Anterior Shoulder Instability

During the past several decades, the treatment of anterior shoulder instability has evolved substantially. Treatment initially was based on conservative management with rehabilitation protocols for shoulder girdle strengthening. Functionally disabling instability and recurrent dislocation precluded the acceptance of conservative management as the definitive treatment for all patients. Attention then was turned to open repair strategies. Despite generally positive results, a significant number of complications became evident. With time, however, techniques improved and surgical complications were lessened. As shoulder arthroscopy was more widely practiced, the surgical reconstruction of instability became significantly less invasive. A high learning curve has been associated with the new arthroscopic techniques, and higher redislocation rates than those of open procedures have limited their acceptance by many orthopaedic surgeons. This review article examines the anatomy and pathology of anterior shoulder dislocations, and critically reviews the actual laboratory and clinical data supporting use of these various treatment options. Only through careful examination of well-controlled scientific studies can clinicians devise their own treatment protocol for symptomatic anterior instability of the shoulder.