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Shoulder Clicking, Popping and Instability

Why a shoulder clicks, pops or feels like it slips — from harmless noises to labral tears and instability — what it means, and when it needs attention.

38 citationsUpdated Sep 2026

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Shoulder instability encompasses a spectrum of pathologies ranging from traumatic anterior dislocations to multidirectional and posterior subluxations, each requiring distinct surgical strategies. For anterior instability with bone loss, arthroscopic congruent-arc distal tibial allograft bone augmentation with cerclage fixation creates a bony 'ramp' to prevent anterior translation [5], while subscapularis and capsule augmentation offers a safe technique for cases associated with capsule-labral deficits [4]. In patients with multidirectional instability and Ehlers-Danlos Syndrome, open capsular shift with Achilles allograft augmentation has demonstrated low rates of recurrent instability and improved clinical outcomes [1]. The clinical presentation of multidirectional instability may include unique anatomic characteristics such as a hypoplastic labrum and the absence of a labral tear [26].

A thorough clinical examination remains the most critical factor in determining surgical indications, as outcomes for posterior instability surgery showed no difference between patients with normal versus pathological magnetic resonance arthrogram studies [6]. Age, labral lesion type, and lesion location are key risk factors for recurrence following arthroscopic labrum repair in anterior instability at a minimum 10-year follow-up [21]. Recurrent anterior dislocation can be accompanied by a posterior humeral avulsion of glenohumeral ligament lesion, with a prevalence of approximately 6.2% [14]. Furthermore, a risk prediction model may assist surgeons in identifying patients at high risk for rotator cuff tears following acute anterior shoulder dislocation [25].

Contemporary studies show comparable instability and functional outcomes between arthroscopic and open Bankart repair for anterior shoulder instability, whereas historical differences were driven primarily by earlier studies [8]. Similar return-to-play rates are observed with either open or arthroscopic anterior shoulder stabilisation in contact and collision athletes [11]. However, rates of recurrent anterior instability were high following isolated arthroscopic Bankart repair for on-track Hill-Sachs lesions with <20% glenoid bone loss, associated with inferior patient-reported outcomes at mean 10-year follow-up [10]. Modified dynamic anterior stabilization and labroplasty is a good option for anterior instabilities with bone loss <15% with concomitant SLAP lesions or severe capsulolabral deficiency or hyperlaxity [22].

Background & Causes

Pathomechanics and Injury Patterns

Injuries in the throwing shoulder are often secondary to the accumulation of repetitive microtrauma, which causes attrition and gradual failure [34]. The injury cascade in the throwing shoulder tends to form a continuum of pathology and pathomechanics [34]. Injury to the thrower’s shoulder joint occurs most commonly in the late cocking or early acceleration phases [34]. A combination of abnormal scapulothoracic and glenohumeral motion can injure the superior and posterosuperior labrum as well as the undersurface of the rotator cuff and posterior capsule [34]. Typical sites of pathoanatomy in the throwing shoulder include the superior and posterosuperior labrum, the articular surface of the supraspinatus and infraspinatus, and the posterior capsule [34]. Instability and internal impingement in throwers are syndromes of collective common pathologies occurring in the static and dynamic stabilizing elements of the shoulders that ultimately lead to pain during throwing [34].

Other specific injury patterns include a posterior glenohumeral dislocation, which can occur in association with a posterior acromion fracture [9]. Bilateral posterior shoulder dislocations with reverse Hill-Sachs lesions are uncommon and prone to misdiagnosis [13]. Recurrent anterior shoulder dislocation can be accompanied by a posterior humeral avulsion of the glenohumeral ligament (PHAGL) lesion, with a prevalence rate of approximately 6.2% [14]. Delayed inferior shoulder subluxation can occur secondary to incidental traumatic plexitis following arthroscopic rotator cuff repair [31]. Multidirectional instability can present with a hypoplastic or diminutive labrum and the absence of a labral tear [26].

Risk Factors and Anatomical Determinants

Bony lesions, including glenoid bone loss and Hill-Sachs lesions, play a significant role in shaping surgical treatment decisions for first-time anterior shoulder dislocation [17]. Coracoid morphology differs significantly in patients undergoing posterior shoulder stabilization compared to patients undergoing surgery for anterior instability or a comparison cohort [12]. Labral morphology does not compensate for reduced bony glenoid concavity in clinically stable shoulders [27].

Predictive tools and outcomes data inform risk stratification. The Instability Severity Index Score and the Hill-Sachs interval-to-glenoid track ratio composite score showed good predictive performance for recurrence after arthroscopic Bankart repair in patients with <20% glenoid bone loss [20]. Rates of recurrent anterior shoulder instability were high following isolated arthroscopic Bankart repair for on-track Hill-Sachs lesions with <20% glenoid bone loss and were associated with inferior patient-reported outcomes at mean 10-year follow-up [10]. A risk prediction model for rotator cuff tears following acute anterior shoulder dislocation may assist orthopedic surgeons in identifying patients at high risk for rotator cuff tears [25].

Clinical Assessment

A thorough clinical exam is the most important factor when determining indication for shoulder instability surgery, regardless of whether the radiologist-reported magnetic resonance arthrogram is normal or pathological [6]. The resisted anterior drawer test is a simple, non-invasive tool that could aid in the early detection of instability and guide management strategies in patients with lateral epicondylitis [18].

Symptoms & Presentation

Clinical Examination & Diagnostic Assessment

A thorough clinical exam is the most important factor when determining indication for shoulder instability surgery [6]. In patients presenting with lateral epicondylitis, the resisted anterior drawer test serves as a simple, non-invasive tool that can aid in the early detection of instability [18].

Injury Patterns & Complications

Posterior glenohumeral dislocation can occur in association with a posterior acromion fracture [9]. In pediatric patients, a Salter-Harris type III physeal fracture in the anterior inferior glenoid is a documented injury pattern [41].

Risk Factors & Predictors

The Instability Severity Index Score and the Hill-Sachs interval-to-glenoid track ratio composite score show good predictive performance for recurrence after arthroscopic Bankart repair in patients with <20% glenoid bone loss [20]. Patients with high levels of kinesiophobia demonstrate poorer shoulder function, reduced shoulder-related quality of life, and lower rates of return to high-level sport following arthroscopic Bankart repair, despite achieving surgical stability [29].

Management

Non-Operative Management

All patients with multidirectional instability (MDI) must undergo extensive physical therapy for 6 to 9 months before surgical consideration [32]. This regimen focuses on rotator cuff strengthening, scapular kinematics, and proprioceptive training [32]. Nonsurgical treatment is the mandatory first line for posterior shoulder instability [36]. Following a single traumatic posterior injury, the arm requires immobilization in neutral rotation with the elbow in adduction for 1 to 2 weeks, followed by therapy [36]. Kinesio taping serves as an adjunctive measure with a clear augmentative effect on postoperative rehabilitation in military personnel with recurrent shoulder dislocation [19]. Psychological factors significantly impact recovery; patients with high levels of kinesiophobia demonstrate poorer shoulder function, reduced shoulder-related quality of life, and lower rates of return to high-level sport following arthroscopic Bankart repair, despite achieving surgical stability [29].

Surgical Indications and Contraindications

Surgery for MDI is appropriate for patients with pain and instability interfering with normal or sport-related activity who have failed extensive nonsurgical treatment [32]. Approximately 20% of MDI patients fail nonsurgical management [32]. Surgery is contraindicated for voluntary dislocators and patients who have not attempted physical therapy [32]. Similarly, surgical intervention for posterior shoulder instability is indicated for symptoms interfering with activities or athletics and for failure of nonsurgical management [36]. Voluntary dislocators are contraindicated for posterior instability surgery [36].

Anterior Instability Procedures

Arthroscopic and open Bankart repair techniques yield comparable instability and functional outcomes in contemporary studies [8]. Return-to-play rates are similar for open or arthroscopic anterior shoulder stabilization in contact and collision athletes [11]. However, isolated arthroscopic Bankart repair for on-track Hill-Sachs lesions with <20% glenoid bone loss is associated with high rates of recurrent anterior shoulder instability and inferior patient-reported outcomes at mean 10-year follow-up [10]. For significant bone loss, arthroscopic distal tibial allograft bone block glenoid reconstruction using 2 pairs of suture buttons yields improved clinical and acceptable radiological outcomes [28]. Open fresh and arthroscopic frozen distal tibial allograft for anatomic glenoid reconstruction results in a clinically stable joint with comparable outcomes and excellent healing rates [23]. Arthroscopic free bone block double end-button fixation with iliac crest autograft resulted in no recurrent instability, even in overhead athletes performing handstands [7]. The Bristow technique provides very good stability and allows return to preinjury activity levels with full shoulder range of motion at 2.5 years follow-up, serving as a viable alternative to the Latarjet procedure when the coracoid fragment is small [30]. Arthroscopic Bankart repair with arthroscopic bone augmentation of the anterior glenoid wall and concomitant remplissage resulted in a favorable outcome for a young patient with extensive sporting activity and severe bipolar bone loss [24]. Arthroscopic repair of PHAGL lesions in recurrent anterior shoulder dislocations yields clinical outcomes consistent with the reported prevalence and management of this associated pathology [14].

Posterior Instability Procedures

The modified Kouvalchouk procedure provides good results in stabilizing recurrent posterior unstable shoulders in traumatic cases and patients without previous surgery, offering the advantage of local bone block harvesting and a potential sling effect [16]. Bilateral posterior shoulder dislocations with reverse Hill-Sachs lesions are uncommon and prone to misdiagnosis; early recognition and tailored treatment strategies are essential for satisfactory functional outcomes [13]. Two cases document an unusual injury pattern where posterior glenohumeral dislocation occurs in association with a posterior acromion fracture [9]. Recurrence is the most common complication of posterior shoulder instability surgery, reported at 8.5% in the general population [36]. Recurrence rates are highest in overhead athletes and increase with posterior glenoid bone loss >20%, which should be considered a contraindication to arthroscopic soft-tissue stabilization alone [36]. Overtightening of the posterior capsule can lead to anterior subluxation or coracoid impingement [36]. Shoulder stiffness or adhesive capsulitis is a concern with rotator interval plication during posterior instability surgery [36]. In arthroscopic labral repair for posterior instability, a high lateral portal provides better access than a standard posterior portal [36].

Multidirectional Instability Procedures

Open capsular shift with Achilles allograft augmentation demonstrated low rates of recurrent instability and improved clinical outcomes in patients with multidirectional shoulder instability, including those with Ehlers-Danlos Syndrome [1]. Arthroscopic pancapsular plication ± rotator interval closure is a surgical technique for MDI, with anterior or posterior labral repair indicated if labral pathology is encountered [32]. To avoid asymmetric tightening in MDI surgery, capsulorrhaphy should address the inferior redundancy in a balanced fashion [32]. Open anterior-inferior capsular shift is a surgical technique for MDI [32]. Recurrence of MDI is 7% for both open and arthroscopic techniques [32]. Axillary nerve injury, stiffness (rare), and subscapularis insufficiency (after open procedure) are complications of MDI surgery [32].

End-Stage and Alternative Procedures

Total shoulder arthroplasty (TSA) and glenohumeral arthrodesis (GHA) are viable options in treating end-stage recurrent shoulder instability [15]. Glenoid augmentation with the long head biceps (GALIN) aims to recreate a passive stabilizing labral 'bumper' while preserving range of motion [39].

Rehabilitation and Return to Sport

Postoperatively for posterior instability, the shoulder should be placed in a rigid immobilizer with the arm abducted to 30° in neutral rotation [36]. Following a short period of immobilization for posterior instability, range of motion exercises may begin, and strengthening should begin at 12 weeks [36]. Patients may return to heavy labor or contact sports 6 months after posterior instability surgery [36]. The pooled published rate of return to any sport following posterior instability surgery is 91% [36]. The pooled published rate of return to preinjury level of sport following posterior instability surgery is 67% [36].

Assessment and Outcomes

The Western Ontario Shoulder Instability Index (WOSI) is a disease-specific quality of life measurement tool designed to be used as the primary outcome measure in clinical trials evaluating treatments for patients with shoulder instability [38]. The WOSI consists of 21 items across four domains: physical symptoms (10 items), sports/recreation/work (4 items), lifestyle (4 items), and emotions (3 items) [38]. The best possible WOSI score is 0, signifying no decrease in shoulder-related quality of life, and the worst possible score is 2100, signifying an extreme decrease in shoulder-related quality of life [38].

Key Considerations

Diagnostic and Risk Stratification

The Pittsburgh Instability Tool (PIT) Score predicts outcomes following arthroscopic anterior shoulder stabilization in patients with subcritical bone loss [42]. Further validation in larger, prospective cohorts with longer follow-up is warranted to refine the tool's clinical utility and predictive accuracy [42].

Operative Management

Contemporary studies show comparable instability and functional outcomes between arthroscopic and open Bankart repair for anterior shoulder instability, whereas historical differences were driven primarily by earlier studies [8]. Arthroscopic Bankart repair with arthroscopic bone augmentation of the anterior glenoid wall and concomitant remplissage resulted in a favorable outcome for a young patient with severe bipolar bone loss and extensive sporting activity [24]. Total shoulder arthroplasty and glenohumeral arthrodesis are viable options in treating end-stage recurrent shoulder instability [15].

Outcomes and Complications

Similar return-to-play rates are seen with either open or arthroscopic anterior shoulder stabilization in the contact and collision athlete [11]. Traumatic posterior shoulder dislocation can occur in association with a posterior acromion fracture, as documented in two cases [9].

Key Evidence

  • [L4] The study demonstrated low rates of recurrent instability and improved clinical outcomes in this high-risk population. [1] (10.1016/j.jse.2026.05.024)
  • [L4] NHL team physicians strongly favor nonoperative management in-season for initial posterior instability events of the shoulder. [2] (10.1177/23259671261440208)
  • [L4] Spin is highly prevalent in abstracts of systematic reviews and meta-analyses investigating FBB for glenohumeral instability. [3] (10.1177/03635465251338079)
  • [Paper] The subscapularis and capsule augmentation is a safe and relatively easy technique for the treatment of shoulder instability. [4] (10.1016/j.eats.2024.103313)
  • [L5] The technique aims to address anterior shoulder instability with bone loss by creating a bony 'ramp' that prevents anterior translation. [5] (10.1016/j.eats.2024.103344)
  • [L3] A thorough clinical exam is the most important factor when determining indication for shoulder instability surgery. [6] (10.1016/j.xrrt.2026.100675)
  • [L4] No recurrent instability was observed, even in overhead athletes performing handstands. [7] (10.1177/2325967126s00516)
  • [L4] Publication period subgroup analysis suggests that historical instability differences were driven primarily by earlier studies, whereas contemporary studies show comparable instability and functional outcomes between approaches. [8] (10.1177/03635465261443999)
  • [L4] Two cases document an unusual injury pattern in which a posterior glenohumeral dislocation occurred in association with a (posterior) acromion fracture. [9] (10.1016/j.xrrt.2025.09.006)
  • [L3] Rates of recurrent anterior shoulder instability were high following isolated ABR for on-track HSLs with <20% glenoid bone loss and were associated with inferior PROs at mean 10-year follow-up. [10] (10.1177/23259671261430742)
  • [L2] However, similar return‐to‐play rates are seen with either approach. [11] (10.1002/ksa.70263)
  • [L3] Coracoid morphology differs significantly in patients undergoing posterior shoulder stabilization when compared to patients undergoing surgery for anterior instability or a comparison cohort. [12] (10.1177/03635465261421534)
  • [L4] Bilateral posterior shoulder dislocations with reverse Hill-Sachs lesions are uncommon and prone to misdiagnosis; early recognition and tailored treatment strategies are essential for satisfactory functional outcomes. [13] (10.1186/s12891-026-09537-y)
  • [L4] Recurrent anterior shoulder dislocation can be accompanied by a PHAGL lesion, with a prevalence rate of approximately 6.2%. [14] (10.1016/j.jse.2025.04.020)
  • [L2] TSA and GHA are viable options in treating end-stage recurrent shoulder instability. [15] (10.1016/j.jseint.2025.101429)
  • [L4] The modified Kouvalchouk procedure provides good results in the stabilization of recurrent posterior unstable shoulders in traumatic cases and patients without previous surgery, with the advantage of local harvesting of a bone block and a potential sling effect. [16] (10.1016/j.jseint.2026.101681)
  • [L5] Our findings highlight the significant role of bony lesions, including glenoid bone loss and Hill-Sachs lesions, in shaping surgical treatment decisions. [17] (10.1016/j.jse.2025.07.018)
  • [L3] This simple, non-invasive test could be a valuable tool in the clinical evaluation of lateral epicondylitis, aiding in the early detection of instability and guiding more effective management strategies. [18] (10.1016/j.jseint.2025.101564)
  • [L4] This suggests kinesio taping has a clear augmentative effect as an adjunctive measure for postoperative rehabilitation in military personnel with recurrent shoulder dislocation. [19] (10.1186/s12891-026-09753-6)
  • [L3] The Instability Severity Index Score and the Hill-Sachs interval-to-glenoid track ratio composite score showed good predictive performance for recurrence after ABR. [20] (10.1002/arj.70009)
  • [L4] Age, labral lesion type, and lesion location are key risk factors for recurrence following arthroscopic labrum repair in patients with anterior shoulder instability at a minimum 10-year follow-up. [21] (10.1016/j.jse.2025.03.034)
  • [L5] It is a good option for anterior instabilities with bone loss <15% with concomitant SLAP lesions or severe capsulolabral deficiency or hyperlaxity. [22] (10.1016/j.eats.2023.07.041)
  • [L4] Open fresh and arthroscopic frozen DTA for anatomic glenoid reconstruction in patients with recurrent anterior shoulder instability resulted in a clinically stable joint with comparable outcomes and excellent healing rates. [23] (10.1177/03635465251399165)
  • [Case_report] This case report demonstrates the efficacy of an arthroscopic Bankart with an arthroscopic bone augmentation of the anterior glenoid wall, in conjunction with an additional remplissage procedure, resulting in a favorable outcome for a young patient with extensive sporting activity. [24] (10.1016/j.xrrt.2025.100606)
  • [L3] The findings may assist orthopedic surgeons in identifying patients at high risk for RCT after shoulder dislocation. [25] (10.1186/s12891-026-09550-1)
  • [Paper] MDI can present with unique anatomic characteristics, notably a hypoplastic or diminutive labrum and the absence of a labral tear. [26] (10.1016/j.eats.2025.103784)
  • [L4] This study demonstrates that labral morphology does not compensate for reduced bony glenoid concavity in clinically stable shoulders. [27] (10.1016/j.jseint.2025.101422)
  • [L4] Arthroscopic DTA bone block glenoid reconstruction using 2 pairs of suture buttons to treat recurrent traumatic anterior instability with significant bone loss yields improved clinical and acceptable radiological outcomes. [28] (10.1002/arj.70008)
  • [L3] Patients with high levels of kinesiophobia demonstrated poorer shoulder function, reduced shoulder-related quality of life, and lower rates of return to high-level sport, despite achieving surgical stability. [29] (10.1186/s12891-026-09567-6)
  • [Case_report] The Bristow technique provided very good stability and allowed the patient to return to preinjury activity levels with full shoulder ROM at 2.5 years follow-up, serving as a viable alternative to the Latarjet procedure when the coracoid fragment is small. [30] (10.1016/j.xrrt.2025.100607)
  • [L4] The case suggests that delayed inferior shoulder subluxation can occur secondary to incidental traumatic plexitis following arthroscopic rotator cuff repair, with functional status reflecting the expected timeline of neurological reinnervation following C5-C6 plexitis. [31] (10.1016/j.xrrt.2026.100754)
  • [L5] It aims to recreate a passive stabilizing labral 'bumper' while preserving range of motion. [39] (10.1016/j.xrrt.2026.100777)
  • [Case_report] This report describes the first case of an SH type III physeal fracture in the anterior inferior glenoid of a 13-year-old boy, outlining successful treatment and management with demonstrated return to function following arthroscopic stabilization. [41] (10.1016/j.xrrt.2025.100596)
  • [L4] Further validation in larger, prospective cohorts with longer follow-up is warranted to refine the tool's clinical utility and predictive accuracy. [42] (10.1177/2325967126s00051)

References

[1] Open Capsular Shift with Achilles Allograft Augmentation for Multidirectional Shoulder Instability: Long-Term Outcomes and Implications for Patients with Ehlers-Danlos Syndrome. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.05.024

[2] Treatment of Posterior Shoulder Instability in National Hockey League Players: A Survey of NHL Team Physicians. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671261440208

[3] Appraisal of the Presence of Spin in Abstracts of Systematic Reviews and Meta-analyses Regarding Free Bone Block Procedures for Glenohumeral Instability. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465251338079

[4] Subscapularis Tendon Augmentation in Patients With Anterior Shoulder Instability Associated With Capsule‐Labral Deficit. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2024.103313

[5] Arthroscopic Congruent‐Arc Distal Tibial Allograft Bone Augmentation With Cerclage Fixation for Anterior Shoulder Instability With Bone Loss. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2024.103344

[6] No difference in outcomes for posterior shoulder instability surgery in patients with a normal vs. pathological radiologist reported magnetic resonance arthrogram study. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2026.100675

[7] Poster 220. Promising Bone Union Rates Following Arthroscopic Free Bone Block Double End-Button Fixation With Iliac Crest Autograft in Patients With Recurrent Shoulder Instability and Glenoid Bone Loss. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/2325967126s00516

[8] Arthroscopic vs Open Bankart Repair for Anterior Shoulder Instability: A Systematic Review and Meta-analysis. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465261443999

[9] Traumatic posterior shoulder dislocation with associated acromion fracture: a report of 2 cases. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2025.09.006

[10] Long-Term Outcomes following Instability After Isolated Arthroscopic Bankart Repair for On-Track Hill-Sachs Lesions With <20% Glenoid Bone Loss. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671261430742

[11] Return to play and recurrent instability rates in open versus arthroscopic anterior shoulder stabilisation in the contact and collision athlete: A systematic review. Knee Surgery, Sports Traumatology, Arthroscopy. 2026. DOI: 10.1002/ksa.70263

[12] Coracoid Morphology and the Risk of Posterior Shoulder Instability: A Magnetic Resonance Imaging Study. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465261421534

[13] Bilateral posterior shoulder dislocations with reverse Hill-Sachs lesions: a report of two cases and a literature review. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09537-y

[14] Clinical outcomes following arthroscopic repair of posterior humeral avulsion of glenohumeral ligament in recurrent anterior shoulder dislocations. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.04.020

[15] A comparison of reverse shoulder arthroplasty and glenohumeral arthrodesis for end-stage shoulder instability. JSES International. 2026. DOI: 10.1016/j.jseint.2025.101429

[16] Modified Kouvalchouk technique for recurrent posterior instability of the shoulder. JSES International. 2026. DOI: 10.1016/j.jseint.2026.101681

[17] Management of a first time anterior shoulder dislocation: the decision-making process of a surgeon. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.07.018

[18] The resisted anterior drawer test: a clinical tool for detecting subtle instability in patients with lateral epicondylitis. JSES International. 2026. DOI: 10.1016/j.jseint.2025.101564

[19] A retrospective analysis of the promoting effect of kinesio taping on the rehabilitation of military personnel with recurrent shoulder dislocation caused by training injury. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09753-6

[20] Combining Instability Severity Index Score and Hill‐Sachs Interval‐to‐Glenoid Track Ratio Predicts Recurrent Instability After Arthroscopic Bankart Repair in Patients With <20% Glenoid Bone Loss. Arthroscopy. 2026. DOI: 10.1002/arj.70009

[21] Age, labral lesion type, and lesion location are key risk factors for recurrence following arthroscopic labrum repair in patients with anterior shoulder instability: a minimum 10-year follow-up study. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.03.034

[22] Modified Dynamic Anterior Stabilization and Labroplasty for Anterior Shoulder Instability With Concomitant SLAP Lesion. Arthroscopy Techniques. 2023. DOI: 10.1016/j.eats.2023.07.041

[23] Surgical Stabilization for Recurrent Shoulder Instability Using Distal Tibial Allograft: Open Technique With Fresh Allograft Versus Arthroscopic Technique With Frozen Allograft, a Cohort Study. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465251399165

[24] Arthroscopic bone block using an autologous iliac crest graft and concomitant remplissage for severe bipolar bone loss in a young patient with anterior shoulder instability: a case report. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2025.100606

[25] Development and validation of a risk prediction model for rotator cuff tears following acute anterior shoulder dislocation. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09550-1

[26] Arthroscopic Labral‐Sparing Technique for Shoulder Capsulorrhaphy in Multidirectional Instability Patients. Arthroscopy Techniques. 2025. DOI: 10.1016/j.eats.2025.103784

[27] Labral morphology does not compensate for reduced bony glenoid concavity in stable shoulders. JSES International. 2026. DOI: 10.1016/j.jseint.2025.101422

[28] Arthroscopic Distal Tibial Allograft Reconstruction With Suture Button Fixation and Capsulolabral Repair for Traumatic Anterior Shoulder Instability Yields High Rates of Graft Union and Improves Clinical Outcomes at 2 Years. Arthroscopy. 2026. DOI: 10.1002/arj.70008

[29] The impact of kinesiophobia on rehabilitation and return to sport following arthroscopic Bankart repair for glenohumeral instability: a minimum 1-year follow-up. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09567-6

[30] Anterior shoulder dislocation with coracoid fracture treated with Bristow procedure: a case report and literature review. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2025.100607

[31] Recurrent inferior shoulder subluxation secondary to incidental traumatic plexitis following arthroscopic rotator cuff repair. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2026.100754

[32] Aaos Comprehensive Orthopaedic Review 3. The Unstable Shoulder > V. Multidirectional Instability.

[34] Rockwood And Matsen S The Shoulder. Arthroscopic Management of Prearthritic and Arthritic Conditions of the Shoulder and the Postarthroplasty Shoulder > THROWING SHOULDER CONDITIONS.

[36] Aaos Comprehensive Orthopaedic Review 3. The Unstable Shoulder > IV. Posterior Instability.

[38] Classifications And Scores Of The Shoulder. 19.15 The Western Ontario shoulder instability index (WOSI) [70]*.

[39] Glenoid Augmentation with the Long Head Biceps for Shoulder Instability (GALIN). JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2026.100777

[41] Salter-Harris type III fracture-dislocation of the glenoid: a case report. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2025.100596

[42] Validation of the Pittsburgh Instability Tool (PIT) Score: The PIT Score Predicts Outcomes Following Arthroscopic Anterior Shoulder Stabilization in Patients with Subcritical Bone Loss. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/2325967126s00051

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d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.