Traumatic anterior shoulder instability: Part I. general concepts and proper management

Abstract

Glenohumeral stability is a result of a complex interplay between passive and active restraints that require intricate balance and synchronicity. The management of anterior shoulder instability is based on the natural history, associated injuries, and consideration of several characteristics such as age, gender, activity demands, and expectations. In the athletic population, the underlying pathoanatomy predisposing to further instability episodes and the individual needs of the athlete must be considered in determining the most appropriate treatment to prevent unnecessary absence from sport. With the advent of and rapid improvement in arthroscopic techniques, arthroscopic stabilization has become a frequently means of address-parting anterior instability. However, the recurrence rate in athletes following an arthroscopic repair may be higher than desired due to a high prevalence of bony defects and high demand, particularly in contact athletes. Preoperative recognition and quantification of bony defects is therefore critical to success. This chapter explores the recent advances in epidemiology and classification of anterior shoulder instability in athletes, reviews the pathoanatomy and biomechanics clinical assessment of shoulder stability, and compares the relative merits and outcomes of the different forms of treatment.