Shoulder Instability

Brief Review:

• Types of Instability: Anterior, Inferior (sulcus sign), and posterior

Treatment:

Anterior dislocation:

Controversy surrounds the ideal treatment for a first-time shoulder anterior dislocation.

• In young athletes or military populations, the risk of recurrence and future shoulder problems approaches 90%. Surgical treatment with repair of labral detachments has led to a high rate of return to play and return to performance, with a low risk (<10%) of recurrent instability for a first dislocation.
• Older nonathletic patients (>40) with first-time dislocations have a reduced risk of recurrent instability (<50%), so surgical treatment is unnecessary.

Posterior Instability:

• Initiate with a course of conservative treatment focused on strengthening the posterior capsular muscles, including the infraspinatus and teres minor.

Multidirectional Instability:

• Patients usually have underlying generalized ligamentous laxity.
• Patients with generalized ligamentous laxity should undergo an extensive course of conservative treatment because of the increased risk of failure associated with most surgical interventions compared with simple unidirectional instability.