The assessment and management of patients with instability of the shoulder joint can be challenging, due to the varying ways patients present, the array of different classification systems, the confusing terminology used and the differing potential management strategies. This review article aims to provide a clear explanation of the common concepts in shoulder instability and how they relate to the assessment and management of patients.There are sections covering the mechanisms of shoulder stability, the clinical assessment of patients and imaging techniques. Beyond that there is a discussion on the common classifications systems used and the typical management options.Some patients fall into reasonably well defined categories of classification and in these cases, the management plan is relatively easy to define. Unfortunately, other patients can elude simple classification and in these instances their management requires very careful consideration. Further research may help to facilitate a better understanding of management of the patients in this latter group.

Introduction COVID-19 was declared a pandemic by the World Health Organization on the 11th of March 2020 with the NHS deferring all non-urgent activity from the 15th of April 2020. The aim of our study was to assess the impact of COVID-19 on Trauma and Orthopaedic trainees nationally. Methods Trauma and Orthopaedic (T&O) specialty trainees nationally were asked to complete an electronic survey specifically on the impact of COVID-19 on their training. This UK based survey was conducted between May 2020 and July 2020. Results A total of 185 out of 975 (19%) T&O specialty trainees completed the survey. Redeployment was experienced by 25% of trainees. 84% of respondents had experienced a fall in total operating numbers in comparison with the same time period in 2019. 89% experienced a fall in elective operating and 63% experienced a fall in trauma operating. The pandemic has also had an effect on the delivery of teaching, with face to face teaching being replaced by webinar-based teaching. 63% of training programmes delivered regular weekly teaching, whilst 19% provided infrequent sessions and 11% provided no teaching. Conclusion This study has objectively demonstrated the significant impact of the COVID-19 pandemic on all aspects of T&O training.

Background. Radial subluxation of the extensor communis tendons at the metacarpophalangeal (MCP) joints is a rarely reportedvinjury. These injuries have proved difficult to reproduce in cadaveric studies and have a low biomechanical likelihood of occurrence due to the ulnar direction of pull of the extensor communis tendons. It has been suggested that the juncturae tendinum may have a stabilising role, preventing radial subluxation after ulnar sagittal band rupture; however this has not been established. Methods. 40 cadaveric digits were dissected to reveal the extensor mechanism around the MCP joints. The ulnar sagittal bands were released and then the juncturae tendinum divided, in stages, before observing for radial subluxation or dislocation during finger flexion. Results. Radial subluxation of the extensor tendon was observed in only one digit after complete ulnar sagisttal band release. When all the fingers were flexed, after the juncturae tendinorum were divided, four additional tendons subluxed radially and a fifth tendon dislocated in this direction. When the digits were then flexed individually, there were eight unstable tendons in total. Conclusions. The juncturae tendinum appear to have a role in stabilising the extensor communis tendons at the MCP joints and preventing radial subluxation after ulnar sagittal band rupture.