Sand, Spikes and a Shoulder That Keeps Slipping Out of Bounds

Whether you are diving on a beach court or hammering an overhead kill shot indoors, volleyball asks a lot of your shoulder. Here is what happens when it asks too much.

PATIENT STORY

“I have played sand volleyball for years. Last summer I went up for a big swing and felt my shoulder shift — like something moved that should not have. It popped back on its own, but it has never felt the same since. Now I hesitate every time I go for an overhead.”

There is something uniquely beautiful about volleyball — the anticipation of a set, the

commitment of a spike, the full-body explosion of a block. Whether you are playing barefoot in the sand on a recreational league, competing against the best in an open tournament, working hard in an indoor rec league or competing at a high level on the hardcourt, the sport demands overhead power, quick lateral movement and deep shoulder stability. It is one of my favorite sports to watch and — full disclosure — one that keeps me quite busy in the clinic.

49% of elite volleyball players report shoulder pain during their career

3x higher shoulder instability risk in overhead athletes

90% of first-time dislocations in athletes under 25 result in labral injury

92% of patients return to volleyball after Bankart repair

Sand Volleyball vs. Indoor Volleyball: Same Shoulder, Different Story

Both versions of the sport stress the shoulder overhead, but in meaningfully different ways. Indoor volleyball is characterized by explosive, high-force spikes and blocks at the net. Sand volleyball introduces a different challenge: the unpredictable surface forces constant postural adjustment, players typically cover more court with fewer teammates and the differing ball speeds often lead to more reaching, more diving and more awkward shoulder positions at contact.

Some volleyball players come to me with gradual-onset instability: a shoulder that has been slowly loosening over seasons. Others present with more acute injuries, a specific spike or block that caused a sudden pop or shift. Both presentations deserve attention.

What Is Shoulder Instability — and What Is a Bankart Tear?

The shoulder is the most mobile joint in the body, which means it relies heavily on soft tissue

structures; the labrum, the capsule, the ligaments, to stay centered. When those structures are damaged, the ball of the humerus can slip too far forward in the socket (anterior instability). The labral tear that typically accompanies this forward instability has a specific name: a Bankart lesion.

Think of the Bankart tear as the seatbelt getting shredded in a car accident. The seatbelt, the

anterior labrum, is what was supposed to hold the ball in the socket when the shoulder was

forced forward. Once it tears, the ball can slip again and again with less and less provocation. This is why untreated shoulder instability tends to get worse over time, not better.

SIGNS YOUR SHOULDER MAY BE UNSTABLE

A feeling of the shoulder slipping or going dead when reaching overhead or behind your back. Hesitation or apprehension before a big swing. Aching at night after a long play session.Recurrent partial or full dislocations. A sense that the shoulder just does not feel as solid as it used to, especially in the cocked-back position before a spike. Any of these warrant an evaluation, not a wait-and-see approach.

Non-Surgical Treatment: The First Line of Defense

Not every unstable shoulder needs surgery. For first-time or mild instability, especially in adult

recreational players, a structured rehabilitation program targeting the dynamic stabilizers of the shoulder can be very effective. A course of physical therapy focused on posterior capsule

flexibility, rotator cuff strengthening and scapular stabilization is my first recommendation for

most recreational players with instability symptoms that have not yet progressed to frank

dislocation. Close attention to the scapula or shoulder blade function is imperative to ensure

the proper treatment and progression.

When Bankart Repair Surgery Is the Right Answer

Surgery becomes the clearest recommendation when the shoulder has dislocated more than

once, when conservative treatment has failed to restore confidence and function, when MRI

confirms a significant Bankart tear, or when the patient is a young competitive athlete who

cannot afford repeated instability episodes.

Arthroscopic Bankart repair is the surgical procedure I perform for most of these patients. Using a small camera and specialized instruments through tiny incisions, I reattach the torn labrum to the glenoid rim using small anchors.

As a team we will discuss the appropriate procedure for the shoulder that may include a remplissage, which can significantly lower the risk of re-dislocation in the right patient. Please reach out for more detail.

Patients go home the same day. Return to full volleyball typically occurs at 5 to 6 months for

recreational players and 6 to 9 months for competitive overhead athletes as long as the play

passes a return to play test.

For Youth and Indoor Competitive Players

Young athletes present a special consideration. A teenager who dislocates their shoulder

during a volleyball match has a very high likelihood — some studies suggest greater than 80% — of redislocation with continued athletic activity. For young, competitive overhead athletes, surgical repair after a first-time traumatic dislocation with confirmed labral injury is a

conversation I take very seriously and often recommend.

Parents: if your young volleyball player dislocates their shoulder at practice or in a game,

please get them evaluated by a shoulder specialist promptly. Do not just put them back in the

rotation after they pop it back in. That moment deserves a thorough workup.

Shoulder feeling loose, unstable or just not right?

Dr. Jamie Lynch specializes in shoulder instability in athletes of all ages and levels at TruOrtho in San Antonio.

Book an appointment through TruOrtho or call (210) 878 4116