Shoulder Instability PDF Evidence

The labrum is a soft cartilage rim that deepens the shallow shoulder socket. When it tears — often during a dislocation — the joint loses its key restraint and starts to feel unstable. Kieran Hirpara 4.0

Shoulder instability — understanding the feeling of looseness, causes, and treatment options.

What you're feeling

You may feel pain in the front or back of your shoulder. This pain often signals larger tissue damage inside the joint. You might notice that certain movements trigger sharp discomfort. Reaching behind your back to fasten a bra can be difficult. Tucking in your shirt may also cause pain. These daily tasks become challenging when the shoulder is unstable.

Your symptoms can flare up at night. You might wake up with a sore shoulder. Pain often worsens after activity. It may also be present when you first wake up in the morning. Sleeping on the affected side can be particularly uncomfortable. You might feel a sense of looseness or instability. However, shoulder laxity does not always mean something is wrong. It must be distinguished from true instability.

In some cases, you may have ambiguous pain during motion without a full dislocation. This is known as microinstability. It is common in young patients. You might not feel the shoulder slip out of place. Instead, you feel pain or a vague sense of unease. This condition can be hard to diagnose. You might also experience extra-articular symptoms that feel like impingement. This is called minor shoulder instability.

If you have recurrent posterior instability, the diagnosis can be difficult. The pain may be deep and hard to pinpoint. You might struggle with specific overhead movements. Despite the challenges, modern treatments can help. Your surgeon will look for specific signs to guide your care. Proper evaluation of bone loss is critical for determining your surgical options. This helps ensure the best possible outcome for your recovery.

What's actually happening

Your shoulder is a ball-and-socket joint designed for wide movement. The ball sits in a shallow socket lined with a soft tissue sleeve called the joint capsule. This capsule acts like a gasket, keeping the joint stable while you move. In shoulder instability, this stabilizing structure is stretched, torn, or loose. The ball may slip partially out of place (subluxation) or pop out completely (dislocation). This mechanical failure allows the ball to move abnormally, causing the pain and catching sensations you feel.

The problem often involves specific tissues that hold the joint together. The labrum is a ring of cartilage that deepens the socket. When it tears, the seal breaks. The rotator cuff muscles and tendons also play a key role in keeping the ball centered. Tears in these tendons, particularly the subscapularis, can significantly alter how your shoulder moves under load. Even small changes in how your shoulder bones move can lead to increased stress on these tissues. Over time, this abnormal motion can cause further wear and tear.

Your surgeon evaluates these changes to determine the best path forward. Modern techniques, such as arthroscopy (keyhole surgery), allow for precise repair of these soft tissues. For some patients, especially those with significant bone loss or recurrent dislocations, a procedure like the Latarjet may be recommended. This surgery uses a small piece of bone to rebuild the socket, providing durable protection against future instability. While surgery can stabilize the joint, it may not fully restore the exact movement quality of an uninjured shoulder. The goal is to stop the slipping and allow you to return to your daily activities with confidence.

What we can do about it

Your journey begins with self-management and physiotherapy. This approach is often the first step, especially if your risk of the shoulder slipping out again is low. Your surgeon may recommend this path if you prefer to avoid surgery or if your clinical exam suggests a stable outcome without an operation. Physiotherapy focuses on strengthening the muscles around your shoulder to improve stability and function. You will work on exercises that help you regain control of the joint. This conservative care aims to reduce pain and prevent future dislocations. However, be aware that nonoperative treatment can carry substantial societal costs due to time away from work or sports. It may also be less reliable for certain types of instability, such as posterior shoulder issues. You should give this approach a fair trial, but understand that it might not stop recurrent events in everyone.

If pain persists, medical management can help you stay active while you heal. Your surgeon may suggest pain medication or anti-inflammatories to manage discomfort and swelling. These medications do not fix the underlying structural problem, but they can make daily activities and therapy more comfortable. In some cases, injections may be considered to reduce inflammation in the joint. While specific injection types like cortisone or hyaluronic acid are sometimes used in broader orthopaedic care, the evidence for shoulder instability focuses heavily on whether conservative care works. The goal here is symptom relief, not structural repair. You should discuss with your surgeon what is appropriate for your specific case, as the primary focus remains on restoring stability through movement and strength rather than just masking pain.

Surgery is considered when conservative care has reached its limit or if you are at high risk for recurrence. This is particularly true for adolescents and young adults under 40 years of age with a first-time anterior shoulder dislocation, where surgery is more effective than conservative options in preventing recurrent instability. Your surgeon will evaluate you thoroughly, as a clinical exam is the most important factor in deciding if surgery is right for you. Imaging, such as MRI or CT scans, helps assess bone loss and soft tissue damage. If your shoulder continues to slip despite therapy, or if you have significant bone loss, surgical stabilization may be recommended. The operation aims to restore joint stability while minimizing loss of motion. This decision should be based on clinical indication, not just a desire to return to sports faster.

What to expect

Your outlook depends largely on whether your shoulder instability is caused by a specific injury or develops without a clear trigger. If you have had a first-time traumatic dislocation, the risk of it happening again is significant. In patients under 40, roughly one-third experience recurrent instability after their initial doctor visit. Without treatment, surgery can reduce these recurrence rates compared to non-surgical care over a 10-year period.

If you undergo surgery for anterior shoulder instability, you can expect a long-term benefit in stability and function, even if you are considered high-risk. However, outcomes vary. In some series, recurrent instability after primary arthroscopic repair was 30% at mid-term follow-up. Other studies show lower recurrence rates, such as 18% after eight years with certain techniques. For posterior shoulder instability, modern arthroscopic management offers reliable and lasting recovery, with emerging data showing durable protection against recurrence and sustained athletic participation.

If you have severe bone loss or recurrent instability requiring complex reconstruction, your surgeon may refer you to a high-volume specialist. Procedures like the Latarjet repair have long-term benefits that appear durable. Even 33 to 35 years after this repair, joint degeneration follows the natural history of shoulder dislocation rather than the surgery itself. For those needing total shoulder replacement due to prior instability, function often continues to improve compared to preoperative values.

It is important to note that not all cases settle easily. Failure of primary stabilization is often linked to uncorrected anatomical issues. Your surgeon will assess your specific risks, such as bone loss or the frequency of your dislocations, to tailor your treatment. While many patients achieve stable shoulders and return to activity, some may experience persistent symptoms or require further intervention. Long-term data remains crucial for understanding the full picture of recovery and potential complications.

When to see someone

See your GP if you have persistent shoulder pain that does not improve with rest. Ask for a specialist review if you feel weakness, instability, or if your shoulder locks or gives way. These symptoms may interfere with your sleep or work. Seek care if you experience a sudden worsening of your condition. A thorough clinical exam is the most important factor in determining if you need surgery. Proper evaluation of bone loss also helps decide on surgical indications. Your surgeon will use this information to guide your treatment plan and optimize your prognosis.

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Reviewed by AI synthesis (v2) — pending human review · 2026-05-18 19:02:24.700155+00:00.

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Evidence & references

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title: "Shoulder Instability" slug: shoulder-instability region: shoulder audience: patient mesh_terms: ["Shoulder Dislocation", "Recurrence", "Bankart Lesions", "Shoulder Injuries", "Shoulder", "Scapula", "Glenoid Cavity", "Arthroplasty"] article_count: 1547 model_used: Qwen3.6-35B-A3B-Q8_0.gguf generated_at: '2026-06-16T19:26:00+00:00' key_articles: - title: "Assessment and diagnosis of non-traumatic shoulder instability: A scoping review" ref_num: 1 evidence_tier: paper evidence_level: 5 doi: 10.1177/17585732251320070 year: 2025 - title: "Non-operative Management of Posterior Shoulder Instability: An Assessment of Survival and Predictors for Conversion to Surgery at 1 to 13 Years After Diagnosis" ref_num: 2 evidence_tier: paper evidence_level: 3 doi: 10.1177/2325967118s00098 year: 2018 - title: "Descriptive Epidemiology of the MOON Shoulder Instability Cohort" ref_num: 3 evidence_tier: paper evidence_level: 4 doi: 10.1177/0363546518755752 year: 2018 - title: "Nonoperative management of anterior shoulder instability can result in high rates of recurrent instability and pain at long-term follow-up" ref_num: 4 evidence_tier: paper evidence_level: 4 doi: 10.1016/j.jse.2021.07.016 year: 2022 - title: "Proper Evaluation of Bone Loss Determines Shoulder Instability Indications and Outcomes" ref_num: 5 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.arthro.2021.01.004 year: 2021 - title: "Posterior shoulder instability: Prospective non-randomised comparison of operative and non-operative treatment in 51 patients" ref_num: 6 evidence_tier: paper evidence_level: 3 doi: 10.1016/j.otsr.2017.08.004 year: 2017 - title: "(ii) The classification of shoulder instability: new light through old windows!" ref_num: 7 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.cuor.2004.04.002 year: 2004 - title: "International survey and surgeon’s preferences in diagnostic work-up towards treatment of anterior shoulder instability" ref_num: 8 evidence_tier: paper evidence_level: 4 doi: 10.1007/s00402-016-2443-7 year: 2016 - title: "No difference in outcomes for posterior shoulder instability surgery in patients with a normal vs. pathological radiologist reported magnetic resonance arthrogram study" ref_num: 9 evidence_tier: paper evidence_level: 3 doi: 10.1016/j.xrrt.2026.100675 year: 2026 - title: "Recurrent Posterior Shoulder Instability" ref_num: 10 evidence_tier: paper evidence_level: 5 doi: 10.5435/00124635-200608000-00004 year: 2006 - title: "Critical Findings on Magnetic Resonance Arthrograms in Posterior Shoulder Instability Compared With an Age-Matched Controlled Cohort" ref_num: 11 evidence_tier: paper evidence_level: 3 doi: 10.1177/0363546516660076 year: 2016 - title: "Biomechanics of posterior shoulder instability - current knowledge and literature review" ref_num: 12 evidence_tier: paper evidence_level: 4 doi: 10.5312/wjo.v9.i11.245 year: 2018 - title: "A predictive model of shoulder instability after a first-time anterior shoulder dislocation" ref_num: 13 evidence_tier: paper evidence_level: 2 doi: 10.1016/j.jse.2010.10.037 year: 2011 - title: "Free Bone Block Procedures for Glenoid Reconstruction in Anterior Shoulder Instability" ref_num: 14 evidence_tier: paper evidence_level: 4 doi: 10.5435/jaaos-d-22-00837 year: 2023 - title: "Failure of Operative Treatment for Glenohumeral Instability: Etiology and Management" ref_num: 15 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.arthro.2010.11.057 year: 2011 - title: "Predictors for surgery in shoulder instability: a retrospective cohort study using the FEDS system" ref_num: 16 evidence_tier: paper evidence_level: 2 doi: 10.1016/j.jse.2016.07.054 year: 2016 - title: "Predictors for Surgery in Shoulder Instability" ref_num: 17 evidence_tier: paper evidence_level: 2 doi: 10.1177/2325967115607434 year: 2015 - title: "Clinical and radiographic outcomes of distal tibia allograft reconstruction for glenoid bone defects in recurrent anterior shoulder instability" ref_num: 18 evidence_tier: paper evidence_level: 2 doi: 10.1016/j.jse.2016.07.053 year: 2016 - title: "Defining clinical significance following primary stabilization of posterior shoulder instability" ref_num: 19 evidence_tier: paper evidence_level: 4 doi: 10.1016/j.jseint.2025.08.006 year: 2025 - title: "Editorial Commentary: Posterior Shoulder Instability in Athletes: Durable Recovery May Be Achievable With Arthroscopic Management" ref_num: 20 evidence_tier: commentary evidence_level: 5 doi: 10.1016/j.arthro.2025.09.003 year: 2025 - title: "Arthroscopic Treatment of Posterior Shoulder Instability: A Systematic Review" ref_num: 21 evidence_tier: paper evidence_level: 1 doi: 10.1016/j.arthro.2014.11.009 year: 2014 - title: "Long-term Results After Arthroscopic Shoulder Stabilization Using Suture Anchors" ref_num: 22 evidence_tier: paper evidence_level: 4 doi: 10.1177/0363546511415657 year: 2011 - title: "Editorial Commentary: Operative Versus Nonoperative Management of Shoulder Instability in the National Football League Athlete: Do What Needs to Be Done—Treatment Choice Does Not Affect Future Performance or Games Played" ref_num: 23 evidence_tier: commentary evidence_level: 5 doi: 10.1016/j.arthro.2021.01.053 year: 2021 - title: "Outcomes of total shoulder arthroplasty in patients with prior anterior shoulder instability: minimum 5-year follow-up" ref_num: 25 evidence_tier: paper evidence_level: 3 doi: 10.1016/j.jse.2023.07.005 year: 2024 - title: "Long-Term Prognosis Of First Time Anterior Shoulder Dislocation In The Young: 229 Shoulders Prospectively Followed For 25 Years" ref_num: 26 evidence_tier: abstract evidence_level: 2 doi: 10.1016/j.jse.2007.02.100 year: 2007 - title: "Latarjet procedure for anterior shoulder instability: a 24-year follow-up study" ref_num: 27 evidence_tier: paper evidence_level: 3 doi: 10.1007/s00402-020-03426-2 year: 2020 - title: "Latarjet Procedure for Anterior Shoulder Instability: A 24-Year Follow Up Study" ref_num: 28 evidence_tier: paper evidence_level: 3 doi: 10.1016/j.jse.2021.03.097 year: 2021 - title: "Patients Aged >50 Years With Anterior Shoulder Instability Have a Decreased Risk of Recurrent Dislocation After Operative Treatment Compared With Non‐Operative Treatment" ref_num: 29 evidence_tier: paper evidence_level: 3 doi: 10.1016/j.asmr.2023.03.014 year: 2023 - title: "Multiple Instability Events at Initial Presentation Are the Major Predictor of Failure of Nonoperative Treatment for Anterior Shoulder Instability" ref_num: 30 evidence_tier: paper evidence_level: 3 doi: 10.1016/j.arthro.2021.03.047 year: 2021 - title: "Shoulder Instability in Women Compared with Men" ref_num: 31 evidence_tier: paper evidence_level: 4 doi: 10.2106/jbjs.rvw.19.00007 year: 2019 - title: "Consensus Statement on Shoulder Instability" ref_num: 32 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.arthro.2009.06.022 year: 2009 - title: "Changes in Scapular Function, Shoulder Strength, and Range of Motion Occur After Latarjet Procedure" ref_num: 33 evidence_tier: paper evidence_level: 4 doi: 10.1016/j.asmr.2023.100804 year: 2023 - title: "Arthroscopic Findings After Traumatic Shoulder Instability in Patients Older Than 35 Years" ref_num: 34 evidence_tier: paper evidence_level: 4 doi: 10.1177/2325967115584318 year: 2015 - title: "Three-dimensional shoulder kinematics normalize after rotator cuff repair" ref_num: 35 evidence_tier: paper evidence_level: 4 doi: 10.1016/j.jse.2015.10.021 year: 2016 - title: "Kinematic evaluation of patients with total and reverse shoulder arthroplasty during rehabilitation exercises with different loads" ref_num: 36 evidence_tier: paper evidence_level: 4 doi: 10.1016/j.clinbiomech.2012.04.009 year: 2012 - title: "A new classification system for shoulder instability" ref_num: 37 evidence_tier: paper evidence_level: 5 doi: 10.1136/bjsm.2009.071183 year: 2010 - title: "Biomechanics of Complex Shoulder Instability" ref_num: 38 evidence_tier: paper doi: 10.1016/j.csm.2013.07.002 year: 2013 - title: "Recurrence and return to play after shoulder instability events in young and adolescent athletes: a systematic review and meta-analysis" ref_num: 39 evidence_tier: paper evidence_level: 2 doi: 10.1136/bjsports-2016-096895 year: 2016 - title: "Arthroscopic Anatomy, Variants, and Pathologic Findings in Shoulder Instability" ref_num: 40 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.arthro.2011.05.017 year: 2011 - title: "Minor or occult shoulder instability: an intra‐articular pathology presenting with extra‐articular subacromial impingement symptoms" ref_num: 41 evidence_tier: paper evidence_level: 3 doi: 10.1007/s00167-011-1552-7 year: 2011 - title: "Comprehensive Review of Shoulder Instability Includes Diagnosis, Nonoperative Management, Bankart, Latarjet, Remplissage, Glenoid Bone‐Grafting, Revision Surgery, Rehabilitation and Return to Play, and Clinical Follow‐Up" ref_num: 42 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.arthro.2021.11.052 year: 2022 - title: "Intraobserver and interobserver agreement of International Classification of Diseases, Ninth Revision codes in classifying shoulder instability" ref_num: 43 evidence_tier: paper evidence_level: 1 doi: 10.1016/j.jse.2008.10.005 year: 2009 - title: "Microinstability characterised by small and easily overlooked anterior labral or Hill–Sachs lesions can be managed with arthroscopic anterior labral repair" ref_num: 44 evidence_tier: paper evidence_level: 3 doi: 10.1007/s00167-022-06941-4 year: 2022 - title: "Minimal clinically important differences in Rowe and Western Ontario Shoulder Instability Index scores after arthroscopic repair of anterior shoulder instability" ref_num: 46 evidence_tier: paper evidence_level: 4 doi: 10.1016/j.jse.2017.10.032 year: 2018 - title: "Arthroscopic Repair of Humeral Avulsion of the Glenohumeral Ligament for Anterior Shoulder Instability" ref_num: 47 evidence_tier: paper doi: 10.1016/j.eats.2020.10.053 year: 2021 - title: "Influential and Highest Cited Shoulder Instability Articles: A Bibliometric Analysis" ref_num: 48 evidence_tier: paper evidence_level: 4 doi: 10.1177/2325967121992577 year: 2021 - title: "Outcomes of capsulolabral reconstruction for posterior shoulder instability" ref_num: 49 evidence_tier: paper doi: 10.1016/j.otsr.2017.08.002 year: 2017 - title: "Shoulder Instability: Surgical Versus Nonsurgical Treatment" ref_num: 50 evidence_tier: paper evidence_level: 1 doi: 10.1016/j.arthro.2006.11.026 year: 2007 - title: "Editorial Commentary: Recurrent Anterior Shoulder Instability With Glenoid Bone Loss Requires Restoring the Bone" ref_num: 51 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.arthro.2021.09.002 year: 2022 - title: "Digital dynamic radiography—a novel diagnostic technique for posterior shoulder instability: a case report" ref_num: 52 evidence_tier: case_report evidence_level: 5 doi: 10.1016/j.jseint.2023.02.015 year: 2023 - title: "Suture Capsulorrhaphy Versus Capsulolabral Advancement for Shoulder Instability" ref_num: 53 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.arthro.2012.04.140 year: 2012 - title: "Arthroscopic Repair for Posterior Shoulder Instability Is Associated With Favorable Outcomes and High Return to Sport or Work: A Systematic Review and Meta‐Analysis" ref_num: 54 evidence_tier: paper evidence_level: 1 doi: 10.1016/j.asmr.2024.101032 year: 2024 - title: "Lesion prevalence and patient outcome comparison between primary and recurrent anterior shoulder instability" ref_num: 55 evidence_tier: paper evidence_level: 3 doi: 10.1016/j.jse.2023.05.029 year: 2023 - title: "ABC classification of posterior shoulder instability" ref_num: 56 evidence_tier: paper evidence_level: 5 doi: 10.1007/s11678-017-0404-6 year: 2017 - title: "Glenoid track evaluation by a validated finite-element shoulder numerical model" ref_num: 57 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.otsr.2020.03.004 year: 2020 - title: "Shoulder Instability: Alternative Surgical Techniques. GiovanniDi Giacomo, AlbertoCostantini, AndreaDe Vita, NicoladeGasperis. 2011. Springer, Milan, Italy, 194 pp" ref_num: 58 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.arthro.2012.09.003 year: 2012 - title: "Open Repairs for the Treatment of Anterior Shoulder Instability" ref_num: 59 evidence_tier: paper evidence_level: 5 doi: 10.1177/03635465030310011001 year: 2003 - title: "Movement control in patients with shoulder instability: a comparison between patients after open surgery and nonoperated patients" ref_num: 60 evidence_tier: paper evidence_level: 3 doi: 10.1016/j.jse.2013.09.021 year: 2014 - title: "MEAN 6 YEAR CLINICAL OUTCOMES, SURVIVORSHIP, AND RETURN TO SPORTS AFTER ARTHROSCOPIC CAPSULAR REPAIR WITH SUTURE ANCHORS FOR ADOLESCENT MULTIDIRECTIONAL SHOULDER INSTABILITY" ref_num: 61 evidence_tier: paper evidence_level: 4 doi: 10.1177/2325967121s00021 year: 2021 - title: "Editorial Commentary : Time‐Zero Biomechanical Shoulder Instability Studies Are Valuable But Limited Because They Do Not Replicate Clinical Dynamics" ref_num: 62 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.arthro.2022.04.006 year: 2022 - title: "Global Perspectives on Management of Shoulder Instability" ref_num: 63 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.ocl.2019.11.008 year: 2020 - title: "Reliability of Manual Measurements Versus Semiautomated Software for Glenoid Bone Loss Quantification in Patients With Anterior Shoulder Instability" ref_num: 64 evidence_tier: paper evidence_level: 3 doi: 10.1177/23259671231222938 year: 2024 - title: "Diagnosis and treatment of posterior shoulder instability based on the ABC classification" ref_num: 65 evidence_tier: paper evidence_level: 5 doi: 10.1530/eor-24-0025 year: 2024 - title: "The clinical physiotherapy assessment of non-traumatic shoulder instability" ref_num: 66 evidence_tier: paper evidence_level: 5 doi: 10.1177/1758573214548934 year: 2014 - title: "Biomechanical Evaluation of the 2 Different Levels of Coracoid Graft Positions in the Latarjet Procedure for Anterior Shoulder Instability" ref_num: 67 evidence_tier: paper evidence_level: 5 doi: 10.1177/23259671231202533 year: 2023 - title: "Challenging the Current Concept of Critical Glenoid Bone Loss in Shoulder Instability: Does the Size Measurement Really Tell It All?" ref_num: 69 evidence_tier: paper evidence_level: 5 doi: 10.1177/0363546518819102 year: 2019 - title: "Revision of failed Latarjet with the Eden-Hybinette surgical technique" ref_num: 70 evidence_tier: paper evidence_level: 4 doi: 10.1016/j.otsr.2019.12.009 year: 2020 - title: "Direct and indirect costs associated with nonoperative treatment for shoulder instability: an observational study in 132 patients" ref_num: 71 evidence_tier: paper evidence_level: 3 doi: 10.1177/1758573218773543 year: 2018 - title: "Complications Related to Latarjet Shoulder Stabilization: A Systematic Review" ref_num: 72 evidence_tier: paper evidence_level: 4 doi: 10.1177/03635465211042314 year: 2021 - title: "Editorial Commentary: Glenoid Bone Loss Measurements in Shoulder Instability—Precise but Not Accurate" ref_num: 74 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.arthro.2020.05.006 year: 2020 - title: "Objective Measures for Assessing Readiness to Return to Sport After Shoulder Instability Procedures Are Not Standardized: A Systematic Review" ref_num: 75 evidence_tier: paper evidence_level: 1 doi: 10.1016/j.asmr.2024.100978 year: 2024 - title: "The Pathophysiology of Shoulder Instability" ref_num: 76 evidence_tier: paper evidence_level: 5 doi: 10.1177/03635465000280062501 year: 2000 - title: "The Epidemiology and Natural History of Anterior Shoulder Instability" ref_num: 77 evidence_tier: paper evidence_level: 4 doi: 10.1007/s12178-017-9432-5 year: 2017 - title: "Posterior Shoulder Instability, Part I—Diagnosis, Nonoperative Management, and Labral Repair for Posterior Shoulder Instability—An International Expert Delphi Consensus Statement" ref_num: 78 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.arthro.2024.04.035 year: 2024 - title: "Shoulder Instability after Total Shoulder Arthroplasty: A Case of Arthroscopic Repair" ref_num: 79 evidence_tier: paper evidence_level: 5 doi: 10.1007/s11420-013-9373-5 year: 2014 - title: "Long‐term outcome of arthroscopic remplissage in addition to the classic Bankart repair for the management of recurrent anterior shoulder instability with engaging Hill–Sachs lesions" ref_num: 80 evidence_tier: paper evidence_level: 4 doi: 10.1007/s00167-018-5261-3 year: 2018 - title: "Treatment of Posterior Shoulder Instability in National Hockey League Players: A Survey of NHL Team Physicians" ref_num: 81 evidence_tier: paper evidence_level: 4 doi: 10.1177/23259671261440208 year: 2026 - title: "High Variability in Standardized Outcome Thresholds of Clinically Important Changes in Shoulder Instability Surgery: A Systematic Review" ref_num: 82 evidence_tier: paper evidence_level: 1 doi: 10.1016/j.arthro.2024.07.039 year: 2024 - title: "Minimum 10-Year Clinical Outcomes After Arthroscopic Capsulolabral Repair for Isolated Posterior Shoulder Instability" ref_num: 83 evidence_tier: paper evidence_level: 4 doi: 10.1177/03635465231162271 year: 2023 - title: "An assessment of quality of randomized controlled trials in shoulder instability surgery using a modification of the clear CLEAR-NPT score" ref_num: 84 evidence_tier: paper evidence_level: 2 doi: 10.1177/1758573218754370 year: 2018 - title: "Posterior Shoulder Instability" ref_num: 85 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.mric.2019.12.005 year: 2020 - title: "The importance of CT for the pre-operative surgical planning in recurrent anterior shoulder instability" ref_num: 86 evidence_tier: paper evidence_level: 3 doi: 10.1007/s00402-012-1656-7 year: 2012 - title: "Shoulder Instability in the Military" ref_num: 87 evidence_tier: paper doi: 10.1016/j.csm.2014.06.006 year: 2014 - title: "Incidence of and Risk Factors for Glenohumeral Osteoarthritis After Anterior Shoulder Instability: A US Population–Based Study With Average 15-Year Follow-up" ref_num: 88 evidence_tier: paper evidence_level: 3 doi: 10.1177/2325967120962515 year: 2020 - title: "Substantial variability in what is considered important in the radiological report for anterior shoulder instability: a Delphi study with Dutch musculoskeletal radiologists and orthopedic surgeons" ref_num: 89 evidence_tier: paper evidence_level: 5 doi: 10.1016/j.jseint.2024.03.012 year: 2024 - 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title: "Magnetic resonance imaging predictors of shoulder instability in adolescents" ref_num: 95 evidence_tier: paper evidence_level: 4 doi: 10.1007/s00247-018-4318-2 year: 2018 - title: "Arthrotomography of the glenoid labrum in shoulder instability." ref_num: 96 evidence_tier: paper evidence_level: 4 doi: 10.2106/00004623-198264040-00005 year: 1982 - title: "Editorial Commentary: Methodology of Measuring Bone Loss in Recurrent Shoulder Instability Surgery: Traditional Computed Tomography Scan and Magnetic Resonance Imaging Do Not Tell the Full Story" ref_num: 97 evidence_tier: commentary evidence_level: 5 doi: 10.1016/j.arthro.2019.10.001 year: 2020 - title: "Quality of life following an open Latarjet-Bristow procedure in a general population with recurrent anterior shoulder instability" ref_num: 99 evidence_tier: paper evidence_level: 4 doi: 10.1016/j.jseint.2022.12.003 year: 2023 - title: "Paper 11: Return to Sport Testing vs Time-Based Clearance in Posterior Shoulder Instability" ref_num: 100 evidence_tier: paper evidence_level: 3 doi: 10.1177/2325967121s00549 year: 2022 - title: "Paper 29: Return to Sport Testing vs Time-Based Clearance in Posterior Shoulder Instability" ref_num: 101 evidence_tier: paper evidence_level: 3 doi: 10.1177/2325967121s00593 year: 2022 synthesis_version: "v2" verifier_status: skipped

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Overview

• Nearly 40% of patients treated non-operatively for posterior shoulder instability eventually require surgery at long-term follow-up [2].
• The MOON Shoulder Instability Study has enrolled the largest cohort of patients undergoing shoulder stabilization to date [3].
• At long-term follow-up of 17 years, a high rate of poor outcomes was observed following nonoperative management of anterior shoulder instability [4].
• Proper evaluation of bone loss best determines shoulder instability surgical indications and outcomes [5].
• The 1-year outcomes in a prospective study suggest superiority of operative over non-operative treatment for posterior shoulder instability [6].
• Free bone block procedures are considered safe and clinically effective for the management of anterior shoulder instability with glenoid bone loss [14].
• The thresholds defined in a 2025 study can provide a guideline for interpreting patient outcomes following arthroscopic stabilization for posterior shoulder instability, allowing for earlier detection of recurrent posterior instability [19].
• With modern arthroscopic management, posterior shoulder instability represents a condition where reliable and lasting recovery may be achievable, supported by emerging data suggesting durable protection against recurrent instability and sustained athletic participation [20].
• Management of shoulder instability should be based on clinical indication, and surgical stabilization should not be done prophylactically in the hope of increasing the number of future games played or enhancing performance [23].
• Despite the wide array of available PROMs for assessing shoulder instability surgery outcomes, the availability of clinically significant outcome thresholds such as MCID and PASS remains relatively limited [82].
• Arthroscopic capsulolabral repair for posterior shoulder instability was a durable treatment option that improved long-term shoulder pain and function and facilitated return to sport in the majority of patients at a mean follow-up of 15.4 years, although a notable proportion of patients met various criteria for failure [83].
• RCTs reporting on shoulder instability surgery are well performed but poorly reported [84].

Anatomy & Pathophysiology

• The shoulder depends on dynamic and static stabilizers because it has little inherent stability, making it prone to instability [63].
• Shoulder instability results from an imbalance between static and dynamic stabilizers [76].
• A thorough understanding of normal anatomy and anatomic variations is critical to differentiate them from pathologic findings [76].
• Biomechanical studies on posterior shoulder instability remain limited in the literature [12].
• Current biomechanical models for posterior shoulder instability are performed in a static manner, which limits their translation for explaining a dynamic pathology [12].
• Time-zero biomechanical shoulder instability studies are valuable but limited because they do not replicate clinical dynamics [62].
• Observed results from time-zero biomechanical studies do not confirm that the surgical approach would provide sufficient long-term noncontractile shoulder stability to withstand repetitive soft-tissue loading in a dynamic, clinical situation [62].
• Influential articles in shoulder instability included a high proportion of biomechanical/cadaveric studies [48].
• The Latarjet procedure leads to anatomic and biomechanical changes in the shoulder [33].
• A more inferior graft position (fixed at 4-6 o'clock) in the Latarjet procedure may improve shoulder biomechanics, but additional work is needed to establish clinical relevance [67].
• In the setting of shoulder instability without evidence of a labral tear, the capsulolabral advancement technique may be considered biomechanically superior to suture capsulorrhaphy [53].
• The observed changes in scapular kinematics after rotator cuff repair are associated with an increased overall range of motion and suggest restored function of shoulder muscles [35].
• Scapular kinematics of patients with shoulder arthroplasty were influenced by implementation of external loads, but not by the type of load [36].
• Arm kinematic analyses suggest that open surgery stabilizes the shoulder but does not necessarily restore normal movement quality [60].
• Integrating digital dynamic radiography (DDR) into the clinical workflow allows dynamic noninvasive examination of shoulder kinematics and provides an inexpensive method to objectively quantify disease severity with low radiation dosage [52].
• A validated finite-element shoulder numerical model is suitable for shoulder articular contact evaluation [57].
• Current glenoid bone loss measurements are unable to provide an adequate estimation on the actual biomechanical effect of glenoid defects because the relation between the glenoid defect size and its biomechanical effect is nonlinear [69].
• Patients with shoulder instability have constitutional biomechanically relevant glenoid concavity shape differences [69].
• Current glenoid defect extent measurements are precise but not accurate because they do not account for the 3-dimensional shape of the glenoid concavity or the native glenoid shape, which are critical for expressing the loss of biomechanical stability [74].
• While more advanced measurement techniques that take glenoid concavity into account are more accurate in determining the biomechanical relevance of glenoid bone loss, the reliability of manually performed, more complex measurements was moderate [64].
• Most patients undergoing shoulder stabilization procedures regained fundamental strength and range of motion [75].

Classification

• A proposed classification system for shoulder instability is all-inclusive and recognizes that more than one pathology can occur in an individual shoulder [7].
• There is a high variety in the use of diagnostic tools and examinations for assessing shoulder instability [8].
• The FEDS classification, particularly the frequency and etiology of shoulder instability, may be helpful in identifying patients with a higher likelihood of undergoing surgical treatment [16].
• The FEDS classification, particularly the frequency and etiology of shoulder instability, may be helpful in identifying patients with a higher likelihood of undergoing surgical treatment [17].
• The FEDS classification, particularly the frequency and etiology of shoulder instability, may be helpful in identifying patients with a higher likelihood of undergoing surgical treatment [18].
• A new classification system for shoulder instability categorizes instability based on frequency, aetiology, direction, and severity [37].
• Shoulder instability cannot reliably be classified using the ICD-9 coding system [43].
• The ABC classification distinguishes three groups of posterior glenohumeral instability with two different subtypes based on the pathomechanical type of instability and the current standard of treatment [56].
• A resource on shoulder instability reviews the classification of shoulder instability, pathoanatomy, the concept of the glenoid track, and evaluation of bone loss [58].
• The ABC classification distinguishes three groups of posterior shoulder instability based on the nature of pathology and two subtypes based on pathomechanical causes [65].
• An expanded assessment framework is useful to estimate the contribution of each component of non-traumatic shoulder instability and offer a framework for targeted rehabilitation [66].
• The validity of testing specific subgroups within the expanded assessment framework for non-traumatic shoulder instability remains to be established [66].

Clinical Presentation

• Non-traumatic shoulder instability has multifactorial aetiologies and clinical manifestations [1].
• The MOON Shoulder Instability Study has enrolled the largest cohort of patients undergoing shoulder stabilization to date [3].
• Proper evaluation of bone loss best determines shoulder instability surgical indications and outcomes [5].
• A proposed classification system for shoulder instability is all-inclusive and recognizes that more than one pathology can occur in an individual shoulder [7].
• There is a high variety in the use of diagnostic tools for assessing shoulder instability [8].
• A thorough clinical exam is the most important factor when determining indication for shoulder instability surgery, with no difference in outcomes for posterior shoulder instability surgery between patients with normal vs. pathological radiologist-reported magnetic resonance arthrogram studies [9].
• Recurrent posterior shoulder instability is an uncommon condition that is often unrecognized, leading to incorrect diagnoses and delays [10].
• Identification of critical radiographic variables on magnetic resonance arthrography assists in the accurate diagnosis and management of clinically significant posterior shoulder instability [11].
• Biomechanical studies on posterior shoulder instability remain limited, with current models performed in a static manner which limits their translation for explaining a dynamic pathology [12].
• Detailed and specific information about prognosis is critical in the management of a first-time anterior shoulder dislocation [13].
• Failure of primary shoulder stabilization procedures is often related to uncorrected anatomic pathology, and the instability severity index score permits precise identification of patients at risk [15].
• Existing data on the presentation of shoulder instability in men and women is evaluated to determine if there are differences in occurrence, treatment, or functional outcome following management [31].
• The consensus statement on shoulder instability aims to improve diagnosis and treatment through universal agreement on outcome measurement tools and tailored treatment based on pathology, patient age, activity demands, and surgeon skills [32].
• Traumatic shoulder instability in patients older than 35 years may result in a wide array of pathologic findings as well as a diversity of clinical presentations [34].
• Proper identification and treatment of osseous defects resulting in complex shoulder instability is critical in minimizing recurrence [38].
• Current literature concerning shoulder anatomy and pathology related to shoulder stability/instability is reviewed to improve clinical diagnosis and surgical treatment [40].
• Minor or occult shoulder instability is an intra-articular pathology presenting with extra-articular subacromial impingement symptoms [41].
• The Delphi method was used to achieve an international consensus statement on shoulder instability covering diagnosis, nonoperative management, surgical options, rehabilitation, and clinical follow-up [42].
• Microinstability is diagnostically challenging and can be diagnosed in young patients with ambiguous shoulder pain during motion, without instability [44].
• HAGL lesions are a rare and underdiagnosed cause of anterior shoulder instability that can lead to recurrent dislocations if unaddressed [47].

Investigations

• Non-traumatic shoulder instability has multifactorial aetiologies and clinical manifestations [1].
• Proper evaluation of bone loss best determines shoulder instability surgical indications and outcomes [5].
• A high variety of diagnostic examinations and tools are used for assessing shoulder instability [8].
• A thorough clinical exam is the most important factor when determining indication for shoulder instability surgery [9].
• Recurrent posterior shoulder instability is an uncommon condition often unrecognized, leading to incorrect diagnoses and delays [10].
• Identification of critical radiographic variables on magnetic resonance arthrography assists in the accurate diagnosis and management of clinically significant posterior shoulder instability [11].
• Magnetic resonance arthrography is regarded as the gold-standard imaging modality for shoulder instability [85].
• CT imaging is more important than MRI for evaluating glenoid defects in recurrent anterior shoulder instability [86].
• Advanced imaging modalities are essential for identifying associated lesions in shoulder instability [87].
• Substantial variability exists in the scoring of important elements in radiological reports for the evaluation of anterior shoulder instability, regardless of modality [89].
• MR-arthrography is identified as the main tool in diagnosing shoulder instability injuries [90].
• Radiography can be used for screening patients for significant glenoid bone loss [91].
• Superior-capsular elongation and its diagnostic criteria of measurements by MR arthrography serve as references for diagnosing atraumatic posteroinferior shoulder instability [92].
• Radiographic progression of glenohumeral arthritis occurred in 14% of patients with posterior shoulder instability [93].
• ZTE MRI demonstrated high reproducibility for the evaluation of glenoid bone defect in shoulders with anterior instability [94].
• MRI is a valid imaging tool to diagnose and measure osseous lesions of the shoulder [95].
• Arthrotomography of the glenoid labrum is a helpful adjunct in substantiating the diagnosis of shoulder instability and in planning the choice of surgical reconstruction [96].
• While CT and MRI measurements of bone loss differ statistically, the differences are clinically imperceptible when using the circle technique [97].

Treatment

Non-Operative Management

• Non-traumatic shoulder instability has multifactorial aetiologies and clinical manifestations [1].
• Nonoperative management of anterior shoulder instability can result in high rates of recurrent instability and pain at long-term follow-up [4].
• At long-term follow-up of 17 years, a high rate of poor outcomes was observed following nonoperative management of anterior shoulder instability [4].
• Primary non-operative management is a prominent risk factor for recurrence of shoulder instability in young and adolescent athletes [39].
• Nonoperative treatment of shoulder instability has substantial societal costs [71].
• Recent studies continue to demonstrate a role for nonoperative treatment in the successful long-term management of anterior glenohumeral instability [77].
• NHL team physicians strongly favor nonoperative management in-season for initial posterior instability events of the shoulder [81].
• The study group achieved strong or unanimous consensus on 63% of statements related to the diagnosis, nonoperative treatment, and labrum repair for posterior shoulder instability [78].

Operative Management

• Proper evaluation of bone loss best determines shoulder instability surgical indications and outcomes [5].
• The success of treating anterior glenohumeral instability relies on multiple factors, including glenoid bone loss [51].
• Free bone block procedures are considered safe and clinically effective for the management of anterior shoulder instability with glenoid bone loss [14].
• Recurrent anterior shoulder instability with glenoid bone loss requires restoring the bone [51].
• Successful treatment of anterior instability of the shoulder requires a balance between restoring joint stability and minimizing loss of glenohumeral motion [59].
• Surgical treatment of primary, traumatic, anterior shoulder instability results in reduced rates of recurrence compared with nonsurgical treatment at 10-year follow-up [50].
• Successful results were obtained in patients younger than 40 years with both primary and recurrent anterior shoulder instability after arthroscopic treatment [55].
• To assess the effectiveness of an arthroscopic stabilization procedure for anterior shoulder instability using the Rowe score, a difference of at least 9.7 in the score is clinically relevant [46].
• Adolescent multidirectional shoulder instability refractory to non-surgical management appears to have long-term outcomes after surgical intervention that are comparable to adolescent patients with unidirectional instability [61].
• Diagnostic and therapeutic arthroscopy is useful for soft tissue instability complicating a previously successful total shoulder arthroplasty [79].
• The 1-year outcomes in a prospective study suggest superiority of operative over non-operative treatment for posterior shoulder instability [6].
• Long-term follow-up demonstrates that nearly 40% of patients treated non-operatively for posterior shoulder instability eventually require surgery [2].
• Most patients younger than 40 years with shoulder instability who were initially treated nonoperatively for 6 months were definitively treated without surgery [30].
• Multiple instability events at initial presentation are the major predictor of failure of nonoperative treatment for anterior shoulder instability [30].
• Management of shoulder instability should be based on clinical indication, and surgical stabilization should not be done prophylactically in the hope of increasing the number of future games played or enhancing performance [23].
• A thorough clinical exam is the most important factor when determining indication for shoulder instability surgery [9].
• Arthroscopic stabilization of the shoulder for posterior instability has promising early and midterm results [21].
• Primary arthroscopic treatment of posterior shoulder instability is associated with favorable outcomes and high return to sport and work rates [54].
• With modern arthroscopic management, posterior shoulder instability represents a condition where reliable and lasting recovery may be achievable, supported by emerging data suggesting durable protection against recurrent instability and sustained athletic participation [20].
• Treatment of posterior shoulder instability by capsulolabral reconstruction leads to good clinical outcomes; however the recurrence rate is high [49].
• The thresholds defined in this study can provide a guideline for interpreting patient outcomes following arthroscopic stabilization for posterior shoulder instability, allowing for earlier detection of recurrent posterior instability [19].

Complications

• Non-traumatic shoulder instability has multifactorial aetiologies and clinical manifestations [1].
• Nearly 40% of patients treated non-operatively for posterior shoulder instability eventually require surgery at long-term follow-up [2].
• Nonoperative management of anterior shoulder instability results in high rates of recurrent instability and pain at long-term follow-up [4].
• At long-term follow-up of 17 years, a high rate of poor outcomes was observed following nonoperative management of anterior shoulder instability [4].
• Operative treatment shows superiority over non-operative treatment for posterior shoulder instability at 1-year outcomes [6].
• Failure of primary shoulder stabilization procedures is often related to uncorrected anatomic pathology [15].
• The instability severity index score permits precise identification of patients at risk for failure of primary shoulder stabilization [15].
• Early and midterm results of arthroscopic stabilization for posterior instability are promising [21].
• About one third of stabilized shoulders experienced at least one redislocation after 8 to 10 years following arthroscopic shoulder stabilization using suture anchors [22].
• Patients with a history of anterior shoulder instability undergoing total shoulder arthroplasty can expect continued improvement in function compared with preoperative values at mid-term follow-up [25].
• The natural history of first-time shoulder dislocations is bound up with arthropathy [26].
• The open Latarjet procedure is a safe and reliable technique for recurrent anterior shoulder instability at 24-year follow-up [27, 28].
• A history of multiple instability episodes prior to presentation was the greatest predictor of recurrent instability and failure of nonoperative treatment and progression to surgery [29].
• Most patients younger than 40 years with shoulder instability who were initially treated nonoperatively for 6 months were definitively treated without surgery [30].
• The Latarjet procedure for anterior shoulder instability results in an overall complication rate of 16.1% and a reoperation rate of 2.6% [72].
• Serious complications at short-term follow-up after the Latarjet procedure appear rare [72].
• Approximately one-fourth of patients younger than 40 years with anterior shoulder instability developed symptomatic osteoarthritis at a mean follow-up of 15 years from their first instability event [88].

Recovery

• Nearly 40% of patients treated non-operatively for posterior shoulder instability eventually require surgery at long-term follow-up [2].
• Nonoperative management of anterior shoulder instability results in high rates of recurrent instability and pain at long-term follow-up [4].
• At long-term follow-up of 17 years, a high rate of poor outcomes was observed following nonoperative management of anterior shoulder instability [4].
• The 1-year outcomes in a prospective study suggest superiority of operative over non-operative treatment for posterior shoulder instability [6].
• About one third of stabilized shoulders experienced at least one redislocation after 8 to 10 years following arthroscopic shoulder stabilization using suture anchors [22].
• Patients with a history of anterior shoulder instability undergoing total shoulder arthroplasty can expect continued improvement in function compared with preoperative values at mid-term follow-up [25].
• The natural history of first-time shoulder dislocations is bound up with arthropathy [26].
• The open Latarjet procedure is a safe and reliable technique for recurrent anterior shoulder instability at 24-year follow-up [27].
• The open Latarjet procedure is a safe and reliable technique for recurrent anterior shoulder instability at 24-year follow-up [28].
• Patients aged >50 years with anterior shoulder instability have a decreased risk of recurrent dislocation after operative treatment compared with non-operative treatment [29].
• A history of multiple instability episodes prior to presentation was the greatest predictor of recurrent instability and failure of nonoperative treatment and progression to surgery [29].
• Outcomes at 3 years' follow-up for revision of failed Latarjet with the Eden-Hybinette surgical technique were satisfactory in 80% of patients, with 86% having stable shoulders [70].
• The combination of arthroscopic remplissage and classic Bankart repair for recurrent anterior shoulder instability with engaging Hill–Sachs lesions has long-term outcomes in terms of recurrence rate and does not significantly influence the range of motion of the shoulder [80].
• The number of episodes of dislocation before surgery and delayed surgical intervention did not increase the recurrent anterior shoulder instability rates postoperatively following an open Latarjet-Bristow procedure [99].
• There was no significant difference in reoperation rate and recurrence of symptoms between athletes who underwent objective return to sport testing and those released to sport on a time-based protocol after arthroscopic surgery for posterior shoulder instability [100].
• There was no significant difference in reoperation rate and recurrence of symptoms between athletes who underwent objective return to sport testing and those released to sport on a time-based protocol after arthroscopic surgery for posterior shoulder instability [101].

Key Evidence

• [L5] Non-traumatic shoulder instability's aetiologies and clinical manifestations are multifactorial. (10.1177/17585732251320070)
• [L3] Long-term follow-up demonstrates that nearly 40% of patients treated non-operatively for posterior shoulder instability eventually require surgery. (10.1177/2325967118s00098)
• [L4] The MOON Shoulder Instability Study has enrolled the largest cohort of patients undergoing shoulder stabilization to date. (10.1177/0363546518755752)
• [L4] At long-term follow-up of 17 years, a high rate of poor outcomes was observed following nonoperative management of anterior shoulder instability. (10.1016/j.jse.2021.07.016)
• [L5] Proper evaluation of bone loss best determines shoulder instability surgical indications and outcomes. (10.1016/j.arthro.2021.01.004)
• [L3] The 1-year outcomes in this prospective study suggest superiority of operative over non-operative treatment for posterior shoulder instability. (10.1016/j.otsr.2017.08.004)
• [L5] The authors propose a classification system, which challenges previous systems by being all inclusive and recognises that more than one pathology can occur in an individual shoulder. (10.1016/j.cuor.2004.04.002)
• [L4] Many different diagnostic examinations for assessing shoulder instability are used and a high variety is seen in the use of diagnostic tools. (10.1007/s00402-016-2443-7)
• [L3] A thorough clinical exam is the most important factor when determining indication for shoulder instability surgery. (10.1016/j.xrrt.2026.100675)
• [L5] Recurrent posterior shoulder instability is an uncommon condition often unrecognized, leading to incorrect diagnoses and delays. (10.5435/00124635-200608000-00004)
• [L3] Identification of these critical radiographic variables on magnetic resonance arthrography assists in the accurate diagnosis and management of clinically significant posterior shoulder instability. (10.1177/0363546516660076)
• [L4] Biomechanical studies on posterior shoulder instability remain limited in the literature, with current models performed in a static manner which limits their translation for explaining a dynamic pathology. (10.5312/wjo.v9.i11.245)
• [L2] Detailed and specific information about prognosis is critical in the management of a first-time anterior shoulder dislocation. (10.1016/j.jse.2010.10.037)
• [L4] They are considered safe and clinically effective for the management of anterior shoulder instability with glenoid bone loss. (10.5435/jaaos-d-22-00837)
• [L5] Failure of primary shoulder stabilization procedures is often related to uncorrected anatomic pathology, and the instability severity index score permits precise identification of patients at risk. (10.1016/j.arthro.2010.11.057)
• [L2] The FEDS classification, particularly the frequency and etiology of the patient's shoulder instability, may be helpful in identifying patients with a higher likelihood of undergoing surgical treatment. (10.1016/j.jse.2016.07.054)
• [L2] The FEDS classification, particularly the frequency and etiology of the patient's shoulder instability, may be helpful in identifying patients with a higher likelihood of undergoing surgical treatment. (10.1177/2325967115607434)
• [L2] The FEDS classification, particularly the frequency and etiology of the patient's shoulder instability, may be helpful in identifying patients with a higher likelihood of undergoing surgical treatment. (10.1016/j.jse.2016.07.053)
• [L4] The thresholds defined in this study can provide a guideline for interpreting patient outcomes following arthroscopic stabilization for posterior shoulder instability, allowing for earlier detection of recurrent posterior instability. (10.1016/j.jseint.2025.08.006)
• [Commentary] With modern arthroscopic management, posterior shoulder instability represents a condition where reliable and lasting recovery may be achievable, supported by emerging data suggesting durable protection against recurrent instability and sustained athletic participation. (10.1016/j.arthro.2025.09.003)
• [L1] The early and midterm results of arthroscopic stabilization of the shoulder for posterior instability are promising. (10.1016/j.arthro.2014.11.009)
• [L4] With a follow-up of 97%, about one third of the stabilized shoulders experienced at least one redislocation after 8 to 10 years. (10.1177/0363546511415657)
• [Commentary] Management of shoulder instability should be based on clinical indication, and surgical stabilization should not be done prophylactically in the hope of increasing the number of future games played or enhancing performance. (10.1016/j.arthro.2021.01.053)
• [L3] At mid-term follow-up, patients with a history of anterior shoulder instability undergoing total shoulder arthroplasty can expect continued improvement in function compared with preoperative values. (10.1016/j.jse.2023.07.005)
• [Abstract] The natural history of the first time shoulder dislocations is bound up with arthropathy. (10.1016/j.jse.2007.02.100)
• [L3] This long-term follow-up study demonstrated that the open Latarjet procedure is a safe and reliable technique for recurrent anterior shoulder instability. (10.1007/s00402-020-03426-2)
• [L3] This long-term follow-up study demonstrated that the open Latarjet procedure is a safe and reliable technique for recurrent anterior shoulder instability. (10.1016/j.jse.2021.03.097)
• [L3] A history of multiple instability episodes prior to presentation was the greatest predictor of recurrent instability and failure of nonoperative treatment and progression to surgery. (10.1016/j.asmr.2023.03.014)
• [L3] Most patients younger than 40 years with shoulder instability who were initially treated nonoperatively for 6 months were definitively treated without surgery. (10.1016/j.arthro.2021.03.047)
• [L4] This review evaluates existing data on the presentation of shoulder instability in men and women to determine if there are differences in occurrence, treatment, or functional outcome following management. (10.2106/jbjs.rvw.19.00007)
• [L5] The consensus statement aims to improve diagnosis and treatment of shoulder instability through universal agreement on outcome measurement tools and tailored treatment based on pathology, patient age, activity demands, and surgeon skills. (10.1016/j.arthro.2009.06.022)
• [L4] The Latarjet procedure leads to anatomic and biomechanical changes in the shoulder. (10.1016/j.asmr.2023.100804)
• [L4] Traumatic shoulder instability in the older patient may result in a wide array of pathologic findings as well as a diversity of clinical presentations. (10.1177/2325967115584318)
• [L4] The observed changes in scapular kinematics are associated with an increased overall range of motion and suggest restored function of shoulder muscles. (10.1016/j.jse.2015.10.021)
• [L4] Scapular kinematics of patients with shoulder arthroplasty was influenced by implementation of external loads, but not by the type of load. (10.1016/j.clinbiomech.2012.04.009)
• [L5] The system categorizes instability based on frequency, aetiology, direction, and severity. (10.1136/bjsm.2009.071183)
• [Paper] Proper identification and treatment of osseous defects resulting in complex shoulder instability is critical in minimizing recurrence. (10.1016/j.csm.2013.07.002)
• [L2] Primary non-operative management is a prominent risk factor for recurrence of shoulder instability. (10.1136/bjsports-2016-096895)
• [L5] The purpose of this article is to review the current literature concerning shoulder anatomy/pathology related to shoulder stability/instability to improve clinical diagnosis and surgical treatment of our patients. (10.1016/j.arthro.2011.05.017)
• [L3] Minor shoulder instability is an intra-articular pathology presenting with extra-articular subacromial impingement symptoms. (10.1007/s00167-011-1552-7)
• [L5] The Delphi method is a structured communication technique used to allow a panel of experts to achieve a consensus in a systematic manner, resulting in an international consensus statement on shoulder instability covering diagnosis, nonoperative management, surgical options, rehabilitation, and clinical follow-up. (10.1016/j.arthro.2021.11.052)
• [L1] Shoulder instability cannot reliably be classified using the ICD-9 coding system. (10.1016/j.jse.2008.10.005)
• [L3] Microinstability is diagnostically challenging and can be diagnosed in young patients with ambiguous shoulder pain during motion, without instability. (10.1007/s00167-022-06941-4)
• [L4] To assess the effectiveness of an arthroscopic stabilization procedure for anterior shoulder instability using the Rowe score, a difference of at least 9.7 in the score is clinically relevant. (10.1016/j.jse.2017.10.032)
• [Paper] HAGL lesions are a rare and underdiagnosed cause of anterior shoulder instability that can lead to recurrent dislocations if unaddressed. (10.1016/j.eats.2020.10.053)
• [L4] Influential articles in shoulder instability included a high proportion of biomechanical/cadaveric studies. (10.1177/2325967121992577)
• [Paper] Treatment of posterior shoulder instability by capsulolabral reconstruction leads to good clinical outcomes; however the recurrence rate is high. (10.1016/j.otsr.2017.08.002)
• [L1] Surgical treatment of primary, traumatic, anterior shoulder instability results in reduced rates of recurrence compared with nonsurgical treatment at 10-year follow-up. (10.1016/j.arthro.2006.11.026)
• [L5] The success of treating anterior glenohumeral instability relies on multiple factors, including glenoid bone loss. (10.1016/j.arthro.2021.09.002)
• [Case_report] Integrating DDR into the clinical workflow allows dynamic noninvasive examination of shoulder kinematics and provides an inexpensive method to objectively quantify disease severity with low radiation dosage. (10.1016/j.jseint.2023.02.015)
• [L5] In the setting of shoulder instability without evidence of a labral tear, the capsulolabral advancement technique may be considered biomechanically superior. (10.1016/j.arthro.2012.04.140)
• [L1] Primary arthroscopic treatment of posterior shoulder instability is associated with favorable outcomes and high return to sport and work rates. (10.1016/j.asmr.2024.101032)
• [L3] Successful results were obtained in patients younger than 40 years with both primary and recurrent anterior shoulder instability after arthroscopic treatment. (10.1016/j.jse.2023.05.029)
• [L5] The ABC classification distinguishes three groups of posterior glenohumeral instability with two different subtypes based on the pathomechanical type of instability and the current standard of treatment. (10.1007/s11678-017-0404-6)
• [L5] The numerical model is suitable for the shoulder articular contact evaluation. (10.1016/j.otsr.2020.03.004)
• [L5] Shoulder Instability: Alternative Surgical Techniques represents a detailed resource that reviews classification of shoulder instability, pathoanatomy, the concept of glenoid track, and evaluation of bone loss and offers a description of various procedures designed to address bone loss and restore stability. (10.1016/j.arthro.2012.09.003)
• [L5] Successful treatment of anterior instability of the shoulder requires a balance between restoring joint stability and minimizing loss of glenohumeral motion. (10.1177/03635465030310011001)
• [L3] Arm kinematic analyses suggest that open surgery stabilizes the shoulder but does not necessarily restore normal movement quality. (10.1016/j.jse.2013.09.021)
• [L4] Adolescent multidirectional shoulder instability refractory to non-surgical management appears to have long-term outcomes after surgical intervention that are comparable to adolescent patients with unidirectional instability. (10.1177/2325967121s00021)
• [L5] Time-zero biomechanical shoulder instability studies are valuable but limited because they do not replicate clinical dynamics, and the observed results do not confirm that the surgical approach would provide sufficient long-term noncontractile shoulder stability to withstand repetitive soft-tissue loading in a dynamic, clinical situation. (10.1016/j.arthro.2022.04.006)
• [L5] The shoulder depends on dynamic and static stabilizers because it has little inherent stability, making it prone to instability. (10.1016/j.ocl.2019.11.008)
• [L3] While more advanced measurement techniques that take glenoid concavity into account are more accurate in determining the biomechanical relevance of glenoid bone loss, the reliability of manually performed, more complex measurements was moderate. (10.1177/23259671231222938)
• [L5] This review guides the reader to correctly identify posterior shoulder instability (PSI) by providing diagnostic criteria and treatment strategies based on the ABC classification, which distinguishes three groups of PSI based on the nature of pathology and two subtypes based on pathomechanical causes. (10.1530/eor-24-0025)
• [L5] An expanded assessment framework is useful to estimate the contribution of each component of non-traumatic shoulder instability and offer a framework for targeted rehabilitation, though the validity of testing specific subgroups remains to be established. (10.1177/1758573214548934)
• [L5] A more inferior graft position (fixed at 4-6 o'clock) may improve shoulder biomechanics, but additional work is needed to establish clinical relevance. (10.1177/23259671231202533)
• [L5] Current glenoid bone loss measurements are unable to provide an adequate estimation on the actual biomechanical effect of glenoid defects because the relation between the glenoid defect size and its biomechanical effect is nonlinear and patients with shoulder instability have constitutional biomechanically relevant glenoid concavity shape differences. (10.1177/0363546518819102)
• [L4] The outcomes at 3 years' follow-up were satisfactory in 80% of patients and 86% had stable shoulders. (10.1016/j.otsr.2019.12.009)
• [L3] Nonoperative treatment of shoulder instability has substantial societal costs. (10.1177/1758573218773543)
• [L4] The Latarjet procedure for anterior shoulder instability results in an overall complication rate of 16.1% and a reoperation rate of 2.6%, though serious complications at short-term follow-up appear rare. (10.1177/03635465211042314)
• [L5] Current glenoid defect extent measurements are precise but not accurate because they do not account for the 3-dimensional shape of the glenoid concavity or the native glenoid shape, which are critical for expressing the loss of biomechanical stability. (10.1016/j.arthro.2020.05.006)
• [L1] Most patients undergoing shoulder stabilization procedures regained fundamental strength and range of motion. (10.1016/j.asmr.2024.100978)
• [L5] Shoulder instability results from an imbalance between static and dynamic stabilizers, and a thorough understanding of normal anatomy and anatomic variations is critical to differentiate them from pathologic findings. (10.1177/03635465000280062501)
• [L4] Recent studies continue to demonstrate a role for nonoperative treatment in the successful long-term management of anterior glenohumeral instability. (10.1007/s12178-017-9432-5)
• [L5] The study group achieved strong or unanimous consensus on 63% of statements related to the diagnosis, nonoperative treatment, and labrum repair for posterior shoulder instability. (10.1016/j.arthro.2024.04.035)
• [L5] This case demonstrates a clear indication for the usefulness of diagnostic and therapeutic arthroscopy in the situation of soft tissue instability complicating a previously successful total shoulder arthroplasty. (10.1007/s11420-013-9373-5)
• [L4] This combination has long-term outcomes in terms of the recurrence rate and does not significantly influence the range of motion of the shoulder. (10.1007/s00167-018-5261-3)
• [L4] NHL team physicians strongly favor nonoperative management in-season for initial posterior instability events of the shoulder. (10.1177/23259671261440208)
• [L1] Despite the wide array of available PROMs for assessing shoulder instability surgery outcomes, the availability of clinically significant outcome thresholds such as MCID and PASS remains relatively limited. (10.1016/j.arthro.2024.07.039)
• [L4] Arthroscopic capsulolabral repair for posterior shoulder instability was a durable treatment option that improved long-term shoulder pain and function and facilitated return to sport in the majority of patients at a mean follow-up of 15.4 years, although a notable proportion of patients met various criteria for failure. (10.1177/03635465231162271)
• [L2] RCTs reporting on shoulder instability surgery are well performed but poorly reported. (10.1177/1758573218754370)
• [L5] Magnetic resonance arthrography is regarded as the gold-standard imaging modality for shoulder instability. (10.1016/j.mric.2019.12.005)
• [L3] Despite the advantages of MRI in the detection of soft tissue damages in recurrent anterior shoulder instability CT imaging proved to be more important for glenoid defects. (10.1007/s00402-012-1656-7)
• [Paper] Advanced imaging modalities are essential for identifying associated lesions, and bony reconstruction procedures should be considered for patients with significant glenoid bone loss or recurrent instability after soft tissue reconstruction. (10.1016/j.csm.2014.06.006)
• [L3] In a US geographic population of patients younger than 40 years with anterior shoulder instability, approximately one-fourth of patients developed symptomatic osteoarthritis at a mean follow-up of 15 years from their first instability event. (10.1177/2325967120962515)
• [L5] Substantial variability was observed in the scoring of important elements in the radiological report for the evaluation of anterior shoulder instability, regardless of modality. (10.1016/j.jseint.2024.03.012)
• [L5] MR-arthrography is identified as the main tool in diagnosing shoulder instability injuries. (10.21037/qims.2017.08.05)
• [L4] Radiography can be used for screening patients for significant glenoid bone loss. (10.1186/s12891-015-0607-1)
• [L3] The superior-capsular elongation as well as its diagnostic criteria of measurements by MR arthrography revealed in the present study could serve as references for diagnosing atraumatic posteroinferior shoulder instability and offer insight into the spectrum of imaging findings corresponding to the pathologies encountered at clinical presentation. (10.3109/02841850903524421)
• [L3] Radiographic progression of glenohumeral arthritis occurred in 14% of patients with posterior shoulder instability. (10.1177/2325967118s00154)
• [L3] ZTE MRI demonstrated high reproducibility for the evaluation of glenoid bone defect in shoulders with anterior instability. (10.1016/j.jseint.2024.03.003)
• [L4] Additionally, MRI is a valid imaging tool to diagnose and measure osseous lesions of the shoulder. (10.1007/s00247-018-4318-2)
• [L4] Arthrotomography of the glenoid labrum is a helpful adjunct in substantiating the diagnosis of shoulder instability and in planning the choice of surgical reconstruction. (10.2106/00004623-198264040-00005)
• [Commentary] The authors conclude that while CT and MRI measurements of bone loss differ statistically, the differences are clinically imperceptible when using the circle technique, and they recommend continuing to use the circle technique for determining individual patient treatment for recurrent shoulder instability. (10.1016/j.arthro.2019.10.001)
• [L4] The number of episodes of dislocation before surgery and the delayed surgical intervention did not increase the recurrent anterior shoulder instability rates postoperatively. (10.1016/j.jseint.2022.12.003)
• [L3] In our cohort of young patients undergoing arthroscopic surgery for posterior shoulder instability, we detected no significant difference in reoperation rate and recurrence of symptoms between athletes who underwent objective return to sport testing and those who were released to sport on a time-based protocol. (10.1177/2325967121s00549)
• [L3] In our cohort of young patients undergoing arthroscopic surgery for posterior shoulder instability, we detected no significant difference in reoperation rate and recurrence of symptoms between athletes who underwent objective return to sport testing and those who were released to sport on a time‐based protocol. (10.1177/2325967121s00593)

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