've dislocated, and how much the instability is limiting your life.
Access & the Orchard Model
No. You can call and schedule directly, no referral or prior authorization required.
You'll always start with Dr. Thon on your initial visit for your instability evaluation and surgery. He remains closely involved in your care throughout.
Surgery & Recovery Logistics
Most patients can be seen same-day or next-day. Call the office and we'll get you scheduled quickly.
Not every unstable shoulder needs immediate surgery. Dr. Thon will help you understand your actual risk of another dislocation and whether waiting is reasonable in your specific case.
6 weeks, worn at all times except during physical therapy, showering, changing, and while awake at complete rest.
Usually after 2 weeks, once you're comfortable and have adequate control of the arm.
Most patients see roughly 20% of their improvement in the first 2 months, up to 80% by 2–4 months, with the final stretch through 4–6 months. Contact athletes should expect the full 6 months before returning to sport.
Get an honest answer about your shoulder instability, and a plan built around you.
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