Recent Shoulder Instability Research
Recent Research & Evidence
Our approach to shoulder rehabilitation, bracing, and return-to-sport decision-making is informed by peer-reviewed research. This page summarises key findings from recent trials and commentary, alongside our own research into shoulder instability, recurrence risk, and functional readiness for return to activity.
The ARTISAN Trial — What Did It Show?
The ARTISAN trial (Acute Rehabilitation following Traumatic Anterior Shoulder Dislocation) was a large, pragmatic, multicentre randomised controlled trial conducted across 40 NHS hospitals in the UK. It compared two approaches following a first-time traumatic anterior shoulder dislocation:
- Advice, education, and supporting materials with the option to self-refer to physiotherapy
- The same advice and materials plus a prescribed programme of physiotherapy
The primary outcome measure was the Oxford Shoulder Instability Score (OSIS), which captures physical function, symptoms, and psychosocial impact.
Key finding
Adding a physiotherapy-led exercise programme was not superior to advice and self-management alone for the group as a whole.
Important Context & Limitations
While the ARTISAN trial was well designed and executed under challenging conditions, caution is needed when applying its findings broadly—particularly for younger, athletic populations.
- Age: Only 46% of participants were under 40 years. Younger individuals are more likely to have labral injuries and recurrent instability.
- Sporting injury: Only 36% of participants were injured during sport, which is lower than reported in many instability cohorts.
- Recurrence rate: The reported re-dislocation rate was ~2%, substantially lower than historical rates (often 30–70% in young, active populations).
- Pandemic influence: Much of the trial occurred during and after COVID-19, when sporting participation and physical demands were reduced.
Unfortunately, the trial was not powered to determine whether younger, high-demand athletes would respond differently to physiotherapy-led rehabilitation.
Clinical takeaway
For some patients, advice and self-management may be sufficient initially. However, this does not negate the importance of targeted rehabilitation for people returning to sport or physically demanding occupations.
Predicting Return to Sport & Recurrent Instability
Research has consistently shown that time alone is a poor indicator of readiness to return to sport following shoulder dislocation. Instead, decision-making should consider injury characteristics, functional capacity, and psychological readiness.
Our research has explored factors associated with:
- Risk of recurrent shoulder instability
- Fear of re-injury and confidence during activity
- Functional loading of the shoulder during return-to-sport testing
Functional tests such as the Shoulder Arm Return to Sport (SARTS) battery have been developed to assess whether the shoulder can tolerate sport-relevant loads. Biomechanical analysis has demonstrated that these tests load the shoulder substantially, challenging both anterior and posterior stability.
Why this matters
Athletes who return to sport without restoring strength, control, and load tolerance may be at increased risk of recurrence—even if pain has settled.
| View SARTS RTS research PubMed | View Predict Recurrent Instability on PubMed | View Instability Management on PubMed |
What This Means for Patients and Clinicians
- Advice and education may be enough for some people after a first dislocation
- Younger and athletic populations may need more targeted rehabilitation
- Return-to-sport decisions should consider load tolerance and confidence
- Functional testing can help guide safe progression back to activity
Evidence-informed rehabilitation allows care to be tailored to the individual— balancing safety, confidence, and performance.
Fear, Confidence & Shoulder Instability
Shoulder instability is not only a physical injury. Many people experience fear of reinjury, loss of confidence, and hesitation with movement long after the shoulder has physically healed.
This fear — often referred to as kinesiophobia — can influence rehabilitation progress, return to sport, and even the risk of future instability if it is not recognised and addressed.
Why Fear Matters
- Fear of movement is common after shoulder dislocation and surgery
- It does not reliably improve over time without targeted intervention
- Higher fear levels are associated with:
- Delayed return to sport
- Reduced confidence in the shoulder
- Increased risk of recurrent instability
Research has shown that addressing strength and range of motion alone may not fully restore confidence in the shoulder.
Clinical Case Insight: Addressing Fear Directly
A published case study by Olds (2025) demonstrated that graded exposure to fear-eliciting images, combined with physical rehabilitation, led to meaningful reductions in kinesiophobia in an athlete with recurrent shoulder instability and multiple failed surgeries.
Improvements were measured using the Tampa Scale of Kinesiophobia (TSK-11), with fear scores reducing beyond the minimal detectable change — alongside improvements in movement, strength, and return to activity.
Research Highlights
Fear & Recurrent Instability
Fear of reinjury is a predictor of recurrent shoulder instability following first-time dislocation.
View PubMedKinesiophobia After Surgery
Fear may remain elevated even after surgical stabilisation and successful physical recovery.
View PubMedGraded Imagery Intervention
Graded exposure to fear-eliciting images can reduce kinesiophobia when combined with rehabilitation.
View Case StudyWhat This Means for Rehabilitation
Effective rehabilitation after shoulder instability should address both:
- Physical capacity — strength, control, range of motion
- Psychological readiness — confidence, fear, trust in the shoulder
Strategies such as education, graded exposure, imagery, and progressive return-to-sport testing can help bridge the gap between physical recovery and confident movement.