Shoulder Conditions: Traumatic Instability and Laxity

Shoulder instability involves increased translation of the humeral head in relation to the glenoid that results in symptoms. Anterior dislocation is the most common type of traumatic instability and typically involves younger male athletes. A comprehensive patient history should include the mechanism of injury, number and severity of episodes, neurovascular symptoms, and personal or family history of connective tissue disorders. Tests to assess instability on physical examination include the anterior apprehension and Jobe relocation tests, load and shift test, sulcus sign, and jerk test. X-rays are the initial imaging modality of choice, followed by 3 T magnetic resonance arthrogram. If concerns exist about significant bone loss, computed tomography scan with 3-dimensional reconstruction can be considered. Multidirectional instability often can be managed with physical therapy. Surgery should be considered if there is no improvement after 3 months. Patients with traumatic dislocations may pursue conservative treatment, but the risk of recurrence and difficulty in returning to the prior level of sport indicate that surgical intervention may be more beneficial, particularly for younger active patients. Patients with significant bone loss may benefit from bone block surgery, such as the Latarjet procedure.