Atraumatic shoulder instability

Borders Ref Help Toolkit
NHS Borders

Atraumatic shoulder instability is best defined as abnormal motion or position of the shoulder that leads to pain, subluxations, dislocations and functional impairment, but importantly it happens without any history of a significant preceding injury.

Atraumatic shoulder instability is generally treated with prolonged rehabilitation (minimum of 1 year). Surgery is very rarely required.

Who to refer, who not to refer, how to refer

Who to Refer

  • Those that have failed Primary care management

Urgent Referral Criteria

  • Avascular necrosis or bone death

Who Not to Refer

  • Those that have not tried Primary care management

Additional Info

  • Surgery is very rarely required

Imaging

  • Shoulder X-ray (Ideally xray is < 1yr old)
  • MRI

How to refer

We accept referrals through SCI gateway for those who are based in Scotland.

We also accept e referrals through the below email address using the attached form for those who are based just on the other side of the border. 

E- Referral Email address - bor.orthoreferrals@borders.scot.nhs.uk

Referral form - E-Referral to Orthopaedics (Non Sci-Gateway)      

Primary care management

  • Education
  • Physio rehab- Patient Specific Physiotherapy - over extended period of 1-2 years
  • Activity Modification

Resources and links

Primary care shoulder pathway - developed by First Contact Practitioners (To be confirmed, will update when available) 

Local service details

orthopaedics@borders.scot.nhs.uk

bor.orthoreferrals@borders.scot.nhs.uk

Editorial Information

Last reviewed: 31/07/2025

Next review date: 31/07/2027

Author(s): Mr Roshan Raghavan, Mr Rehan Siddiqi.

Author email(s): Roshan.Raghavan@nhs.scot.