Clinicians › General-Health

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.

75 citationsUpdated Oct 2026

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

Overview

Shoulder instability encompasses a spectrum of conditions ranging from atraumatic multidirectional instability (MDI), characterized by symptomatic global laxity of the glenohumeral joint [91], to posttraumatic recurrent pain in professional athletes, which is generally caused by symptomatic glenohumeral instability [9]. In the majority of cases involving young overhead athletes, secondary impingement develops, typically affecting the intraarticular part of the rotator cuff [82]. The rotator cuff should be considered globally rather than individually when addressing the prevention of posterior instability [37]. Clinical presentation often includes clicking or popping; arthroscopic resection of the superomedial corner of the scapula is a useful technique for patients whose pain and clicking are clinically localized and who have failed conservative measures [8]. The concept of the glenoid track has been extended to posterior instability through the ‘reverse glenoid track’ concept, broadening its applicability across the spectrum of shoulder instability [89].

Diagnostic accuracy is high, with anterior labrum findings in MR arthrography and arthroscopy accorded in 20 shoulders (87%) [2]. However, reporting spin is highly prevalent in systematic reviews and meta-analyses addressing shoulder instability and is strongly associated with lower methodological quality [1]. This issue is also noted in abstracts investigating free bone block procedures for glenohumeral instability [35]. As knowledge of the basic science behind the pathophysiology of shoulder instability improves and more clinical reports emerge, the exact indications for arthroscopic stabilization are gradually being refined [12].

Headline outcomes indicate that surgical intervention generally improves symptoms and objective instability. In 8 / 9 shoulders (89%), both subjective symptoms and objective posterior instability were improved following surgical treatment for recurrent posterior glenohumeral instability [4]. 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 [3]. A prospective study of an initial series of 29 shoulders with a minimum of 26 months’ follow-up (mean, 36 months) showed 1 poor result because of the recurrence of instability, 1 fair result, 2 good, and 25 excellent results according to the Duplay scale [22]. While rates of recurrent instability in published reports are generally higher with arthroscopic stabilization, and other complications occur [16], complications are frequently technique-specific and can be prevented by familiarity with the common pitfalls inherent in each arthroscopic repair procedure [21]. Patients should be advised to monitor symptoms in the year post injury and seek a review if symptoms of pain, clicking, or clunking arise [20].

Background & Causes

Definitions and Classification

Posterior shoulder instability (PSI) is defined as a pathologic state characterized by dynamic, recurrent, and symptomatic partial or total loss of posterior joint contact [23]. This condition arises when pain and/or dysfunction occur due to the humeral head repeatedly translating posteriorly on the glenoid [26]. The trauma-instability-voluntarism classification serves as a useful framework for comparing pathogenesis and treatment results in patients with glenohumeral instability [38].

Etiology and Pathophysiology

The etiology of multidirectional instability appears multifactorial, with both biochemical and biomechanical abnormalities present in affected shoulders [10]. In cases of progressive muscular dystrophy, muscle weakness is considered a primary cause of shoulder instability [27]. For the throwing shoulder, injuries often result from the accumulation of repetitive microtrauma, leading to attrition and gradual failure [49]. Injury to the thrower’s shoulder joint occurs most commonly during the late cocking or early acceleration phases [49]. A combination of abnormal scapulothoracic and glenohumeral motion can injure the superior and posterosuperior labrum, the undersurface of the rotator cuff, and the posterior capsule [49]. Typical sites of pathoanatomy in the throwing shoulder include: * The superior and posterosuperior labrum [49] * The articular surface of the supraspinatus and infraspinatus [49] * The posterior capsule [49]

Obligate insufficiency of lateral stabilizers is required for rotatory instability to occur [50]. Conversely, no significant difference in muscle contraction latency was detected between stable and unstable shoulders, suggesting no significant defect in muscular reflex activity in anterior shoulder instability [46].

Structural and Bony Pathology

Postero-inferior shoulder instability is associated with capsular laxity and well-defined pathological lesions of the gleno-labral concavity [28]. A shallow Hill-Sachs lesion indicates a greater degree of anterior instability of the shoulder [87]. Focal cortical bone loss at the inferior aspect of the glenoid appears to be a radiographic sign of damage to the anterior capsular mechanism [30]. Glenohumeral bony morphology is associated with anterior shoulder instability, with differences present even in the contralateral unaffected shoulder [34]. In contrast, there are few predisposing osseous factors in traumatic anterior instability [88]. Alteration of scapular position and motion is common in association with symptoms and dysfunction from glenohumeral instability [13]. In posttraumatic anterior shoulder instability, the appearance of an additional lesion with each recurrence explains intraarticular disease [32]. Bony changes of the glenoid do not support prophylactic shoulder stabilization to avoid the development of arthritic changes of a generalized and major degree [29].

Clinical Presentation and Prevalence

In 87% of 20 shoulders, findings of the anterior labrum in MR arthrography and arthroscopy accorded [2]. In 89% of 9 shoulders, both subjective symptoms and objective posterior instability were improved following surgical treatment for recurrent posterior glenohumeral instability [4]. In most cases, posttraumatic recurrent shoulder pain was caused by symptomatic glenohumeral instability in professional athletes [9]. Approximately 20% of the general population shows unilaterally increased scaphoid mobility, and more than half of these are totally asymptomatic [7].

Symptoms & Presentation

Definitions and Clinical Presentation

Posttraumatic recurrent shoulder pain is most commonly caused by symptomatic glenohumeral instability [9]. Clinicians must also recognize that shoulder instability can serve as a presenting symptom and sign of syringomyelia [71].

Etiology and Risk Factors

In patients with progressive muscular dystrophy, muscle weakness is a primary cause of shoulder instability [27].

Diagnostic Findings and Imaging

Diagnostic accuracy for anterior shoulder instability is high; in 20 shoulders (87%), findings from MR arthrography and arthroscopy regarding the anterior labrum accorded [2]. Radiographic assessment may reveal focal cortical bone loss at the inferior aspect of the glenoid, which appears to be a new sign of damage to the anterior capsular mechanism [30]. Functional assessment via awake side-to-side comparison demonstrates slightly increased anterior translation on the affected side [36]. Cine MRI is useful for confirming the clinical evaluation of shoulder instability [79]. Regarding engagement mechanics, in 7 of 100 cases, no gap was shown between the Hill-Sachs lesion and the glenoid rim, indicating that engagement occurred in exactly the same arm position each time [70].

Associated Symptoms and Differential Diagnosis

When evaluating clicking symptoms, subluxation of the annular ligament should be considered in the differential diagnosis of the clicking elbow [77]. For patients with carpal instability following a fall onto an outstretched hand, clinicians should advise monitoring symptoms for one year post-injury and seeking review if pain, clicking, or clunking arises [20].

Management

Non-Operative Management

All patients with multidirectional instability (MDI) must undergo extensive physical therapy for 6 to 9 months before surgical treatment is considered [45]. This therapy focuses on rotator cuff strengthening, scapular kinematics, and proprioceptive training [45]. Prescribed shoulder-strengthening exercise is a useful treatment option for MDI [47]. The crux of treating the instability continuum is to halt instability before anatomic damage occurs through a specific and intense exercise program [61]. Nonsurgical treatment is always attempted first for posterior glenohumeral instability [52]. Following a single traumatic injury causing posterior instability, the arm is immobilized in neutral rotation with the elbow in adduction for 1 to 2 weeks, followed by therapy [52].

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 [45]. Approximately 20% of patients with MDI fail nonsurgical management [45]. Surgery for MDI is contraindicated for voluntary dislocators and patients who have not attempted physical therapy [45]. Surgical intervention for posterior instability is indicated for patients with symptoms interfering with activities or athletics and for failure of nonsurgical management [52]. Surgery for posterior instability is contraindicated for voluntary dislocators [52]. Surgery is considered for patients who fail conservative treatment with persistent or worsening symptoms of at least 6 months’ duration [48].

Anterior Instability Procedures

Arthroscopic repair for recurrent anterior shoulder instability in a series of 29 shoulders with a minimum of 26 months’ follow-up showed 25 excellent results, 2 good, 1 fair, and 1 poor result due to recurrence of instability [22]. The arthroscopic revision surgery for the single poor result had a successful outcome [22]. Bankart repair and anterior capsular shift as a combined procedure provides good long-term stability for shoulders with a high rate of recurrency that are not successful candidates for an arthroscopic procedure [33]. The Latarjet-Patte triple-locking procedure for recurrent anterior instability has a recurrence rate lower than that reported in previous series, potentially reflecting the beneficial effect of systemic capsular retensioning on a flap of coracoacromial ligament [39]. Open anterior capsular reconstruction of the shoulder for chronic instability using a tibialis anterior allograft is a feasible salvage procedure that can help avoid more invasive procedures such as fusion of the glenohumeral joint [56]. Subscapularis and capsule augmentation is a safe and relatively easy technique for the treatment of shoulder instability associated with capsule-labral deficit [57]. In the Caspari operation for anterior shoulder instability, 76% of patients could continue their sporting activities [58]. In a series of 18 patients undergoing repair of anterior-inferior shoulder instability, 11 (61%) maintained symmetric motion, while the others had minimal loss of external rotation compared with the contralateral shoulder [65]. Arthroscopic free bone block transfer technique using iliac crest autograft with anchor-button fixation attempts to reduce recurring instability and improve long-term outcomes for patients with glenohumeral instability accompanying glenoid bone loss [62]. Arthroscopic congruent-arc distal tibial allograft bone augmentation with cerclage fixation aims to address anterior shoulder instability with bone loss by creating a bony 'ramp' that prevents anterior translation [68]. Osteoarticular allograft reconstruction of a large glenoid and humeral head defect in recurrent shoulder instability resulted in the patient being asymptomatic and living an active lifestyle with a 10/10 satisfaction on the University of Pennsylvania Shoulder Score, though long-term follow-up may not be as favorable [24]. Treatment of instability impingement is usually difficult [54]. The approach to the treatment of shoulder instability should be based on a pathogenetic principle [25].

Posterior Instability Procedures

In 8 of 9 shoulders (89%) treated for recurrent posterior glenohumeral instability, both subjective symptoms and objective posterior instability were improved [4]. No progressive radiographic signs of glenohumeral arthritis were seen up to 22 years after open posterior stabilization for recurrent posterior glenohumeral instability [15]. No complication or recurrence of instability was noted in 11 patients treated with a 4-portal arthroscopic stabilization for posterior shoulder instability [18]. In the treatment of symptomatic posterior glenohumeral instability with an anterior capsular shift reconstruction, five shoulders were graded as excellent, three good, and one fair [40]. The goal of surgery for posterior instability is to repair the posterior capsulolabral structures and to re-tension the posterior capsule to prevent recurrent instability [52]. Soft-tissue procedures for posterior instability include open or arthroscopic labral repair and posterior capsular shift [52]. Some authors recommend plication of the rotator interval for posterior instability, though this is controversial [52]. Options for an engaging reverse Hill-Sachs lesion include structural bone graft to the humeral head, the McLaughlin or modified McLaughlin procedure, or resurfacing arthroplasty [52]. Options for posterior glenoid bone loss include distal tibial allograft or autograft reconstruction using the posterior acromion, iliac crest, or distal clavicle [52]. Recurrence is the most common complication of posterior instability surgery, reported at 8.5% in the general population [52]. Recurrence rates for posterior instability are highest in overhead athletes [52]. Recurrence rates for posterior instability increase with posterior glenoid bone loss >20%, which should be considered a contraindication to arthroscopic soft-tissue stabilization alone [52]. Shoulder stiffness or adhesive capsulitis is a concern with rotator interval plication for posterior instability [52]. Overtightening of the posterior capsule can lead to anterior subluxation or coracoid impingement [52]. In arthroscopic labral repair for posterior instability, a high lateral portal provides better access than a standard posterior portal [52].

Multidirectional Instability Procedures

Arthroscopic pancapsular plication with or without rotator interval closure is a surgical technique for MDI [45]. If labral pathology is encountered during MDI surgery, anterior or posterior labral repair is indicated [45]. To avoid asymmetric tightening in MDI surgery, capsulorrhaphy should address the inferior redundancy in a balanced fashion [45]. Open anterior-inferior capsular shift is a surgical technique for MDI [45]. Recurrence of MDI is 7% for both open and arthroscopic techniques [45]. Axillary nerve injury is a complication of MDI surgery [45]. Stiffness is a rare complication of MDI surgery [45]. Subscapularis insufficiency is a complication after open MDI procedures [45]. The study shows the long-term effectiveness of arthroscopic capsular shift in the treatment of multidirectional shoulder instability [63]. Open capsular shift with Achilles allograft augmentation for multidirectional shoulder instability demonstrated low rates of recurrent instability and improved clinical outcomes in patients with Ehlers-Danlos Syndrome [3]. Achilles allograft stabilization is currently the only treatment with any success rate for multidirectional glenohumeral instability in patients with Ehlers-Danlos syndrome [31].

Salvage and End-Stage Procedures

Shoulder arthrodesis eliminated recurrent instability and provided a relative decrease in pain and increase in function [14]. Total shoulder arthroplasty (TSA) and glenohumeral arthrodesis (GHA) are viable options in treating end-stage recurrent shoulder instability [69].

Rehabilitation and Outcomes

Postoperatively for posterior instability, the shoulder should be placed in a rigid immobilizer with the arm abducted to 30° in neutral rotation [52]. After a short period of immobilization for posterior instability, range of motion exercises may begin [52]. Strengthening for posterior instability should begin at 12 weeks [52]. Patients may return to heavy labor or contact sports 6 months after posterior instability surgery [52]. The pooled published rate of return to any sport after posterior instability surgery is 91% [52]. The pooled published rate of return to preinjury level of sport after posterior instability surgery is 67% [52].

Comparative Evidence and Complications

Recent randomized trials and systematic reviews have not shown the superiority of modern arthroscopic techniques compared with open repairs for shoulder instability [53]. Open repair resulted in a significantly lower risk of recurrence compared to arthroscopic repair in terms of patient quality of life [53]. Secondary outcome data suggest that open surgical repair may be recommended to reduce the risk of recurrent instability in younger male patients with a Hill-Sachs lesion [53]. Arthroscopic and open repair techniques for the treatment of recurrent traumatic shoulder instability yield comparable results if the procedure is selected on the basis of the pathologic findings at the time of surgery [53]. Available evidence indicates that arthroscopic approaches are not as effective as open approaches in preventing recurrent instability or enabling patients to return to work [53]. Misplaced suture anchors in arthroscopic instability repairs can give rise to secondary degenerative joint disease or "anchor arthropathy" [53]. Use of intra-articular infusion of local antibiotics via a pain pump after arthroscopic instability repairs results in a risk of glenohumeral chondrolysis [53]. The healing time for a labral reattachment is likely to be the same as the time to heal a subscapularis tenotomy, so the time to return to activity should not be different with arthroscopic versus open approaches [53]. The routine use of bone transfers for glenohumeral instability in the absence of major glenoid bone loss is not advisable due to increased risk of arthritis, screw-related problems, damage to the subscapularis, and difficulty in revision [53]. Complications are not uncommon when attempting to stabilize an anterior injury, and include recurrent instability, loss of motion, and pain [48].

Key Considerations

Diagnostic and Methodological Quality

Accurate diagnosis is critical for developing an appropriate treatment plan and explaining options and anticipated outcomes to the patient [55]. Diagnostic concordance is high, with both MR arthrography and arthroscopy findings for the anterior labrum of anterior shoulder instability accorded in 20 shoulders (87%) [2].

Posterior Instability

Posterior shoulder instability is defined by dynamic, recurrent and symptomatic partial or total loss of posterior joint contact [23].

Anterior Instability

Contemporary studies show comparable instability and functional outcomes between arthroscopic and open Bankart repair approaches, whereas historical differences were driven primarily by earlier studies [86]. Arthroscopic management of a failed instability repair provides similar success to open reconstruction if proper indications are selected [60].

Outcomes of Anterior Repair: * A prospective study of 29 shoulders with a minimum of 26 months’ follow-up (mean, 36 months) reported 25 excellent, 2 good, 1 fair, and 1 poor result according to the Duplay scale, with the poor result due to recurrence of instability [22]. * No patients experienced instability after an average follow-up of 26 months following repair of humeral and glenoid detachment of the anterior inferior glenohumeral ligament [17]. * The recurrence rate in the Latarjet-Patte Triple-locking Procedure study is lower than previously reported series, potentially reflecting the beneficial effect of systemic capsular retensioning on a flap of coracoacromial ligament [39]. * Bankart repair and anterior capsular shift as a combined procedure provides good long-term stability for shoulders with a high rate of recurrency that are not successful candidates for an arthroscopic procedure [33]. * The shoulder remained stable with no recurrent dislocations at a final follow-up of 24 months following anterior capsular reconstruction using a dermal allograft [76].

Multidirectional and Special Populations

Patients with Ehlers-Danlos syndrome undergoing open capsular shift with Achilles allograft augmentation for multidirectional shoulder instability demonstrate low rates of recurrent instability and improved clinical outcomes [3]. For arthroscopic treatment of bidirectional glenohumeral instability, 91% (49 of 54 patients) rated good to excellent according to the Rowe Scale at final follow-up, whereas no patients rated good to excellent preoperatively [74].

Salvage and Complications

Glenohumeral arthroplasty for arthritis after instability surgery yielded 13 (77%) satisfactory results and four (23%) unsatisfactory results at an average follow-up period of 3 years [81]. In a patient undergoing osteoarticular allograft reconstruction of a large glenoid and humeral head defect, results are short term and long-term follow-up may not be as favorable; however, the patient is currently asymptomatic and living an active lifestyle with a 10/10 satisfaction on the University of Pennsylvania Shoulder Score [24].

Key Evidence

• [Paper] Reporting spin is highly prevalent in systematic reviews and meta-analyses addressing shoulder instability and is strongly associated with lower methodological quality. [1] (10.1016/j.jse.2026.10.020)
• [L4] In another 20 shoulders (87%), both findings accorded. [2] (10.1016/s1058-2746(95)80288-6)
• [L4] The study demonstrated low rates of recurrent instability and improved clinical outcomes in this high-risk population. [3] (10.1016/j.jse.2026.05.024)
• [L4] In 8 / 9 shoulders (89%), both subjective symptoms and objective posterior instability were improved. [4] (10.1016/s1058-2746(96)80550-7)
• [L4] NHL team physicians strongly favor nonoperative management in-season for initial posterior instability events of the shoulder. [5] (10.1177/23259671261440208)
• [L3] We followed 573 cases of atraumatic shoulder instability for 3 years or more. [6] (10.1067/mse.2001.111962)
• [L4] Roughly one-third of these subjects had associated symptoms, and it is useful to know that approximately 20% of the general population shows unilaterally increased scaphoid mobility and that more than half of these are totally asymptomatic. [7] (10.1016/0266-7681(93)90199-p)
• [L4] Arthroscopic resection of the superomedial corner of the scapula is a useful technique in patients whose pain and clicking can be clinically localized and who have failed to respond to conservative measures. [8] (10.1016/s1058-2746(99)90056-3)
• [L4] In most cases posttraumatic recurrent shoulder pain caused by symptomatic glenohumeral instability. [9] (10.1016/s1058-2746(96)80239-4)
• [L5] The cause appears to be multifactorial, with biochemical and biomechanical abnormalities present in shoulders with MDI. [10] (10.1016/s1058-2746(10)80009-6)
• [Paper] As the knowledge of the basic science behind the pathophysiology of shoulder instability improves and as more clinical reports emerge, the exact indications for arthroscopic stabilization are gradually being refined. [12] (10.1016/s0278-5919(05)70294-5)
• [Paper] Alteration of scapular position and motion is common in association with symptoms and dysfunction from glenohumeral instability. [13] (10.1097/00132589-200309000-00001)
• [L4] Shoulder arthrodesis eliminated recurrent instability and provided a relative decrease in pain and increase in function. [14] (10.1016/s1058-2746(02)86883-5)
• [L4] No progressive radiographic signs of glenohumeral arthritis were seen up to 22 years after surgery. [15] (10.1016/j.jse.2004.06.008)
• [Paper] Rates of recurrent instability in published reports are generally higher with arthroscopic stabilization, and other complications occur. [16] (10.1016/s0278-5919(05)70182-4)
• [L4] None of the patients has had instability after an average follow-up of 26 months. [17] (10.1016/s1058-2746(97)90064-1)
• [L4] No complication or recurrence of instability was noted in the 11 patients. [18] (10.1016/s1058-2746(03)00039-9)
• [L4] The short-term outcome in this small series of arthroscopic revision surgery in shoulder instability is challenging and encouraging. [19] (10.1016/s1058-2746(96)80315-6)
• [L3] Patients should be advised to monitor symptoms in the year post injury and seek a review if symptoms of pain, clicking, or clunking arise. [20] (10.1177/1558944716660555jq)
• [L5] Complications are frequently technique-specific and can be prevented by familiarity with the common pitfalls inherent in each arthroscopic repair procedure. [21] (10.1016/s0278-5919(05)70183-6)
• [L3] The prospective study of an initial series of 29 shoulders with a minimum of 26 months’ follow-up (mean, 36 months) shows 1 poor result because of the recurrence of instability (arthroscopic revision has had a successful outcome), 1 fair result, 2 good, and 25 excellent results (according to the Duplay scale). [22] (10.1097/00132589-200112000-00002)
• [L5] Posterior shoulder instability (PSI) is defined by dynamic, recurrent and symptomatic partial or total loss of posterior joint contact. [23] (10.1016/j.otsr.2024.104061)
• [L5] The results in our patient are short term and that long-term follow-up may not be as favorable; however, the patient is currently asymptomatic and living an active lifestyle with a 10/10 satisfaction on the University of Pennsylvania Shoulder Score. [24] (10.1097/bte.0b013e318057fb1a)
• [L4] The results obtained in our patients testify that the approach to the treatment of the shoulder instability should be based on a pathogenetic principle. [25] (10.1016/s1058-2746(96)80199-6)
• [L5] Posterior shoulder instability is a pathologic state that arises when a patient has pain and/or dysfunction that occurs when the humeral head repeatedly translates posteriorly on the glenoid. [26] (10.1097/01.bte.0000171162.82430.5a)
• [L4] We feel weakness of muscle was one of the main causes of shoulder instability in these cases. [27] (10.1016/s1058-2746(96)80440-x)
• [L3] Postero-inferior shoulder instability is associated with capsular laxity and well defined pathological lesions of the gleno-labral concavity. [28] (10.1016/s1058-2746(98)90088-x)
• [L4] These findings do not support prophylactic shoulder stabilization to avoid the development of arthritic changes of a generalized and major degree. [29] (10.1016/s1058-2746(96)80056-5)
• [L4] This pattern of bone loss, although small and uncommon, appears to be a new radiographic sign of damage to the anterior capsular mechanism. [30] (10.1016/1058-2746(92)90092-h)
• [L4] Currently, it is the only treatment with any success rate for multidirectional glenohumeral instability in patients with Ehlers-Danlos syndrome. [31] (10.1097/bte.0b013e31816938da)
• [L3] By delineating the appearance of an additional lesion with each recurrence, we hope to have created an explanation of intraarticular disease in posttraumatic anteroinferior shoulder instability. [32] (10.1016/s1058-2746(99)90058-7)
• [L4] This combined procedure provides good long term stability for shoulders with high rate of recurrency and which seem to be not a successful case for an arthroscopic procedure. [33] (10.1016/s1058-2746(95)80098-0)
• [L4] These findings suggest that glenohumeral bony morphology is associated with anterior shoulder instability, with differences present even in the contralateral unaffected shoulder. [34] (10.1016/j.jse.2026.09.013)
• [L4] Spin is highly prevalent in abstracts of systematic reviews and meta-analyses investigating FBB for glenohumeral instability. [35] (10.1177/03635465251338079)
• [L4] Awake side-to-side comparison of patients with anterior shoulder instability demonstrated slightly increased anterior translation on the affected side. [36] (10.1016/s1058-2746(99)90153-2)
• [L5] The rotator cuff should be considered globally and not individually in preventing posterior instability of the shoulder. [37] (10.1016/s1058-2746(95)80169-3)
• [L4] This classification is very useful to compare pathogenesis and results of treatment in patients with glenohumeral instability. [38] (10.1016/s1058-2746(05)80051-5)
• [L4] The recurrence rate reported in this study is lower than that reported in previously series and may reflect the beneficial effect of systemic capsular retensioning on a flap of coracoacromial ligament. [39] (10.1097/bte.0b013e3182961957)
• [L4] Five shoulders were graded as excellent, three good, and one fair. [40] (10.1016/s1058-2746(96)80372-7)
• [L4] There is a high prevalence of osteoarthritis in patients with shoulder instability who have been operated on with a staple capsulorrhaphy. [41] (10.1016/s1058-2746(96)80203-5)
• [L5] As of the most recent follow-up, which occurred 2 years after surgery, there have been no further episodes of dislocation. [44] (10.1016/s1058-2746(99)90145-3)
• [L4] No significant difference in muscle contraction latency was detected between the stable and unstable shoulders suggesting that there was no significant defect in muscular reflex activity. [46] (10.1016/s1058-2746(97)90036-7)
• [L3] The prescribed shoulder-strengthening exercise represents a useful treatment option for patients with multidirectional shoulder instability. [47] (10.1016/s1058-2746(02)86886-0)
• [L5] Obligate insufficiency of these structures is required for rotatory instability to occur. [50] (10.1016/s1058-2746(95)80049-2)
• [L3] Treatment of instability impingement is usually difficult. [54] (10.1016/s1058-2746(96)80238-2)
• [L5] Being able to distinguish the type of instability then allows development of an appropriate treatment plan and explanation to the patient of options and anticipated outcomes. [55] (10.1016/s0894-1130(12)80078-0)
• [L4] The presented technique of open anterior capsular reconstruction of the shoulder for chronic instability using a tibialis anterior allograft is a feasible salvage procedure that can help in avoiding much more invasive and lifestyle-limiting procedures such as fusion of the glenohumeral joint. [56] (10.1097/bte.0b013e31817303e6)
• [Paper] The subscapularis and capsule augmentation is a safe and relatively easy technique for the treatment of shoulder instability. [57] (10.1016/j.eats.2024.103313)
• [L4] Majority (76%) of the patients could continue their sporting activities. [58] (10.1016/s1058-2746(96)80382-x)
• [L4] Arthroscopic management of a failed instability repair provides similar success to open reconstruction if one selects proper indications. [60] (10.1097/00132589-200212000-00008)
• [L5] The crux of treatment is to halt the instability before anatomic damage occurs by means of a specific and intense exercise program. [61] (10.1016/s0894-1130(12)80106-2)
• [L5] This technique with an anchor-button unit attempts to reduce recurring instability and improve long-term outcomes for patients with glenohumeral instability accompanying glenoid bone loss. [62] (10.1002/atn2.70250)
• [L4] The study shows the long-term effectiveness of arthroscopic capsular shift in the treatment of multidirectional shoulder instability. [63] (10.1016/s1058-2746(99)90158-1)
• [L4] Of the 18 patients, 11 (61%) maintained symmetric motion; the others had minimal loss of external rotation compared with that of the contralateral shoulder. [65] (10.1016/s1058-2746(95)80019-0)
• [L5] The technique aims to address anterior shoulder instability with bone loss by creating a bony 'ramp' that prevents anterior translation. [68] (10.1016/j.eats.2024.103344)
• [L2] TSA and GHA are viable options in treating end-stage recurrent shoulder instability. [69] (10.1016/j.jseint.2025.101429)
• [L5] They note that 7 of 100 cases showed no gap between the Hill-Sachs lesion and the glenoid rim, indicating engagement occurred in exactly the same arm position each time. [70] (10.1177/0363546519878140)
• [L4] Shoulder instability can be a presenting symptom and sign of syringomyelia. [71] (10.1016/1058-2746(92)90094-j)
• [L4] At final follow-up, 91% (49 of 54 patients) rated good to excellent according to the Rowe Scale, whereas no patients rated good to excellent preoperatively. [74] (10.1067/mse.2001.109324)
• [L5] The shoulder remained stable with no recurrent dislocations at a final follow-up of 24 months. [76] (10.1097/bte.0000000000000172)
• [L4] Subluxation of the annular ligament should be considered in the differential diagnosis of the clicking elbow. [77] (10.1016/s1058-2746(00)90012-0)
• [Paper] The CINE MRI appears useful to confirm the clinical evaluation of shoulder instability. [79] (10.1016/s1058-2746(96)80178-9)
• [L4] At an average follow-up period of 3 years, 13 (77%) satisfactory results and four (23%) unsatisfactory results were obtained. [81] (10.1016/s1058-2746(05)80060-6)
• [L4] In the majority of the cases secondary impingement gets developed, generally on the intraarticular part of the rotator cuff. [82] (10.1016/s1058-2746(95)80143-x)
• [L5] Based on the literature and using six categories describing chronicity, constancy, etiology, location, direction, and pattern of the instability, we present a proposal for a standardized analysis. [84] (10.1016/s0363-5023(05)80426-5)
• [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. [86] (10.1177/03635465261443999)
• [L4] A shallow Hill-Sachs lesion was indicative of a greater degree of anterior instability of the shoulder. [87] (10.1067/mse.2000.106920)
• [L4] The authors consider that there are little predisposing osseous factors in traumatic anterior instability. [88] (10.1016/s1058-2746(95)80233-9)
• [L5] Furthermore, the concept has been extended to posterior shoulder instability through the development of the ‘reverse glenoid track’ concept, broadening its applicability across the spectrum of shoulder instability. [89] (10.1007/s00264-026-06930-z)
• [L5] Multidirectional instability (MDI) of the shoulder is a complex entity characterized by symptomatic global laxity of the glenohumeral joint. [91] (10.1016/s0278-5919(05)70207-6)

References

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