Posterior Shoulder Instability in Contact Athletes: Recognition, Evaluation, and Management

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Athletic Training

Background:

• Posterior shoulder instability is a common cause of pain and dysfunction in contact/collision athletes.
• It is frequently underrecognized, presenting as vague posterior shoulder pain and activity-related symptoms.
• Repetitive loading during sports can cause posterior capsulolabral complex pathology, from microinstability to recurrent instability.

Purpose of the Study:

• To review the diagnosis and management of posterior shoulder instability in athletes.
• To discuss factors influencing treatment selection, including osseous morphology.
• To outline criterion-based return-to-play protocols.

Main Methods:

• Review of current literature on posterior shoulder instability in athletes.
• Analysis of diagnostic challenges, including history, physical examination, and imaging.
• Evaluation of nonoperative and operative treatment strategies.
• Discussion of return-to-play criteria.

Main Results:

• Accurate diagnosis requires pattern recognition and clinical context.
• Nonoperative management is an initial strategy, but may be less predictable in high-demand sports.
• Operative treatment is considered for persistent symptoms, recurrent instability, or significant structural pathology.
• Osseous morphology can influence treatment decisions.
• Return-to-play should be criterion-based, focusing on function, strength, stability, and readiness.

Conclusions:

• An individualized approach to managing posterior shoulder instability in athletes is supported by current evidence.
• Further prospective studies are needed to refine risk stratification, treatment selection, and return-to-play decision-making.
• Emphasis on criterion-based return-to-play is crucial for athlete safety and optimal outcomes.