Dynamic pediatric shoulder instability: Etiology, pathogenesis and treatment

Area of Science:

• Orthopedics
• Pediatric Sports Medicine
• Skeletal Biology

Background:

• Dynamic shoulder instability in skeletally immature patients is rare and challenging to diagnose.
• Unlike adults, atraumatic and recurrent forms are prevalent in children and adolescents with open glenohumeral growth plates.
• Contributing factors include disruptions in capsular and ligamentous maturation, muscle imbalances, and bone growth abnormalities.

Purpose of the Study:

• To outline the diagnostic approach for pediatric shoulder instability.
• To describe current treatment strategies, including conservative and surgical options.
• To highlight factors influencing treatment outcomes and long-term prognosis.

Main Methods:

• Multidisciplinary etiological assessment involving detailed medical history.
• Analysis of instability direction, voluntary vs. involuntary nature, and associated conditions (trauma, connective tissue disorders, psychological, neuromuscular, congenital).
• Review of conservative management principles and indications for surgical stabilization after failed rehabilitation.

Main Results:

• Conservative management is the initial treatment of choice.
• Multidisciplinary team involvement is crucial, especially for voluntary instability.
• Surgical treatment is indicated for symptomatic cases unresponsive to conservative care after 6 months of rehabilitation.
• Treatment success is contingent upon instability characteristics, damaged anatomy, and underlying etiology.

Conclusions:

• Recurrent shoulder instability in pediatric patients can resolve or progress to structural damage and osteoarthritis.
• Early identification of prognostic indicators and appropriate interventions are vital for mitigating long-term joint damage.
• Optimal management necessitates a comprehensive, individualized approach considering the unique aspects of pediatric glenohumeral instability.