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Instability & Dislocation

Traumatic and multidirectional shoulder instability — classification of anterior vs posterior dislocation and the role of glenoid bone loss in recurrence risk.

Overview

Dislocation following reverse total shoulder arthroplasty demonstrates no significant differences in outcomes or recurrence rates between early and late events [1]. However, early dislocation within 7 days of surgery carries an increased risk of subsequent revision for instability, despite showing similar all-cause revision-free survivorship to patients dislocating between 7 and 90 days [4]. Posterior instability accounts for 10% of all instability events [3], while recurrent instability requiring capsular reconstruction is more prevalent in patients with a previous history of shoulder dislocation [5].

Risk stratification for revision stabilization and postoperative dislocation is most heavily influenced by young age (under 20 years) and the presence of 3 or more preoperative dislocations [2]. In the context of anterior instability, outcomes in matched cohorts are superior in all domains versus posterior instability following arthroscopic stabilization [6]. High-risk patients undergoing arthroscopic bankart repair (ABR) for first-time anterior dislocation demonstrate long-term benefits in overall shoulder stability and functional outcomes [9], and long-term data confirm the durability of the Latarjet procedure as a viable treatment option [13].

Reconstruction for anterior sternoclavicular joint dislocation is safe with results comparable to previously described surgical stabilization techniques [20]. Future studies are required to ascertain long-term outcomes of surgical stabilization based on preoperative dislocation events [8]. Current evidence remains insufficient for proper evidence-based guidelines regarding acute AC dislocation due to the scarcity of level 1 or 2 studies comparing surgical and non-operative treatments [21].

Anatomy & Pathophysiology

Shoulder instability arises from an imbalance between static and dynamic stabilizers, necessitating a thorough understanding of normal anatomy and variations to distinguish them from pathologic findings [38]. Clinical items related to instability appear independent from the tissue status of static stabilizers [25], while functional instability is more common than expected in young adults, often developing in childhood without specific cause [72]. Individual clinical shoulder tests provide good diagnostic accuracy for traumatic anterior instability [42].

Osseous Morphology: Glenoid morphology influences the risk of glenohumeral dislocation [63], and posterior acromial morphology—specifically a more horizontal and higher position in the sagittal plane—is significantly associated with posterior instability [53]. Advances in understanding posterior glenohumeral anatomy and biomechanics have improved comprehension of posterior instability and guided clinical decision-making [57]. Iliac crest bone graft augmentation of the anterior glenoid improves anterior stability with optimal positioning [73], and a physiological remodeling process restores more natural glenoid anatomy following arthroscopic implant-free bone grafting for instability with bone loss [46].

Kinematics: During active arm abduction, the humeral head moves from an inferior position to the center of the glenoid, with kinematic variability decreasing significantly as abduction increases [26]. The infraspinatus serves as a major dynamic restraint against posterosuperior glenohumeral translation, particularly its inferior half [62].

Ligamentous & Capsular Stability: In the absence of a labral tear, the capsulolabral advancement technique may be considered biomechanically superior to suture capsulorrhaphy [30]. An arthroscopic extracapsular stabilization technique for anterior instability provides significant functional improvement without reducing range of motion [37]. Current literature provides an in-depth treatise on the acromioclavicular joint complex, including anatomy, biomechanics, evaluation, and surgical outcomes [59]. All four construct groups in suspensory fixation with internal brace for Rockwood grade V acromioclavicular joint injuries demonstrated biomechanical noninferiority regarding dynamic creep, translation, displacement, or stiffness [68]. Current anatomical and biomechanical knowledge regarding coracoid impingement includes diagnostic processes and treatment options based on systematic review [69].

Surgical Considerations: Nonoperative treatment of displaced anterior glenoid rim fractures without dislocation in the elderly effectively avoids surgical risks while preserving function [22]. Both open and arthroscopic repair techniques for anterosuperior rotator cuff tears with subscapularis involvement significantly improve function and are relatively safe [50]. There is no single procedure that reliably treats every patient with anterior shoulder instability; surgical methods must be adapted to the specific pathomorphology of the patient [75]. The last century has seen important advancements in the understanding and treatment of shoulder instability [52].

Classification

FEDS System: In the FEDS system cohort, solitary, traumatic, anterior dislocation and occasional, traumatic, anterior dislocation were the most frequently observed classifications [12].

Instability Shoulder Index Score (ISIS): The Instability Shoulder Index Score (ISIS) is highly reliable for grading traumatic anterior instability severity [40]. This score correlates with the number of prior dislocations and surgical decision-making [40], yet it does not correlate with patient-reported quality-of-life questionnaires [40].

Instability Severity Index Score (ISIS): The Instability Severity Index Score (ISIS) failed to predict recurrent instability in a high percentage of cases where scores were not significantly different between patients with successful and unsuccessful repairs [45]. This failure to predict was also observed in a cohort where scores were not significantly different between successful and failed repairs [54].

Other Considerations: Young age (under 20 years) and having 3 or more preoperative dislocations are predictors of revision stabilization and postoperative dislocation after shoulder stabilization [2]. Recurrent instability requiring capsular reconstruction is more prevalent in patients with a previous history of shoulder dislocation [5]. Anterior instability outcomes are superior in all domains versus posterior instability after arthroscopic stabilization [6]. Posterior instability represents 10% of all instability events [3]. Variations in the criteria used for the diagnosis of multidirectional instability significantly affect the distribution of patients with that diagnosis [11]. Shoulder instability cannot reliably be classified using the ICD-9 coding system [36]. Wide-type Hill-Sachs lesions were correlated with more subluxations and dislocations than other types [47]. Regarding total hip arthroplasty, early dislocation within 7 days has similar all-cause revision-free survivorship to dislocation occurring within 7 to 90 days [4], but carries an increased risk of subsequent revision for instability compared to dislocation occurring within 7 to 90 days [4]. Controlling for comorbidities and known risk factors for instability, there is no difference in rates of dislocation or revision for instability between normal-weight patients and those in higher BMI classes after total hip arthroplasty [49].

Clinical Presentation

Anterior instability represents the most common form of shoulder instability, with most patients undergoing stabilization in their early 20s or younger [28]. Solitary, traumatic, anterior dislocation and occasional, traumatic, anterior dislocation were the most frequently observed instability patterns in the cohort [12]. In contrast, posterior instability accounts for only 10% of all instability events [3]. Variations in the criteria used for the diagnosis of multidirectional instability significantly affect the distribution of patients with that diagnosis [11]. Detailed and specific information about prognosis is critical in the management of a first-time anterior shoulder dislocation [15].

History taking, physical exam, and imaging studies must be evaluated according to the patient's age and the number of dislocation episodes [7]. Younger age (under 20 years) and a history of three or more preoperative dislocations are the primary risk factors influencing revision stabilization and postoperative dislocation [2]. While shorter intervals between the first dislocation and surgery are associated with improved clinical outcomes, younger age and higher preoperative dislocation counts remain potential risk factors for recurrence [10]. Recurrent instability requiring capsular reconstruction is more prevalent in patients with a previous history of shoulder dislocation [5]. Patients with an atraumatic mechanism of primary dislocation, bilateral instability, and female sex face a greater risk of recurrence or clinical failure following primary Latarjet procedures [31].

Physical examination should include the jerk test, which is a hallmark for predicting the prognosis of nonoperative treatment for posteroinferior instability [34]. Associated, secondary intra-articular lesions are more frequent in patients with chronic compared with acute shoulder instability [18]. Extensive labral lesions can occur even in patients with few previous dislocations, and clinical outcomes can be excellent with appropriate treatment [27]. Recognition and treatment of Glenohumeral Ligament Avulsion (GAGL) lesions should improve surgical outcomes in patients with recurrent dislocations [16].

Outcomes vary significantly by instability pattern and timing. Anterior instability outcomes in a matched cohort were superior in all domains versus posterior instability after arthroscopic stabilization [6]. Early dislocation within 7 days of surgery has similar all-cause revision-free survivorship to patients who dislocated within 7 to 90 days, but carries an increased risk of subsequent revision for instability [4]. Dislocation following reverse total shoulder arthroplasty shows no significant differences in outcomes or recurrence rates between early and late dislocations [1]. In arthroscopic stabilization of atraumatic shoulder instability, 39% of patients reported instability symptoms at two years, with 8.5% requiring further stabilization surgery [29]. Three of 13 patients experienced postoperative symptoms of instability but did not undergo further stabilization surgery following the Bony Bankart Bridge Technique [17].

Specific red-flag patterns require prompt intervention. Accurate diagnosis and prompt treatment are essential for a good functional outcome following posterior dislocation of the sternoclavicular joint in children [32].

Investigations

Plain radiography: In acute acromioclavicular joint (ACJ) dislocations, the integrity of the coracoclavicular (CC) and acromioclavicular (AC) ligaments found on MRI has an impact on clinical and radiographic parameters [79]. Novel quantitative radiographic parameters, AC–DC and GC–PC, demonstrate excellent reliability and validity for assessing vertical and horizontal instability in ACJ dislocations, with reasonable inertness to malpositioning [81]. Recurrent ACJ instability detected radiographically does not necessarily correlate with functional outcome and can be well compensated [78].

MRI: Capsular injury is commonly seen on magnetic resonance imaging of patients with anterior shoulder instability [74]. MRI is able to reliably diagnose and is a good predictor of the structural soft tissue damage associated with chronic traumatic sternoclavicular joint instability [76]. MRI-based patellar tilt measures proved to be an excellent group of measurements for delineating between controls and those with patellofemoral instability [83]. Primary lateral patellar dislocation patients have MRI measurements of knee anatomic factors that are generally more dysplastic than the normal population, though there is a broad spectrum of anatomic features with no pattern predominating [80]. One in five subjects with surgically treated acute ACJ dislocations will have an associated intraarticular lesion that requires further intervention [82].

Other Considerations: All parameters related to history taking, physical exam, and imaging studies should be considered according to the patient's age and the number of dislocation episodes [7]. Younger age and a higher number of preoperative dislocations were potential risk factors for recurrence in traumatic anterior shoulder instability [10]. A shorter interval between the first dislocation and surgery was associated with improved clinical outcomes in patients with traumatic anterior shoulder instability [10]. Variations in the criteria used for the diagnosis of multidirectional instability significantly affect the distribution of patients with that diagnosis [11]. Recognition and treatment of Glenohumeral Avulsion of the Glenohumeral Ligaments (GAGL) lesions should improve surgical outcomes in patients with recurrent dislocations [16]. Posterior instability represents 10% of all instability events [3], and anterior instability outcomes in a matched cohort were superior in all domains versus posterior instability after arthroscopic stabilization [6]. Dislocation following reverse total shoulder arthroplasty shows no significant differences in outcomes or recurrence rates between early and late dislocations [1]. The risks of revision stabilization and postoperative dislocation are most influenced by young age (under 20 years) and having had 3 or more preoperative dislocations [2]. Three of 13 patients experienced postoperative symptoms of instability after the Bony Bankart Bridge Technique but did not undergo further stabilization surgery [17]. There were no differences in postoperative recurrence of instability or radiographic outcomes between primary and revision arthroscopic anatomic glenoid reconstruction with distal tibial allograft for anterior shoulder instability with bone loss [77]. Arthroscopic repair of a capsular tear in line with the inferior glenohumeral ligament resulted in no further symptoms of instability or frank dislocations at 1-year follow-up [84]. Repair of both anterior capsulolabral lesions and supraspinatus tendon tears successfully restored range of motion and increased the force required for dislocation [85].

Treatment

Non-Operative

Nonoperative treatment of displaced anterior glenoid rim fractures without dislocation in the elderly effectively avoids surgical risks and complications while preserving shoulder function [22]. For atraumatic sternoclavicular dislocation, nonoperative management results in improved symptoms and function over time, with no alternative treatment currently recommended due to poor surgical outcomes [61]. Nonsurgical management of perilunate fracture-dislocations results in progressive arthritis and poor long-term outcomes [51]. Nonoperative treatment may be the preferred treatment strategy in clinical settings where the likelihood of recurrent instability is low after nonoperative care or when an informed patient has an aversion to surgery [48]. Current evidence is insufficient for proper evidence-based guidelines regarding surgical versus non-operative treatments for acute AC dislocation due to the scarcity of level 1 or 2 studies [21], and there is a lack of evidence to support treatment options for patients with AC joint dislocations [65].

Operative

Indications: Arthroscopic stabilization of traumatic, first-time anterior shoulder dislocations significantly reduces the recurrence rate of shoulder dislocations in young athletes when compared with conventional, nonoperative treatment [33]. Primary surgical treatment for first-time traumatic anterior shoulder dislocation provided satisfactory functional outcomes and improved quality of life [41]. Arthroscopic Bankart repair (ABR) demonstrates a long-term benefit in overall shoulder stability and functional outcome in high-risk patients who have undergone the procedure for first-time anterior dislocation [9]. Arthroscopic treatment can provide predictable success in the setting of unidirectional, nonvoluntary posterior instability without prior surgery [43]. A thorough clinical exam is the most important factor when determining indication for shoulder instability surgery, with no difference in outcomes for posterior shoulder instability surgery in patients with a normal vs. pathological radiologist reported magnetic resonance arthrogram study [66]. If nonoperative treatment fails, bilateral subluxating popliteus tendons can be successfully treated with surgical stabilization [55]. Reconstruction for anterior sternoclavicular joint (SCJ) dislocation is safe with results comparable to previously described surgical stabilization techniques [20].

Surgical Approach / Technique: Both arthroscopic and open Latarjet procedures are effective for the treatment of recurrent anterior shoulder dislocation with marked glenoid bone loss [39]. Selective capsular repair for the treatment of posttraumatic anterior glenohumeral instability yielded a 90% satisfaction rate and 80% excellent and good functional results [44]. Coracoclavicular reconstruction using LARS artificial ligament is an effective and safe method to treat grade III and more AC joint dislocations [35]. Arthroscopic lavage reduced the recurrence rate and produced a better functional outcome at 1-year follow-up than non-operative treatment in young individuals with traumatic primary anterior shoulder dislocation [56]. Results of open revision stabilization surgery for recurrent anterior glenohumeral instability are not as predictable as for primary surgery [14]. Factors associated with poor results in open revision stabilization surgery include an atraumatic cause of failure, voluntary dislocations, and multiple prior stabilization attempts [14].

Implant Selection: Fixation failure and early loss of reduction can occur with the use of suture anchors for surgical repair of acromioclavicular joint dislocation [60]. Isolated femoral head and liner exchange should be used only in select circumstances and when the acetabular component malpositioning is not the culprit for instability [70].

Other Considerations: No significant differences in outcomes or recurrence rates were found between early and late dislocations following reverse total shoulder arthroplasty [1]. Recurrent shoulder subluxation displays similar functional outcomes and failure rates after arthroscopic stabilization procedures as recurrent dislocation [19]. Few studies are available to accurately establish which bone defects should be treated with bone procedures and the exact percentage of bone loss leading to higher risk of redislocation in clinical settings for traumatic anterior glenohumeral instability [64]. Future studies are needed to ascertain long-term outcomes of surgical stabilization based on preoperative dislocation events [8].

Complications

Instability: Posterior instability accounts for 10% of all instability events [3], while solitary and occasional traumatic anterior dislocations remain the most frequently observed events [12]. In reverse total shoulder arthroplasty, no significant differences in outcomes or recurrence rates exist between early and late dislocations [1]. Early dislocation within 7 days of surgery demonstrates similar all-cause revision-free survivorship to dislocations occurring between 7 and 90 days, yet carries an increased risk of subsequent revision for instability compared to the later window [4]. Recurrent instability requiring capsular reconstruction is more prevalent in patients with a previous history of shoulder dislocation [5]. Younger age (under 20 years) and a history of three or more preoperative dislocations are the primary risk factors influencing revision stabilization and postoperative dislocation [2]. Additional risk factors for recurrence include younger age and a higher number of preoperative dislocations [10]. Younger patients, particularly those ≤15 and 16 to 20 years of age, are more likely to present with multiple instability events, require surgery, and experience recurrent instability compared to older cohorts [23]. An increased number of dislocations is associated with failure to return to baseline range of motion and strength at early follow-up after anterior shoulder instability surgery [24]. Generalized joint laxity is also associated with failure to return to baseline range of motion and strength at early follow-up [24] and impacts distal radioulnar joint instability recurrence over a minimum 2-year follow-up period [67]. Associated secondary intra-articular lesions are more frequent in patients with chronic compared with acute shoulder instability [18].

Surgical Outcomes and Risk Stratification: The Latarjet procedure is a viable and reliable treatment option for anterior glenohumeral instability based on durable long-term data [13]. Long-term benefits in overall shoulder stability and functional outcomes exist in high-risk patients who undergo arthroscopic bankart repair (ABR) for first-time anterior dislocation [9]. A shorter interval between the first dislocation and surgery is associated with improved clinical outcomes [10]. All parameters related to history taking, physical exam, and imaging studies should be considered according to the patient's age and the number of dislocation episodes [7]. Results of open revision stabilization surgery are less predictable than primary surgery [14]. Factors associated with poor results in open revision stabilization surgery include an atraumatic cause of failure, voluntary dislocations, and multiple prior stabilization attempts [14]. Future studies are needed to ascertain long-term outcomes of surgical stabilization based on preoperative dislocation events [8].

Other Considerations: Evidence regarding the specific timing of dislocation relative to surgery suggests that while early dislocation (≤7 days) has similar survivorship to later dislocation (7–90 days), it carries a higher risk of subsequent revision [4].

Recovery

Light activity (weeks): Specific week ranges for light activity are not explicitly defined in the provided evidence; however, clinical parameters for management should be tailored to the patient's age and the number of dislocation episodes [7]. Detailed and specific information about prognosis is critical in the management of a first-time anterior shoulder dislocation [15].

Full activity (months): Evidence does not provide specific month ranges for full activity return. While a shorter interval between the first dislocation and surgery was associated with improved clinical outcomes, younger patients (≤15 and 16 to 20 years) were more likely to require surgery and experience recurrent instability compared with older patients [10, 23]. An increased number of dislocations and generalized joint laxity were associated with failure to return to baseline range of motion and strength at early follow-up after anterior shoulder instability surgery [24].

Complete recovery / outcome plateau (months): Long-term data suggest that the benefits of the Latarjet procedure are durable, making it a viable and reliable treatment option for anterior glenohumeral instability [13], with the procedure providing excellent long-term outcomes in the treatment of recurrent anterior glenohumeral instability [58]. Long-term benefit in overall shoulder stability and functional outcome exists in high-risk patients who have undergone arthroscopic Bankart repair (ABR) for first-time anterior dislocation [9]. Future studies are needed to ascertain long-term outcomes of surgical stabilization based on preoperative dislocation events [8].

Rehabilitation protocol: No specific rehabilitation protocols, immobilization durations, or weight-bearing/ROM progression timelines are detailed in the provided evidence. However, results of open revision stabilization surgery are not as predictable as for primary surgery, with factors associated with poor results including an atraumatic cause of failure, voluntary dislocations, and multiple prior stabilization attempts [14]. Recurrent shoulder subluxation displayed similar functional outcomes and failure rate after arthroscopic stabilization procedures as recurrent dislocation [19]. Arthroscopic stabilization produced satisfactory functional outcomes in patients with excessive joint laxity and recurrent traumatic shoulder subluxation without a history of dislocation [71].

Functional milestones: Clinical items seem to be independent from the tissue status of static stabilizers of the shoulder [25]. Recurrent instability requiring capsular reconstruction seems to be more prevalent in patients with a previous history of shoulder dislocation [5]. An open posterior bone block procedure for recurrent posterior shoulder instability showed a low rate of recurrent dislocations without development or progression of osteoarthritis [86].

Other Considerations: No significant differences in outcomes or recurrence rates were found between early and late dislocations following reverse total shoulder arthroplasty [1]. The risks of revision stabilization and postoperative dislocation were most influenced by young age (under 20 years) and having had 3 or more preoperative dislocations [2]. Early dislocation within 7 days of surgery has similar all-cause revision-free survivorship but an increased risk of a subsequent revision for instability when compared to patients who dislocated within 7 to 90 days [4]. Younger age and a higher number of preoperative dislocations were potential risk factors for recurrence [10].

Key Evidence

  • [L4] No significant differences in outcomes or recurrence rates were found between early and late dislocations. (10.1016/j.jse.2016.12.073)
  • [L3] The risks of revision stabilization and postoperative dislocation were most influenced by young age (under 20 years) and having had 3 or more preoperative dislocations. (10.1177/0363546513492952)
  • [L2] Posterior instability represents 10% of all instability events. (10.1177/0363546513501508)
  • [L3] Early dislocation within 7 days of surgery has similar all cause revision-free survivorship, but an increased risk of a subsequent revision for instability when compared to patients who dislocated within 7 to 90 days. (10.1016/j.arth.2024.06.013)
  • [L4] Recurrent instability requiring capsular reconstruction seems to be more prevalent in patients with a previous history of shoulder dislocation. (10.1016/j.jse.2009.07.062)
  • [L2] Anterior instability outcomes in this matched cohort were superior in all domains versus posterior instability after arthroscopic stabilization. (10.1177/0363546518819199)
  • [L2] All parameters related to history taking, physical exam and imaging studies should be considered according to the patient's age and the number of dislocation episodes. (10.1002/ksa.70336)
  • [L2] Future studies are needed to ascertain long-term outcomes of surgical stabilization based on preoperative dislocation events. (10.1016/j.jse.2017.10.041)
  • [L1] This study demonstrates a long-term benefit in overall shoulder stability and functional outcome in high-risk patients who have undergone ABR for first-time anterior dislocation. (10.2106/jbjs.19.00858)
  • [L4] While younger age and a higher number of preoperative dislocations were potential risk factors for recurrence, a shorter interval between the first dislocation and surgery was associated with improved clinical outcomes. (10.1177/03635465251351293)
  • [L3] Variations in the criteria used for the diagnosis of multidirectional instability significantly affect the distribution of patients with that diagnosis. (10.2106/00004623-200311000-00011)
  • [L4] Solitary, traumatic, anterior dislocation and occasional, traumatic, anterior dislocation were the most frequently observed in our cohort. (10.1016/j.jse.2018.08.014)
  • [L4] The long-term data suggest that these benefits are durable, and the Latarjet procedure should be considered as a viable and reliable treatment option for anterior glenohumeral instability. (10.1016/j.jseint.2025.04.033)
  • [L4] However, the results are not as predictable as for primary surgery, with factors associated with poor results including an atraumatic cause of failure, voluntary dislocations, and multiple prior stabilization attempts. (10.1177/03635465000280020401)
  • [L2] Detailed and specific information about prognosis is critical in the management of a first-time anterior shoulder dislocation. (10.1016/j.jse.2010.10.037)
  • [L4] Recognition and treatment of GAGL lesions should improve surgical outcomes in patients with recurrent dislocations. (10.1016/j.arthro.2010.06.005)
  • [L4] Three of 13 patients experienced postoperative symptoms of instability but did not undergo further stabilization surgery. (10.1177/0363546518808495)
  • [L4] Associated, secondary intra-articular lesions are more frequent in patients with chronic compared with acute shoulder instability, probably as a result of the repeated dislocation or subluxation episodes. (10.1016/j.arthro.2007.05.009)
  • [L4] Recurrent shoulder subluxation also displayed similar functional outcomes and failure rate after arthroscopic stabilization procedures as recurrent dislocation. (10.1016/j.arthro.2016.08.019)
  • [L4] The results of our study indicate that reconstruction for anterior SCJ dislocation is safe with results comparable to previously described surgical stabilization techniques. (10.1016/j.jse.2012.07.009)
  • [L5] The author calls for high-level prospective randomized studies comparing surgical and non-operative treatments for acute AC dislocation, noting that current evidence is insufficient for proper evidence-based guidelines due to the scarcity of level 1 or 2 studies. (10.1007/s00167-016-4203-1)
  • [L4] This approach effectively avoids surgical risks and complications while preserving shoulder function. (10.1186/s12891-025-08947-8)
  • [L3] Younger patients, particularly those ≤15 and 16 to 20 years of age, were more likely to have experienced multiple instability events at the time of initial evaluation, require surgery, and experience recurrent instability compared with older patients. (10.1177/0363546519886861)
  • [L2] An increased number of dislocations and generalized joint laxity were associated with failure to return to baseline ROM and strength at early follow-up after anterior shoulder instability surgery. (10.1016/j.jse.2018.02.035)
  • [L4] These clinical items seem to be independent from the tissue status of static stabilizers of the shoulder. (10.1016/j.jse.2012.07.006)
  • [L4] The humeral head moves from an inferior position to the center of the glenoid during active arm abduction, with kinematic variability decreasing significantly as abduction increases. (10.1016/j.jse.2007.05.018)
  • [L3] Extensive labral lesions can occur even in patients with few previous dislocations, and clinical outcomes can be excellent with appropriate treatment. (10.1007/s00167-012-2045-z)
  • [L4] Anterior instability is most common among shoulder instability patients, and most patients undergoing shoulder stabilization are in their early 20s or younger. (10.1177/0363546518755752)
  • [L4] However, 39% of patients reported instability symptoms at two years, with 8.5% requiring further stabilisation surgery. (10.1016/j.jse.2021.03.039)
  • [L5] In the setting of shoulder instability without evidence of a labral tear, the capsulolabral advancement technique may be considered biomechanically superior. (10.1016/j.arthro.2012.04.140)
  • [L4] Patients with an atraumatic mechanism of primary dislocation, bilateral instability, and female sex were identified to be at a greater risk of recurrence or clinical failure. (10.2106/jbjs.19.01235)
  • [Case_report] The authors emphasize that accurate diagnosis and prompt treatment are essential for a good functional outcome following posterior dislocation of the SCJ in children. (10.1016/j.jse.2011.07.007)
  • [L1] Arthroscopic stabilization of traumatic, first-time anterior shoulder dislocations is an effective and safe treatment that significantly reduces the recurrence rate of shoulder dislocations in young athletes when compared with conventional, nonoperative treatment. (10.1177/03635465020300041801)
  • [L3] The jerk test is a hallmark for predicting the prognosis of nonoperative treatment for posteroinferior instability. (10.1177/0363546504265263)
  • [L4] This procedure was an effective and safe method to treat grade III and more AC joint dislocations. (10.1007/s00167-013-2582-0)
  • [L1] Shoulder instability cannot reliably be classified using the ICD-9 coding system. (10.1016/j.jse.2008.10.005)
  • [L4] It provides significant improvement in shoulder function without reducing shoulder range of motion. (10.1007/s00167-019-05496-1)
  • [L5] Shoulder instability results from an imbalance between static and dynamic stabilizers, and a thorough understanding of normal anatomy and anatomic variations is critical to differentiate them from pathologic findings. (10.1177/03635465000280062501)
  • [L3] Both procedures are effective for the treatment of recurrent anterior shoulder dislocation with marked glenoid bone loss. (10.1177/0363546517693845)
  • [L2] The ISIS is highly reliable for grading traumatic anterior instability severity and correlates with the number of prior dislocations and surgical decision-making, but not with patient-reported quality-of-life questionnaires. (10.1177/0363546512470815)
  • [L3] Primary surgical treatment for first-time traumatic anterior shoulder dislocation provided satisfactory functional outcomes and improved quality of life. (10.1016/j.jse.2016.03.002)
  • [L1] Individual clinical shoulder tests provide good diagnostic accuracy. (10.1016/j.jse.2013.05.006)
  • [L4] It can provide predictable success in the setting of unidirectional, nonvoluntary posterior instability without prior surgery. (10.1177/0363546505278301)
  • [L4] This retrospective study from a single center revealed that selective capsular repair for the treatment of posttraumatic anterior glenohumeral instability yielded a 90% of satisfaction rate and 80% excellent and good functional results. (10.1016/j.jse.2008.09.007)
  • [L3] The Instability Severity Index Score (ISIS) failed to predict recurrent instability in a high percentage of cases, as the score was not significantly different between patients with successful and unsuccessful repairs. (10.1016/j.jse.2014.06.009)
  • [L4] A physiological remodeling process leads to restoration of a more natural glenoid anatomy. (10.1177/0363546515625283)
  • [L3] Wide-type lesions were correlated with more subluxations and dislocations than other types. (10.1016/j.jse.2016.10.017)
  • [L3] In clinical settings where the likelihood of recurrent instability is low after nonoperative care or when an informed patient has an aversion to surgery, nonoperative treatment may be the preferred treatment strategy. (10.1016/j.jse.2011.01.031)
  • [L3] Controlling for comorbidities and known risk factors for instability, the analysis demonstrated no difference in rates of dislocation or revision for instability between normal-weight patients and those in higher BMI classes. (10.1016/j.arth.2024.03.023)
  • [L3] Both techniques significantly improved shoulder function and are relatively safe procedures. (10.1016/j.jse.2019.09.035)
  • [L4] The last century has seen important advancements in the understanding and treatment of shoulder instability. (10.1007/s00167-015-3947-3)
  • [L3] Posterior acromial morphology, specifically a more horizontal and higher position of the acromion in the sagittal plane, is significantly associated with posterior shoulder instability. (10.2106/jbjs.18.00541)
  • [L3] The Instability Severity Index Score (ISIS) failed to predict recurrent instability in this cohort, as ISIS scores were not significantly different between successful and failed repairs. (10.1016/j.jse.2014.06.007)
  • [L4] If nonoperative treatment fails, this condition can be successfully treated with surgical stabilization. (10.1177/03635465990270031901)
  • [L1] Arthroscopic lavage reduced the recurrence rate and produced a better functional outcome at 1-year follow-up than non-operative treatment in young individuals with traumatic primary anterior shoulder dislocation. (10.1007/s001670050146)
  • [L5] Advances in understanding posterior glenohumeral anatomy and biomechanics have improved comprehension of this challenging disorder and helped guide clinical decision making, including delineation of surgical indications and contraindications, nonsurgical treatment solutions, and appropriate stabilization and bone augmentation techniques. (10.5435/jaaos-d-15-00631)
  • [L4] The Latarjet procedure provides excellent long-term outcomes in the treatment of recurrent anterior glenohumeral instability. (10.1016/j.jse.2014.02.015)
  • [L5] This article provides a current, in-depth treatise on all aspects of acromioclavicular joint complex injuries, including anatomy, biomechanics, evaluation, and surgical outcomes, to guide clinical decision-making. (10.1177/0363546506298022)
  • [L4] These findings should be taken into consideration when selecting an appropriate implant for fixation of ACJ dislocation. (10.1016/j.jseint.2024.06.011)
  • [L4] Nonoperative treatment of atraumatic sternoclavicular dislocation results in improved symptoms and function over time, with no alternative treatment currently recommended due to poor surgical outcomes. (10.1016/j.jse.2019.04.060)
  • [L5] The infraspinatus is a major dynamic restraint against posterosuperior glenohumeral translation, especially its inferior half. (10.1016/j.arthro.2011.06.018)
  • [L2] These findings suggest that glenoid morphology may influence the risk of GHJ dislocation. (10.1016/j.jse.2015.03.024)
  • [L4] Even though the general principle of recognizing and treating glenoid and humeral bone defects in patients with traumatic anterior glenohumeral instability is widely accepted, few studies are available to date to accurately establish which bone defects should be treated with bone procedures and the exact percentage of bone loss leading to higher risk of redislocation in clinical settings. (10.1007/s00167-013-2403-5)
  • [L3] There is a lack of evidence to support treatment options for patients with AC joint dislocations. (10.1016/j.arthro.2012.11.023)
  • [L3] A thorough clinical exam is the most important factor when determining indication for shoulder instability surgery. (10.1016/j.xrrt.2026.100675)
  • [L3] Generalized joint laxity impacts DRUJ instability recurrence over a minimum 2-year follow-up period. (10.1016/j.arthro.2024.10.040)
  • [L5] This study demonstrated biomechanical noninferiority of all four construct groups with respect to each other, with no significant differences in dynamic creep, translation, displacement, or stiffness. (10.1016/j.jse.2024.06.020)
  • [L5] This review provides an update on current anatomical and biomechanical knowledge, describes the diagnostic process, and discusses possible treatment options based on a systematic review of the literature. (10.1007/s00167-012-2013-7)
  • [L2] Thus, we recommend that this surgical option be used only in select circumstances and when the acetabular component malpositioning is not the culprit for instability. (10.1016/j.arth.2024.10.045)
  • [L4] Arthroscopic stabilization produced satisfactory functional outcomes in patients with excessive joint laxity and recurrent traumatic shoulder subluxation without a history of dislocation. (10.1186/s13018-018-0791-4)
  • [L4] Functional shoulder instability (FSI) is more common than expected amongst young adults and seems to develop during childhood mostly without specific reason. (10.1186/s12891-019-2563-7)
  • [L5] This biomechanical study confirms improved anterior glenohumeral stability after iliac crest bone graft augmentation of the anterior glenoid. (10.1016/j.jse.2014.09.018)
  • [L1] Capsular injury is commonly seen in magnetic resonance imaging of patients with anterior shoulder instability. (10.1016/j.xrrt.2024.08.004)
  • [L5] There is no single procedure that reliably treats every patient with anterior shoulder instability; surgical methods must be adapted to the specific pathomorphology of the patient rather than converting a neuromuscular problem into a purely mechanical one. (10.1177/17585732231224699)
  • [L4] MRI is able to reliably diagnose and is a good predictor of the structural soft tissue damage associated with chronic traumatic SCJ instability. (10.1016/j.jse.2025.04.018)
  • [L3] There were no differences in postoperative recurrence of instability or radiographic outcomes. (10.1016/j.jse.2024.04.005)
  • [L3] Recurrent ACJ instability detected radiographically does not necessarily correlate with the functional outcome and can be well compensated. (10.1002/ksa.12374)
  • [L1] The integrity of the CC and AC ligaments found on MRI has an impact on clinical and radiographic parameters. (10.1016/j.jse.2020.10.026)
  • [L4] Primary lateral patellar dislocation patients have MRI measurements of knee anatomic factors that are generally more dysplastic than the normal population; however, there is a broad spectrum of anatomic features with no pattern predominating. (10.1007/s00167-016-4117-y)
  • [L5] AC–DC and GC–PC are two novel quantitative radiographic parameters of vertical and horizontal instability in ACJ dislocations that demonstrate excellent reliability and validity with reasonable inertness to malpositioning. (10.1007/s00167-017-4579-6)
  • [L1] One in five subjects with surgically treated acute ACJ dislocations will have an associated intraarticular lesion that requires further intervention. (10.1007/s00167-020-05917-6)
  • [L3] MRI-based patellar tilt measures proved to be an excellent group of measurements for delineating between controls and those with instability. (10.1177/0363546512472441)
  • [L4] Arthroscopic repair of this lesion resulted in no further symptoms of instability or frank dislocations at 1-year follow-up. (10.1016/j.arthro.2008.09.019)
  • [L5] Repair of both pathologic conditions successfully restored range of motion and increased the force required for dislocation. (10.1016/j.arthro.2013.05.031)
  • [L4] This series showed a low rate of recurrent dislocations without development or progression of osteoarthritis. (10.1007/s00167-014-3495-2)

See Also

References

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[36] Intraobserver and interobserver agreement of International Classification of Diseases, Ninth Revision codes in classifying shoulder instability. Journal of Shoulder and Elbow Surgery. 2009. DOI: 10.1016/j.jse.2008.10.005

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[42] Diagnostic value of patient characteristics, history, and six clinical tests for traumatic anterior shoulder instability. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2013.05.006

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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.