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Tomasz Poboży

Kategoria: Shoulder (EN)

English-language patient articles about shoulder pain, rotator cuff disorders, instability and treatment.

  • Rotator Cuff Tears — When Is Surgery Needed?

    Rotator Cuff Tears — When Is Surgery Needed?

    PATIENT INFORMATION · SHOULDER

    We very often consider surgery for full-thickness tears, but it is not always necessary.

    The cause and size of the tear, tissue quality and shoulder function all matter. A recent, large traumatic tear with sudden weakness needs prompt assessment and may favour early repair.

    Shoulder weakness during clinical assessment of a rotator cuff tear. Medical content prepared by: Tomasz Poboży - orthopaedic surgeon.

    PODCAST · DOCTOR POBOŻY ON HEALTH

    Rotator Cuff Tears — When Is Surgery Needed?

    An English episode about early repair after injury, individual rehabilitation, imaging and the role of injections.

    Listen on Spotify ↗

    What does a rotator cuff tear mean?

    The rotator cuff consists of the tendons of four muscles surrounding the head of the upper arm bone. They stabilise the shoulder and help lift and rotate the arm. Tears most often affect the supraspinatus tendon, sometimes extending into part of the infraspinatus tendon.

    A tear can involve part or all of the tendon’s thickness. It may occur suddenly after a fall or a forceful pull, but often develops gradually with degenerative tendon changes. Pain when raising the arm, weakness and difficulty sleeping on the affected side are common symptoms.

    An abnormal scan does not establish the source of every symptom. Some tears cause little pain; symptoms may also arise from the subacromial bursa, the long head of the biceps tendon, stiffness or arthritis. Findings need to be matched to the examination.

    When is earlier surgery preferable?

    A recent, large traumatic tear, especially with sudden weakness or inability to lift the arm, usually favours early surgical repair. If the tendons are repairable and the patient’s health permits surgery, there is no need to complete months of rehabilitation first.

    Prompt orthopaedic assessment is important. Tendon retraction, muscle wasting and fatty changes can make later repair more difficult. The timing is planned individually after assessment; this does not mean that every tear needs emergency surgery on the day of injury.

    Other reasons to consider surgery include persistent pain, weakness and functional loss despite appropriate nonsurgical treatment, a repairable tear at risk of progression, and substantial work or sports demands. No single age or tear-size threshold settles the decision for every patient. [1, 2]

    When can treatment start without surgery?

    For many gradually developing tears, particularly smaller ones without major loss of function, individual rehabilitation is a reasonable starting point. This also applies to some symptomatic full-thickness tears. Both physiotherapy and surgery can improve outcomes in small and medium full-thickness tears. [1]

    Treatment involves adapting activities that worsen pain, restoring movement, improving rotator cuff and shoulder blade muscle strength and control, and gradually increasing loading. It is an active plan, not simply avoiding use of the arm. Pain medicines are selected individually, taking contraindications into account.

    Pain relief does not necessarily mean the tendon has healed. Tear size, muscle wasting and fatty changes may progress in some patients, so symptom improvement and tendon condition both need follow-up. [1, 3, 4]

    What do longer-term studies show?

    In the prospective MOON cohort of 452 patients with symptomatic, atraumatic full-thickness tears, more than 70% were managed successfully without surgery. Patient-reported outcomes improved in the first months and did not decline over ten years among those continuing nonsurgical care. These findings do not mean that every tendon healed or that surgery is unnecessary for every tear.

    Long-term comparative research also supports the importance of repair in selected patients and monitoring of tear progression. Conservative management means reviewing function, symptoms and tissue condition rather than leaving the problem unassessed for years. [3, 4]

    Ultrasound, MRI or X-ray?

    Assessment starts with the history and examination. Combining examination findings is more useful than relying on one provocative test. Imaging should answer a clinical question rather than replace the examination. [1]

    What can ultrasound show?

    Ultrasound assesses tendon continuity, the location and extent of many tears, the biceps tendon and bursa. Selected structures can be observed during movement. It is a useful examination when performed and interpreted by an experienced clinician.

    When is MRI useful, and what do X-rays add?

    MRI helps assess tendon retraction, muscle wasting and fatty changes, and deeper shoulder structures. It is particularly useful for surgical planning or when examination and ultrasound leave important questions unanswered. X-rays add information about bones, joint alignment and arthritis.

    Injections: different treatments, different aims

    Corticosteroid: an injection into the subacromial bursa may reduce inflammation and pain, but does not repair a torn tendon. Repeated injections require caution, particularly when tendon repair is planned. They should not be used to indefinitely postpone indicated surgery. [1]

    Platelet-rich plasma (PRP): in selected partial tears, including splits within the tendon, treatment may be considered with the aim of supporting repair processes. Results are mixed; routine PRP use for partial tears is not supported by the AAOS guideline. Improvement in symptoms should not be equated with proven structural healing. [1]

    Injectable platelet-rich fibrin (i-PRF): this is also being investigated, but evidence in these injuries remains limited. Published case reports involving liquid fibrin do not establish its superiority to PRP. Neither blood-derived treatment replaces surgery when surgery is needed. [5]

    How is the tendon repaired?

    Repair is most often arthroscopic, through small incisions. The tendon is secured to its attachment on the upper arm bone using anchors and sutures. The aim is to restore the attachment without excessive tension. The configuration, number of anchors and single- or double-row technique depend on tear size and shape, tendon quality and how far the tissue can be mobilised.

    Healing matters: healed repairs are associated with better functional outcomes than unhealed repairs and, in comparative studies, physiotherapy alone. Tissue quality, repair tension and biological healing potential therefore influence planning. [1, 2, 4]

    Rehabilitation after repair

    The repaired tendon needs protection and gradual rehabilitation following the orthopaedic surgeon’s instructions. Exercises used before surgery are not automatically suitable immediately afterwards.

    Postoperative protocol — for clinicians →

    The linked protocol concerns small and medium tears. Extensive or additional repairs require individual restrictions.

    What if the tear is extensive or irreparable?

    Not every extensive tear can be fully repaired. Marked retraction, advanced muscle wasting or fatty changes may make reattachment under acceptable tension impossible. Options depend on function, arthritis, health, age and goals, and may include nonsurgical care, partial repair, a biceps procedure, selected reconstructions, tendon transfers or a reverse shoulder replacement.

    A publication co-authored by Tomasz Poboży described ultrasound-guided implantation of a biodegradable subacromial spacer in one patient with a massive irreparable tear. This technical case report is not a basis for routinely recommending a spacer to everyone with an extensive tear. [6]

    How long should nonsurgical treatment continue?

    There is no compulsory rehabilitation period for everyone. Treatment may continue if it improves pain, movement and daily function and the tear’s characteristics allow ongoing nonsurgical care.

    A recent, large, repairable traumatic tear with major strength loss is different: early repair is usually preferred when health and tissue condition permit. Surgery should not be delayed merely to complete an arbitrary number of months of exercise. Progression of the tear or deterioration in muscle quality also calls for reassessment.

    When should you seek prompt help?

    • Sudden marked weakness or inability to lift the arm after an injury.
    • Deformity or suspected dislocation or fracture.
    • A hot, red shoulder with fever or feeling unwell.
    • New sensory changes or increasing arm weakness.
    • Unusually rapid deterioration or general symptoms such as unexplained weight loss.

    What should you remember?

    Full-thickness tears often lead us to consider surgery, but the decision is individual. Recent, large traumatic tears need prompt treatment planning, often with early repair. With gradually developing changes, nonsurgical care may provide lasting improvement. Symptoms, function, examination and tissue condition should guide the decision together.

    References
    1. American Academy of Orthopaedic Surgeons. Management of Rotator Cuff Injuries: Evidence-Based Clinical Practice Guideline. 2025. Guideline.
    2. American Academy of Orthopaedic Surgeons. Rotator Cuff Tears: Surgical Treatment Options. OrthoInfo. Patient information.
    3. Kuhn JE, Dunn WR, Sanders R, et al.; MOON Shoulder Group. 2024 Kappa Delta Ann Doner Vaughan Award: Nonsurgical Treatment of Symptomatic, Atraumatic Full-Thickness Rotator Cuff Tears—a Prospective Multicenter Cohort Study With 10-Year Follow-Up. J Am Acad Orthop Surg. 2024;32(23):1061–1073. doi:10.5435/JAAOS-D-24-00841.
    4. Moosmayer S, Lund G, Sire Seljom U, et al. Fifteen-Year Results of a Comparative Analysis of Tendon Repair Versus Physiotherapy for Small-to-Medium-Sized Rotator Cuff Tears. J Bone Joint Surg Am. 2024;106(19):1785–1796. doi:10.2106/JBJS.24.00065.
    5. Ogéus T. Treatment of a fractured humerus and partially torn supraspinatus tendon in a professional boxer with liquid platelet-rich fibrin and heat-coagulated albumin gel: a case report. J Med Case Rep. 2024;18:124. doi:10.1186/s13256-024-04458-7.
    6. Poboży T, Kielar M, Miąskiewicz J. Ultrasound-guided biodegradable subacromial spacer implantation in a patient with massive irreparable rotator cuff tears. Wideochir Inne Tech Maloinwazyjne. 2019;14(1):145–148. doi:10.5114/wiitm.2018.77555.

    Tomasz Poboży - orthopaedic surgeon, MD, PhD — specialist in orthopaedics and musculoskeletal traumatology.

    Educational material; it does not replace an individual medical consultation, examination or treatment plan. Updated: 28 September 2026.

  • Clavicle Fracture — When Is Surgery Needed?

    Polish version

    A clavicle fracture does not automatically mean surgery. Many fractures can be treated successfully without an operation, usually with a sling. The choice depends on the location of the fracture, the degree of displacement and comminution, the condition of the skin, shoulder-girdle stability, neurovascular findings, and the patient’s age and functional needs. In selected displaced fractures, surgery reduces the risk of nonunion, but it does not give every patient a better long-term functional result.

    How does a clavicle fracture happen?

    The most common mechanism is a direct fall onto the shoulder, for example while cycling, skiing or taking part in contact sport. A clavicle fracture can also occur in a road-traffic injury or after a fall onto an outstretched arm.

    The location matters as much as the fact that the bone is broken. Midshaft fractures behave differently from lateral fractures near the acromioclavicular joint, while medial fractures near the sternum are less common and raise a different set of anatomical concerns.

    What symptoms are typical?

    • pain over the clavicle that increases with arm movement;
    • swelling and bruising;
    • a palpable step, irregularity or deformity;
    • difficulty lifting the arm;
    • sometimes a clearly prominent bone fragment beneath the skin.

    The appearance of the shoulder alone cannot determine whether surgery is required. Clinical examination and X-rays are central to the decision.

    How is a clavicle fracture diagnosed?

    Plain X-rays are the first-line imaging test. They usually show the fracture location, displacement and comminution well enough to guide initial management. CT can be useful in selected fractures with more complex anatomy, particularly when standard radiographs do not answer the relevant clinical questions.

    Ultrasound does not replace X-ray for routine diagnosis of a clavicle fracture. It may, however, help assess selected associated soft-tissue problems around the shoulder.

    When does a clavicle fracture need urgent assessment?

    Many isolated clavicle fractures can be reviewed in an urgent or planned orthopaedic pathway depending on the injury. Some findings should not wait.

    • An open wound over the fracture or visible bone may indicate an open fracture.
    • Marked skin tenting, blanching or skin damage over a sharp fragment can mean that the fragment is threatening to break through the skin.
    • Numbness, weakness of the hand, a cold or pale limb, or abnormal pulses require assessment for nerve or vascular injury.
    • Shortness of breath, chest pain or a high-energy mechanism requires assessment for chest injury and other associated trauma.
    • Major shoulder-girdle deformity or suspicion of an associated scapular fracture may indicate a more unstable injury pattern.

    When can treatment be non-operative?

    Non-operative treatment is often appropriate when displacement is limited or the overall alignment is acceptable, the skin is not threatened and there is no neurovascular injury.

    In the acute phase, a sling is usually used. The American Academy of Orthopaedic Surgeons guideline favours a sling over a figure-of-eight brace for most acute clavicle fractures. The main purpose is pain relief and protection during the early phase of healing.

    This does not mean complete immobility for many weeks. Movement of the elbow, wrist and fingers is usually maintained from the outset, while shoulder movement is gradually increased according to pain, fracture stability and the treating clinician’s instructions.

    When is surgery more likely to be considered?

    Absolute or very strong indications for urgent operative treatment include open fractures, threatened skin, significant neurovascular injury and selected unstable injuries of the shoulder girdle.

    Outside those situations, the decision is more individual. Surgery is considered more often in adults with markedly displaced, shortened or comminuted midshaft fractures and in selected unstable fractures of the lateral end. Occupation, sport, arm dominance, patient expectations and the estimated risk of nonunion also matter.

    No single X-ray measurement determines the need for surgery on its own. Shortening and displacement are part of the assessment, but they need to be interpreted in the full clinical context.

    Does surgery give a better result?

    The best available evidence is more nuanced than simply saying that surgery is better. Meta-analyses of randomised trials in displaced midshaft clavicle fractures show that operative treatment reduces the risk of nonunion. It may also provide faster functional improvement during the first weeks.

    That functional advantage becomes much smaller over time. A meta-analysis of 10 randomised trials including 1,333 patients found a DASH difference of about 9.4 points at 6 weeks in favour of surgery, but the differences at 3 and 6 months were smaller and no longer clinically meaningful.

    A 2026 systematic review of 18 randomised trials including 1,201 adults treated non-operatively for displaced midshaft clavicle fractures found that function generally improved substantially during the first months. Nonunion occurred in about 14%, while approximately 13% later underwent surgery.

    The practical conclusion is that surgery can reduce the risk of union-related problems in appropriately selected patients, but it is not necessary for every adult with a displaced fracture.

    What are the disadvantages of surgery?

    Plate fixation or another form of internal fixation carries the usual operative risks, including infection, wound problems, nerve injury, implant-related symptoms and the possibility of another procedure, for example to remove symptomatic hardware. The benefit of reducing nonunion risk therefore has to be weighed against the risks and burden of surgery itself.

    How long does a clavicle fracture take to heal?

    Healing takes weeks and varies between patients. Pain often improves before full bony union is achieved, so feeling better does not mean the clavicle is ready for heavy loading or contact sport.

    Return to heavy work, strength training or sport with a meaningful risk of falling should be based on several factors together: pain resolution, recovery of movement and strength, and adequate fracture healing. Lighter daily activity is often possible earlier, but progression should remain individual.

    When should you seek reassessment during non-operative treatment?

    • pain is clearly increasing rather than gradually improving;
    • a new deformity appears or the fragments seem to be moving;
    • the skin over a fragment becomes increasingly tense or red;
    • numbness, weakness, or a change in the colour or temperature of the hand develops;
    • marked tenderness and lack of healing progress persist after many weeks;
    • general symptoms or wound problems develop after operative treatment.

    Key points for an orthopaedic surgeon

    • Many clavicle fractures can be treated without surgery.
    • X-ray is the main imaging test.
    • When non-operative care is chosen, a sling is generally preferred to a figure-of-eight brace.
    • Surgery is considered more strongly for open fractures, threatened skin, neurovascular injury, instability and selected markedly displaced fractures.
    • In adults with displaced midshaft fractures, surgery reduces nonunion risk, but long-term functional results often converge with non-operative treatment.
    • The decision should not be based on one radiographic measurement alone.

    Back to: Injuries and Fractures

    References

    1. American Academy of Orthopaedic Surgeons. Treatment of Clavicle Fractures: Evidence-Based Clinical Practice Guideline. Published December 2, 2022. Full AAOS guideline.
    2. Vaajala M, Tarkiainen J, Liukkonen R, Launonen AP, Mattila VM. Non-surgical treatment for displaced midshaft clavicle fractures: a systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-10208-1.
    3. Qvist AH, Jensen SL. Minimal early functional gains after operative treatment of midshaft clavicular fractures: a meta-analysis of 10 randomized controlled trials including 1333 patients. JSES International. 2024;8(3):400–406. DOI: 10.1016/j.jseint.2023.12.011.

    This material is educational and does not replace individual medical assessment of a fracture.

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Pain at the Front of the Shoulder — Could the Biceps Tendon Be the Cause?

    Polish version · Explore Shoulder Conditions

    Pain at the front of the shoulder can arise from the long head of the biceps tendon, but the source cannot be identified from pain location alone. Biceps tendon pathology often coexists with rotator cuff disease, labral lesions or injury to the structures that stabilise the tendon in the bicipital groove. Diagnosis therefore depends on combining symptoms, clinical examination and appropriately selected imaging.

    Where does the biceps tendon run in the shoulder?

    The biceps brachii has two proximal attachments around the shoulder. The long head originates near the superior glenoid and labrum, passes through the joint and then enters the bicipital groove of the humerus. Along this course it is stabilised by several structures, including fibres from the subscapularis and supraspinatus tendons and surrounding ligaments.

    This is why isolated “biceps tendinopathy” is not the only possible explanation. Pain may come from the tendon itself or its sheath, but also from a rotator cuff tear, a SLAP lesion, biceps tendon instability or another disorder within the shoulder joint.

    Which symptoms fit long-head biceps tendon pathology?

    • pain at the front of the shoulder, sometimes extending down the front of the upper arm;
    • pain that increases when raising the arm, working overhead, throwing or lifting an object;
    • pain when reaching behind the body, for example for a seat belt or while putting on a jacket;
    • tenderness over the bicipital groove;
    • sometimes painful snapping or clicking at the front of the shoulder.

    None of these findings is specific. Rotator cuff disease, frozen shoulder, acromioclavicular joint pathology and referred pain from the neck can produce a similar pattern. Speed’s test, Yergason’s test or tenderness over the groove may strengthen the suspicion, but a single positive test does not establish the diagnosis.

    A sudden pop and a bulge in the arm — could this be a rupture?

    An acute proximal biceps rupture may be accompanied by a pop, bruising and distal displacement of the muscle belly, producing a characteristic bulge lower in the upper arm. Pain can be substantial initially and then settle. Some patients are left with weakness during forearm supination, muscle cramping or a cosmetic concern.

    This appearance does not automatically mean surgery is required, particularly when the long head has ruptured and arm function remains good. The decision depends on age, activity level, the dominant arm, occupational demands and associated shoulder lesions.

    How is it assessed?

    Clinical examination

    The examination includes active and passive range of motion, rotator cuff strength, shoulder stability, the cervical spine, and sensation and strength throughout the limb. It is important to establish whether symptoms began after a single injury or developed with repetitive loading. Tendon snapping can suggest disruption of the structures that retain it in the groove, particularly near the subscapularis tendon.

    X-ray

    X-rays do not show the biceps tendon well, but they may reveal calcification, osteoarthritis, post-traumatic bony changes or another cause of shoulder pain. In an adult with persistent shoulder symptoms, radiographs are often a reasonable initial imaging study.

    Ultrasound

    Ultrasound can show the portion of the tendon within the groove, fluid around the tendon, thickening, partial or complete rupture and tendon displacement during movement. Dynamic scanning is useful when instability is suspected. The rotator cuff and subacromial-subdeltoid bursa can be assessed at the same examination.

    Ultrasound also has limitations. The intra-articular portion of the tendon and its attachment near the superior labrum are more difficult to assess completely. A normal appearance within the groove does not exclude pathology deeper inside the joint.

    MRI

    MRI can assess the biceps tendon together with the rotator cuff, cartilage, bone and other intra-articular structures. When a superior labral lesion is suspected, MR arthrography may be considered in selected cases. MRI is not necessary for every patient with anterior shoulder pain; it should answer a specific clinical question.

    How is biceps-related shoulder pain treated?

    Non-operative treatment

    Most overload-related symptoms are initially treated without surgery. This usually means temporarily reducing movements that clearly provoke pain rather than completely immobilising the shoulder, followed by a gradual return to loading. Rehabilitation may address range of motion, scapular control, rotator cuff exercises and progressive biceps strengthening.

    Analgesic or anti-inflammatory medication should be selected with other medical conditions and current medicines in mind. Cooling may reduce short-term symptoms after overload. If an injection is considered, it should follow a specific diagnosis. In selected situations medication can be placed into the tendon sheath under ultrasound guidance while avoiding injection into the tendon substance itself. Accurate needle placement does not by itself guarantee a durable clinical effect.

    When does an orthopaedic surgeon consider surgery?

    Surgery is considered mainly when appropriately conducted non-operative treatment does not restore acceptable function, when there is substantial tendon damage or instability, or when surgery is already planned for an associated rotator cuff or labral lesion. Common options include tenotomy, in which the damaged tendon is released, and tenodesis, in which it is detached from its intra-articular origin and fixed to the humerus. SLAP repair is reserved for appropriately selected patients.

    There is no single best procedure for everyone. Age, activity, cosmetic concerns, risk of cramping, occupational requirements and the other shoulder lesions all influence the choice.

    When is earlier assessment needed?

    • after an injury, the arm cannot be raised or there is clear new weakness;
    • the shoulder is deformed, markedly swollen or bruising is spreading quickly;
    • there is numbness, hand weakness, pallor or cooling of the limb;
    • pain is severe even at rest and is accompanied by fever, redness or deterioration in general condition;
    • shoulder pain occurs with shortness of breath, chest pressure or sudden general weakness.

    Key points

    Anterior shoulder pain can come from the long head of the biceps tendon, but associated pathology is common. Ultrasound is particularly useful for dynamic assessment of the tendon within the bicipital groove, whereas MRI better demonstrates intra-articular structures. For most patients, treatment begins with load modification and targeted rehabilitation; a decision about injection or surgery requires identification of the actual pain generator.

    References

    1. Poboży T et al. Clock-Face Sonography of the Glenoid Labrum: A Pictorial Technical Protocol for Patients Ineligible for MRI/MR Arthrography. Diagnostics. 2025;15(23):3031. DOI: 10.3390/diagnostics15233031. This publication includes assessment of the superior labrum and the region of the biceps attachment; it is not a treatment-effectiveness study for biceps tendinopathy.
    2. Lalehzarian SP, Agarwalla A, Liu JN. Management of proximal biceps tendon pathology. World Journal of Orthopedics. 2022;13(1):36–57. DOI: 10.5312/wjo.v13.i1.36. Full text.
    3. American Academy of Orthopaedic Surgeons. Biceps Tendinitis. Patient information prepared or reviewed by a member of the American Shoulder and Elbow Surgeons.

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Recurrent Shoulder Instability — Why Does the Shoulder Keep Giving Way?

    If the shoulder repeatedly dislocates, partially slips out, or gives a clear sensation of “giving way”, recurrent glenohumeral instability may be the cause. Not every click or snap represents instability. Diagnosis depends on the pattern of episodes, stability testing and appropriately selected imaging.

    What does it mean when the shoulder “comes out”?

    In a complete dislocation, the humeral head loses contact with the glenoid and usually requires reduction. A subluxation is a partial, often brief loss of joint congruity; the shoulder may return to position spontaneously. Patients may describe sudden slipping, apprehension in a particular arm position, or the need to stop the movement immediately.

    Painless clicking, scapular crepitus or tendon snapping do not necessarily indicate instability. More important are true loss of control, visible deformity, numbness, weakness or repeated episodes after a previous dislocation.

    Why does instability recur?

    A traumatic anterior dislocation may damage the anterior labrum and capsuloligamentous structures, classically producing a Bankart lesion. Recurrent episodes can increase bone loss from the glenoid or humeral head. Recurrence risk is higher in younger patients, particularly those involved in contact and overhead sports.

    A different mechanism is seen in generalized ligamentous laxity or multidirectional instability. In these patients the shoulder may be excessively mobile without a single major traumatic event. Rehabilitation and indications for surgery differ from those used after a typical traumatic anterior dislocation.

    How does an orthopaedic surgeon assess shoulder instability?

    The history is essential: the arm position during the first and subsequent episodes, whether reduction was required, the number of recurrences, the patient’s activity or sport, and any associated numbness or weakness. Examination includes range of motion, rotator cuff strength, scapular control, the direction of instability and generalized ligamentous laxity.

    X-ray, MRI, CT and ultrasound

    • X-ray assesses joint position, fractures and some osseous changes related to previous dislocations.
    • MRI or MR arthrography can assess the labrum, capsule, ligaments, cartilage and associated tendon injury.
    • CT is particularly useful when glenoid or humeral head bone loss must be quantified before surgery.
    • Ultrasound can add dynamic information and assess selected labral, tendon and nerve structures, but it does not replace MRI or CT when comprehensive surgical planning is required.

    Is surgery always necessary?

    No. In some forms of instability, the first-line approach is structured rehabilitation: improving scapular and humeral head control, strengthening the rotator cuff, gradually restoring confidence in movement, and modifying activities that provoke instability. Progress is assessed over months rather than after a few sessions.

    Surgery is considered particularly after recurrent dislocations, persistent giving-way despite appropriate rehabilitation, a high predicted recurrence risk, or clinically relevant labral and bone injury. The procedure depends on the direction of instability, tissue quality and the amount of bone loss. A “loose shoulder” alone does not determine one operation.

    Return to sport

    Return to sport should not be based only on the number of weeks since injury or surgery. Relevant criteria include pain-free range of motion, strength and endurance, shoulder control in sport-specific positions, absence of instability or apprehension, and tolerance of progressively increasing training loads.

    When is urgent assessment needed?

    A new visible deformity, inability to move the arm, severe pain, increasing numbness or weakness, or a pale or cold hand require urgent assessment. A suspected dislocation should not be reduced without appropriate training and assessment. Even when the shoulder appears to relocate spontaneously, neurovascular examination and usually an X-ray are still advisable.

    References

    1. Poboży T, et al. Clock-Face Sonography of the Glenoid Labrum: A Pictorial Technical Protocol for Patients Ineligible for MRI/MR Arthrography. Diagnostics. 2025;15(23):3031. DOI: 10.3390/diagnostics15233031.
    2. American Academy of Orthopaedic Surgeons. Chronic Shoulder Instability.
    3. Van Gastel ML, et al. Clinical practice on treatment of primary traumatic anterior shoulder dislocation: a multidisciplinary guideline. Acta Orthopaedica. 2026;97:531–537. DOI: 10.2340/17453674.2026.46434.

    For Patients · Polish version

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.