The Epidemiology and Natural History of Anterior Shoulder Instability

Abstract

Purpose of Review The purpose of this review is to outline the natural history and best clinical practices for nonoperative management of anterior shoulder instability. Recent Findings Recent studies continue to demonstrate a role for nonoperative treatment in the successful long-term management of anterior glenohumeral instability. The success of different positions of shoulder immobilization is reviewed as well. Summary There are specific patients who may be best treated with nonoperative means after anterior glenohumeral instability. There are also patients who are not good nonoperative candidates based on a number of factors that are outlined in this review. There continues to be no definitive literature regarding the return to play of in-season athletes. Successful management requires a thorough understanding of the epidemiology, pathoanatomy, history, physical examination, diagnostic imaging modalities, and natural history of operative and nonoperative treatment.

Nanoscopic Single-Incision Anterior Labrum Repair

“…This number increases up to 15% for athletes participating in contact sports. 1,2 Traditionally, open repair of a torn labrum has provided excellent results with high patient satisfaction scores and low reoperation rates. [3][4][5] This surgery, however, can be associated with a high morbidity and a significant loss of shoulder motion.…”

Variations in the Anatomic Morphology of the Lateral Distal Tibia: Surgical Implications for Distal Tibial Allograft Glenoid Reconstruction

“…Anterior glenohumeral instability is a common problem, especially in the young athletic patient population. 11,27 Glenoid bone loss after anterior shoulder dislocation presents a frequent injury pattern, occurring with a reported prevalence of up to 90%. 26 With increasing amounts of anterior glenoid bone loss, arthroscopic soft tissue stabilization procedures become less successful in preventing instability, and bony reconstruction of the glenoid is recommended.…”

Effect of Anterior Glenoid Labral Tears and Glenoid Bone Loss at the NFL Combine on Future NFL Performance

“…Anterior glenohumeral instability is a common abnormality in the young, athletic population, especially in those participating in contact or collision sports. 13 , 15 Typically caused by an initial traumatic event, shoulder instability is described as disruption of the inert (glenohumeral ligaments, glenoid labrum, etc) and dynamic (rotator cuff muscles, rotator cuff interval, etc) stabilizers of the glenohumeral joint, which leads to dislocations, subluxations, or apprehension. 13 Anterior disruption of the labrum, also known as a Bankart lesion, has been reported in up to 96% of patients with anterior instability, making it the most common pathoanatomic feature of this condition.…”

“… 13 , 15 Typically caused by an initial traumatic event, shoulder instability is described as disruption of the inert (glenohumeral ligaments, glenoid labrum, etc) and dynamic (rotator cuff muscles, rotator cuff interval, etc) stabilizers of the glenohumeral joint, which leads to dislocations, subluxations, or apprehension. 13 Anterior disruption of the labrum, also known as a Bankart lesion, has been reported in up to 96% of patients with anterior instability, making it the most common pathoanatomic feature of this condition. 3 Variant lesions of the glenoid labrum include anterior labroligamentous periosteal sleeve avulsions, humeral avulsions of the glenohumeral ligament (HAGLs), and superior labrum from anterior to posterior (SLAP) tears.…”

“… 3 Variant lesions of the glenoid labrum include anterior labroligamentous periosteal sleeve avulsions, humeral avulsions of the glenohumeral ligament (HAGLs), and superior labrum from anterior to posterior (SLAP) tears. 13 , 26 These lesions, along with other associated injuries such as rotator cuff tears and bony defects, can contribute to the severity and outcomes of anterior shoulder instability. ∥…”