Shoulder dislocation and instability in Vienna
The shoulder dislocated once — and you have not trusted it since. With certain movements comes the feeling that it might jump out again. I establish which structures are injured and discuss the way forward with you.
In short
In a shoulder dislocation the humeral head jumps out of the shoulder socket, usually towards the front and below, typically in a fall onto the outstretched arm. The labrum and the capsule often tear away in the process; if they do not heal at their former tension, the shoulder stays unstable. With the conversation, the examination and ultrasound I establish which structures are affected; treatment is conservative first. If the shoulder remains insecure, I stabilise it arthroscopically, and with open surgery where bone is missing.
What is a shoulder dislocation?
A broad humeral head faces a small, shallow shoulder socket; the shoulder is therefore guided hardly at all by bone, but by the labrum, by the capsule with its ligaments and by the muscles. In a dislocation (luxation, or in everyday language a shoulder that has popped out) the head leaves the socket completely; in a subluxation it does so only partly.
The trigger is usually a fall onto the arm, outstretched or raised to the side, in handball or contact sport for instance. The joint rarely comes through unharmed: the labrum tears away from the front rim of the socket (a Bankart lesion), the capsule overstretches, a dent forms on the humeral head (a Hill-Sachs lesion); sometimes the bony rim of the socket breaks as well. In older people it is more likely the tendon cap that gives way — a tear of the rotator cuff is then the main concern.
When the shoulder stays unstable
If the torn structures heal at a poorer tension, over time a lesser occasion suffices for the shoulder to jump out again. The risk depends on your age at the first event, on the extent of the damage and on the sport. Not every instability begins with an accident: where the connective tissue is very stretchy (hyperlaxity), the shoulder becomes insecure without any event at all.
Dislocation of the acromioclavicular joint (AC joint)
To be kept apart from this is the dislocation of the acromioclavicular joint (AC joint) between the collarbone and the acromion. It arises in a direct fall onto the shoulder. Depending on the extent, only the joint ligaments are stretched, or the ligaments to the coracoid process are torn as well; the collarbone then visibly stands higher.
Typical symptoms
- An acute dislocation — severe pain, a protective posture, a squared-off shoulder contour, hardly any movement possible
- A feeling of insecurity — with the arm raised sideways and turned outwards, or when winding up to throw
- Recurrent dislocations — on ever more harmless occasions, at times in bed
- Pain and loss of strength — above all when raising the arm sideways and turning it outwards
- Numbness or tingling in the upper arm — a pointer to nerves being involved, to be assessed promptly
- A raised collarbone and tenderness over the acromioclavicular joint after a fall
A freshly dislocated shoulder belongs in medical care without delay. Only further examination shows which structures were injured.
How I make the diagnosis
It begins with the conversation: what happened, the position of the arm, how often the shoulder has jumped out already. Then I examine clinically — range of movement, strength, specific stability tests, and nerve function as well. In the practice I assess tendons, bursa and any effusion in the joint with ultrasound. Where needed I arrange an X-ray, an MRI or, where bone loss is suspected, a computed tomography scan. You will find further conditions in the overview of shoulder surgery in Vienna.
Treatment: conservative first
After a first dislocation I settle the joint to begin with: a short period of immobilisation in a sling, pain relief, then a step-by-step build-up. The aim is to get the muscles that centre the humeral head in the socket working strongly and in a coordinated way again. Physiotherapy and exercise therapy take place in-house at the Orthozentrum Döbling.
Where instability follows no accident, this training is the load-bearing pillar. I treat accompanying irritation of the bursa or the tendons with an ultrasound-guided injection. I do not set fixed timetables; immobilisation and loading follow the findings. For contact and overhead sport the build-up proceeds in stages — more on this under sports orthopaedics in Vienna.
In contact and overhead sport I weigh things differently: anyone who wants to tackle, throw or press overhead again after a first dislocation at a young age carries a high risk of recurrence, and every further episode damages the labrum and the rim of the socket further. For this group I therefore raise stabilisation specifically, rather than relying solely on training to succeed.
When an operation is necessary
Stabilisation becomes a consideration when the shoulder dislocates repeatedly, when the labrum or the bony rim of the socket is markedly damaged, or when the insecurity remains despite training. With young athletes I often discuss this route as early as the first dislocation.
As a rule, the stabilisation is arthroscopic: through small incisions I fix the torn labrum back onto the rim of the socket with suture anchors and restore the tension of the capsule. I explain how this works under arthroscopy in Vienna. Where bone is missing at the rim of the socket, repairing the soft tissue is not enough; I then reconstruct the rim with bone in open surgery. I likewise stabilise a markedly dislocated acromioclavicular joint surgically.
I carry out necessary procedures at the ATOMOS Klinik Währing, the Privatklinik Döbling or the Rudolfinerhaus, and I accompany you from planning through the procedure to aftercare. I discuss the aftercare plan beforehand.
My practice is a private practice, in Austria a Wahlarztordination. I do not settle directly with any public health insurer; you receive an invoice and submit it to your insurer — on request I take care of the submission for you. For operations, direct settlement with a supplementary private insurance is possible, see private practice and reimbursement.
Whether an operation makes sense depends on the findings. We look at that together and decide only once all the findings are in.
Frequently asked
Frequently asked questions about shoulder dislocation and instability
No. After a first dislocation I often treat conservatively: a short period of immobilisation, then a targeted build-up of the stabilising muscles. In favour of a stabilisation are repeated dislocations, greater damage to the labrum or to the rim of the socket, and high sporting loads. Whether an operation makes sense depends on the findings.
The humeral head leaves the shoulder socket, usually towards the front and below. In doing so the labrum often tears away from the front rim of the socket (a Bankart lesion), the capsule is overstretched, and a dent forms on the humeral head (a Hill-Sachs lesion). Sometimes a piece of the bony rim of the socket breaks off as well. The damage determines the path of treatment.
I advise against it. Putting it back yourself can injure cartilage, ligaments, vessels and nerves in addition, and an accompanying fracture goes unrecognised. A freshly dislocated shoulder belongs in medical care without delay, as a rule in an emergency department with an X-ray before and after.
Typical is a feeling of insecurity: with the arm raised sideways and turned outwards, when winding up to throw or when bench pressing, you have the impression that the shoulder is slipping away. Added to that are pain under load, fading strength and an avoidance of certain movements. Such symptoms can be tested well clinically.
In a shoulder dislocation the humeral head jumps out of the shoulder socket. In a dislocation of the acromioclavicular joint, by contrast, the connection between the collarbone and the acromion gives way, usually after a direct fall onto the shoulder; the collarbone then visibly stands higher. Examination and X-ray separate the two pictures from one another.
I do not give fixed times, because the course depends on the pattern of injury, on the path of treatment and on the sport. The return happens in stages: first movement free of pain, then strength and coordination, finally sport-specific load with overhead and contact elements. I plan this path together with you and with physiotherapy.
Dr. med. Martin Eigenschink
Specialist in Orthopaedics and Traumatology · Specialist in elbow, shoulder and hand surgery
Surgical and conservative treatment of the elbow, shoulder and hand, preferably minimally invasive. Practice at the Orthozentrum Döbling, 1190 Vienna. More about my background
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Medical notice: The contents of this page serve as general information. They do not replace a medical examination, diagnosis or individual advice. Medicine is a constantly evolving field — despite careful research, no guarantee can be given that the content is fully up to date.