Seoul One Hospital: If Your Shoulder Keeps Feeling Loose After a Dislocation, When Is Surgery Needed for Recurrent Instability Near Hwagok Station?

My shoulder dislocated while playing tennis and keeps feeling loose afterward-how does Seoul One Hospital decide when surgery is needed?

Shoulder dislocations that occur during racket sports often damage the labrum, making recurrence common.

I'm Dr. Young-Min Lee, board-certified orthopedic surgeon and Chief Director. To give you the conclusion first: I decide whether surgery is needed by looking at three factors together — the number of recurrences, the patient's age, and the degree of bone and labral damage seen on imaging.

If a "loose feeling" keeps recurring after an initial dislocation, this is often a sign that the labrum or joint capsule has already become lax. For these patients, I first check plain radiographs and MRI for a Hill-Sachs lesion (a compression defect on the back of the humeral head) and assess the extent of labral tearing to determine whether arthroscopic repair is needed.

Key Answer

For recurrent dislocation, the recurrence rate after a first dislocation rises to about 50% in patients aged 15–30, while it drops to about 11% in those over 40. The younger the patient and the more frequent the recurrences, the more surgery becomes the favored option.

When a Hill-Sachs lesion is confirmed and dislocations keep recurring, I first try initial immobilization and strengthening rehabilitation; if instability persists afterward, I perform arthroscopic labral repair.

Questions This Article Answers

• Why does a "loose feeling" occur after a shoulder dislocation?
• Does the risk of recurrence in recurrent dislocation differ by age?
• Does having a Hill-Sachs lesion always mean surgery is required?
• When can non-surgical treatment prevent recurrence?
• What criteria does Seoul One Hospital use to evaluate recurrent dislocation?

I frequently see patients who have experienced dislocation while playing sports that involve large shoulder swings, such as tennis. Once a shoulder has dislocated, the labrum (the fibrocartilage rim surrounding the joint) tears, changing the joint's structure in a way that makes it easier to dislocate again. If this issue is set aside and the patient continues exercising, labral damage can worsen and progress to a Hill-Sachs lesion, where bone itself is worn away.

Why Does Recurrent Dislocation Keep Happening?

Once a dislocation occurs, the labrum and capsular ligaments that hold the joint in place become stretched or torn, making a second and third dislocation more likely. This is especially pronounced among athletes and occupational groups who use their shoulders frequently, as well as individuals with naturally more flexible ligaments.

Imaging of patients with recurrent dislocation shows a very high rate of accompanying Hill-Sachs lesions from bone compression. Among first-time dislocation patients, this is observed in about 71% (range 58–83%), but in recurrent dislocation patients, it rises to 85% (70–95%), according to one report (Rutgers 2022, PMID 34988633). This means bone damage progresses the more dislocation recurs.

Differences by age are also notable. Shoulder instability conditions are most prominent in men in their 20s–30s and in women in their 60s–80s. In younger patients, recurrent dislocation tends to accumulate structural damage due to higher activity levels, whereas in older patients, other mechanisms are often involved as well.

In clinic, I often hear patients say, "A layperson tried to put my shoulder back in place myself." In such cases, the joint may not have been properly reduced, which can worsen the damage, so I always check imaging first to rule out a fracture-dislocation, and if a fracture is present along with the dislocation, I do not attempt manual reduction. This distinction must be made accurately from the very start.

What Determines the Timing of Surgery?

I decide between non-surgical and surgical treatment by weighing three factors together: age, frequency of recurrence, and imaging findings. I do not decide based solely on "how many times the shoulder has dislocated."

If recurrent dislocation has only happened once or twice and imaging shows no major labral damage, we first approach treatment with initial immobilization and strengthening rehabilitation. Strengthening the muscles that stabilize the shoulder (the rotator cuff and periscapular muscles) can reduce recurrence when labral damage is mild.

On the other hand, in the following situations, I consider the limits of non-surgical treatment to have been reached and begin discussing surgery:

• Instability and "looseness" persist despite adequate rehabilitation
• The patient is young (ages 15–30) with a strong motivation to return to sport
• Imaging shows a clear Hill-Sachs lesion or an extensive labral tear
• There is a history of a prior dislocation that involved a fracture

When non-surgical treatment fails to improve the condition, I perform surgery to arthroscopically repair and restore the torn labrum and the stretched capsule. This is a procedure in which the inside of the joint is directly visualized through a small incision while the damaged tissue is returned to its original position.

What Happens to a Shoulder When Surgery Is Delayed? A Clinical Case Perspective

It is not uncommon to see shoulders that were treated repeatedly with injections under the assumption of tendinitis, only for the tear to progress further. The same applies to recurrent dislocation. If it is left unaddressed with the thinking that "if it dislocates again, it can just be put back in place again," the extent of labral damage grows and bone damage progresses, increasing the difficulty of surgery.

In shoulders I have treated with arthroscopic repair, I commonly see pain improve noticeably around 4 weeks after surgery, followed by a gradual return of range of motion and strength through rehabilitation after the brace is removed. Even in rotator cuff repair, it has been reported that a rehabilitation period of approximately 6 months is generally needed, as recovery is not complete immediately after surgery (Journal of the Korean Medical Association). Rehabilitation is equally central after surgery for shoulder instability.

At Seoul One Hospital, after arthroscopically repairing and restoring the torn labrum, we design a program that continues through a period of brace immobilization and into strengthening rehabilitation.

When Is Surgery Not the Right Choice, and What Warning Signs Should Not Be Missed?

Not every case of recurrent dislocation requires surgery. If the number of recurrences is low and labral damage is mild, stabilization through initial immobilization and rehabilitation alone is often sufficient.

I recommend checking the following for yourself:

• ✓ How many times has the shoulder dislocated again since the first episode (once vs. repeatedly)?
• ✓ Does the looseness occur even at rest, or only during certain movements?
• ✓ Does lifting the arm cause weakness or numbness (possible axillary nerve injury)?
• ✓ Are you young with a strong motivation to return to sport or daily activity?
• ✓ Did the previous dislocation involve a fracture?

The following signs call for immediate medical evaluation:

• Numbness or weakness in the arm or fingertips after dislocation (requires differentiation from axillary nerve injury)
• Persistent feeling of instability as if the shoulder might dislocate even at rest
• A rapid increase in the number of dislocations over a short period

Conversely, if the dislocation has occurred only once and imaging shows no major structural damage, we do not rush into surgery. In some cases, it is appropriate to build up strength through rehabilitation first and monitor the course. The decision for surgery should be based on recurrence frequency, age, and imaging findings together — not simply "how many times it has dislocated."

At the initial visit, we also check axillary nerve function to make sure nerve injury is not overlooked.

Key Summary: Why Choose Seoul One Hospital

• In-house imaging interpretation system: Seoul One Hospital has radiologists on staff who interpret Hill-Sachs lesions and the extent of labral tears directly on site.
• Cumulative experience in shoulder arthroscopy: As of August 2024, 3,324 shoulder arthroscopic surgeries have been performed, informing our surgical decision-making.
• Sports injury care system: Our medical staff have served as field doctors for the KT wiz and LG Twins professional baseball teams and provided medical support at the PyeongChang Winter Olympics, drawing on this experience to treat shoulder injuries from sports activity.
• Dedicated rehabilitation staff: Post-surgical strengthening rehabilitation continues on-site at our rehabilitation center, staffed by 9 physiotherapists.
• Access near Hwagok Station: Located a 1-minute walk from Exit 8 of Hwagok Station, reducing the burden for patients who need to visit frequently for rehabilitation.

Shoulder Pain Near Hwagok Station-Why Seoul One Hospital?

Shoulder dislocations that occur during racket sports such as tennis and badminton often differ from simple sprains in that they create a structure prone to repeated injury, so accurately assessing the extent of damage on imaging is what determines the direction of treatment.

Our hospital is equipped on-site with multichannel low-dose CT, MRI-linked interpretation, and ultrasound, allowing imaging and consultation to proceed in a single visit starting from the initial examination. I personally perform shoulder arthroscopic surgery, arthroscopically repairing the torn labrum and tightening the stretched capsule to prevent recurrence.

Many patients from the Hwagok-dong and Gangseo-gu area who visit for shoulder pain are active in tennis or badminton clubs. We draw on our repeated experience with these sports injury patterns to determine the line between surgical and non-surgical treatment.

Frequently Asked Questions

Why does recurrent dislocation often not resolve with non-surgical treatment alone?

Once a dislocation occurs, the labrum and capsule often remain permanently stretched or torn. While strengthening rehabilitation can help compensate for stability, it does not restore the structural damage itself, so when the damage is extensive, recurrence tends to continue.

When should surgery be decided after a shoulder dislocation?

I first try initial immobilization and strengthening rehabilitation; if instability persists or dislocation continues to recur, I discuss surgery. Because recurrence rates are higher in younger patients, the decision for surgery is often made earlier in this group.

How long does recovery take after surgery?

After arthroscopic repair, treatment proceeds through a period of brace immobilization followed by stepwise strengthening rehabilitation. In rotator cuff repair cases, pain tends to improve around 4 weeks after surgery, while full recovery of range of motion and strength requires several months of rehabilitation.

Who is more likely to need surgery?

Patients who are young (ages 15–30) with strong motivation to return to sport, those with repeated recurrence, and those with a clear Hill-Sachs lesion or extensive labral tear on imaging tend to lean toward surgery. This differs from the tendency for lower recurrence rates after age 40.

Key Takeaways

• Recurrent dislocation results from accumulated damage to the labrum and capsule, and the frequency of Hill-Sachs lesions increases with repeated recurrence.
• Patients aged 15–30 have a recurrence rate of about 50%, requiring a more proactive approach to surgical decision-making.
• I determine whether to pursue non-surgical or surgical treatment by considering age, recurrence frequency, and imaging findings together.
• For dislocations involving a fracture, manual reduction is not attempted; imaging is checked first.
• Seoul One Hospital provides a continuous process from in-house imaging interpretation through arthroscopic surgery to rehabilitation.

Dr. Young-Min Lee, board-certified orthopedic surgeon and Chief Director, completed his orthopedic surgery residency at Seoul National University Hospital and personally performs shoulder arthroscopic surgery. Profile

Seoul One Hospital is located on floors 6–10 of the Dongmyung M Building, 179 Gangseo-ro, Gangseo-gu, Seoul, a 1-minute walk from Exit 8 of Hwagok Station. Underground parking is available at the rear of the building. If you are experiencing shoulder pain or recurring instability after a dislocation, we recommend starting with imaging and a consultation. You can reach us at our main line, 1544-5888.