REVIEWS   

Minerva Ortopedica e Traumatologica 2015 December 66(6):285-302

Copyright © 2015 EDIZIONI MINERVA MEDICA

language: English

Shoulder instability: a review of the current literature

Luchetti T. J. ¹, Collins M. J. ¹, Swindell H. W. ², Saltzman B. M. ¹

¹ Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA; ² Department of Orthopedic Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA

Shoulder instability is a relatively common problem in young, otherwise healthy overhead athletes. Within this topic heading, three distinct entities exist: anterior shoulder instability, posterior shoulder instability, and multidirectional instability. Each has its own associated anatomic abnormalities, clinical presentations, and treatment algorithms. While anterior and posterior instability are relatively easy to identify acutely, multidirectional instability can present with vague and often subacute symptomatology. It is important to accurately diagnose these distinct entities and to promote early rehabilitation or surgical intervention when indicated as this helps provide the patient with the highest likelihood for favorable results. Goals of treatment include improvement of pain level, prevention of repeat instability events, and return to pre-injury level of sport and activity. While there are a variety of surgical techniques that have been described to correct these pathologies, controversies still exist in the current literature as to the most appropriate operative — or non-operative — management of these disease processes. When surgery is indicated, surgeon preference will often dictate which procedure is performed, but almost universally postoperative immobilization followed by a strict rehab protocol will serve to optimize results of surgery.