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Clin J Sport Med 2021 Mar 1. Epub 2021 Mar 1.

Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; Department of Orthopedic Surgery, Sierra Pacific Orthopedics, Fresno, California; and Department of Orthopedic Surgery, Pan Am Clinic, Winnipeg, MB, Canada.

Objective: To report the injury characteristics, radiographic findings, and long-term outcomes of nonoperative management for posterior shoulder instability (PSI).

Design: A retrospective review of 143 patients with PSI using a large geographic database.

Setting: Single county between January 1994 and July 2012. Read More

Arthrosc Tech 2021 Mar 15;10(3):e781-e787. Epub 2021 Feb 15.

The Steadman Clinic, Vail, Colorado, U.S.A.

Traumatic posterior dislocations of the shoulder can result in bony defects, labral tears, and cartilage injuries of the glenohumeral joint. Although traditional Hill-Sachs lesions from anterior dislocations are more commonly identified, reverse Hill-Sachs lesions caused by posterior dislocation often leads to recurrent engagement of the humeral head with the glenoid and significantly greater damage to the humeral chondral surface. In severe traumatic cases, concomitant damage of the capsulolabral soft tissues, such as circumferential labral lesions, can lead to chronic shoulder instability and residual glenoid bone loss. Read More

Arthrosc Tech 2021 Mar 2;10(3):e629-e637. Epub 2021 Feb 2.

Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.

The surgical results of shoulder multidirectional instability are not satisfactory. To address the structural and biological factors that are related to the low success rate of surgical treatment, we developed a whole glenoid reconstruction technique, which includes mainly 270° glenoid bone grafting and capsule labrum reconstruction, and glenohumeral ligament reconstruction. Our clinical experience indicates that the application of this technique can result in optimal shoulder stability. Read More

Orthop J Sports Med 2021 Feb 24;9(2):2325967120982965. Epub 2021 Feb 24.

Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Medical College of Hallym University, Hwaseong, Republic of Korea.

Background: Posterior shoulder instability (PSI) is a relatively uncommon condition that occurs in about 10% of patients with shoulder instability. PSI is usually associated with dislocations due to acute trauma and multidirectional instability, but it can also occur with or without recognizable recurrent microtrauma. The infrequency of atraumatic or microtraumatic PSI and the lack of a full understanding of the pathoanatomy and the knowledge of management can lead to misdiagnosis or delayed diagnosis. Read More

Asia Pac J Sports Med Arthrosc Rehabil Technol 2021 Jan 9;23:1-7. Epub 2020 Nov 9.

St Georges University Medical Center, Beirut, Achrafieh, St Georges Street, Lebanon.

Introduction: Anterior labrum periosteal sleeve avulsion (ALPSA) is the avulsion of the labrum and of the non-disrupted periosteum with the subsequent healing of the labrum in a medialized nonfunctional position on the glenoid neck.

Obejctive: In this study, a modified technique for arthroscopic repair of ALPSA lesions is presented, along with post operative clinical results and follow up.

Method: 72 patients who underwent this procedure were included in this study. Read More

Ann Phys Rehabil Med 2021 Jan 28;64(1):101457. Epub 2020 Nov 28.

Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Corneel Heymanslaan 10, 0k5, 9000 Ghent, Belgium; Centre for Medical Genetics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium. Electronic address:

Background: Several studies reported the importance of glenohumeral and scapular muscle activity and scapular kinematics in multidirectional shoulder instability (MDI), yet a systematic overview is currently lacking.

Objective: This systematic review evaluates and summarizes the evidence regarding muscle activity and shoulder kinematics in individuals with MDI compared to healthy controls.

Method: The electronic databases PubMed and Web of Science were searched in September 2020 with key words regarding MDI (population), muscle activity, and glenohumeral and scapular movement patterns (outcomes). Read More

J Shoulder Elbow Surg 2020 Sep 16. Epub 2020 Sep 16.

Department of Orthopaedics & Traumatology, Gazi University School of Medicine, Ankara, Turkey.

Background: This study aimed to determine the prevalence of the Buford complex and to investigate its association with labral pathologies (superior labrum anterior-posterior [SLAP] lesion and anterior, posterior, or multidirectional instability) using a very large patient database. Furthermore, the prevalence of the Buford complex in patients without any labral pathology was also determined.

Methods: A total of 3129 consecutive shoulder arthroscopy procedures were retrospectively evaluated for the presence of the Buford complex and coexisting labral pathologies. Read More

Jt Dis Relat Surg 2020 18;31(2):223-229. Epub 2020 Jun 18.

Harran Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı, 63300 Şanlıurfa, Türkiye.

Objectives: This study aims to compare the clinical results of patients with traumatic isolated Bankart lesions and type V superior labrum anterior to posterior (SLAP) lesions after arthroscopic repair.

Patients And Methods: Patients who underwent arthroscopic repair for traumatic anterior glenohumeral instability were evaluated retrospectively between December 2014 and January 2019. Fifty-one patients (49 males, 2 females; mean age 25 years; range, 18 to 36 years) without bone defects affecting >20% of the glenoid fossa, off-track engaging Hills-Sachs lesions, multidirectional instability, or ligamentous laxity were included in the study. Read More

JSES Int 2020 Jun 16;4(2):297-301. Epub 2020 Mar 16.

Department of Orthopaedic Surgery, University of Utah Medical Center, Salt Lake City, UT, USA.

Background: Although surgical shoulder stabilization is a substantial cost nationally within the United States, little information exists to analyze this cost. The purpose of this study was to identify factors associated with variation in direct costs with the arthroscopic treatment of glenohumeral instability.

Methods: This was a retrospective study of all patients who underwent arthroscopic treatment of glenohumeral instability between January 12, 2012 and July 11, 2017. Read More

Arthrosc Tech 2020 May 25;9(5):e657-e662. Epub 2020 Apr 25.

Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.

Recurrent multidirectional shoulder instability is a common clinical presentation in certain demographics and sporting groups. One such demographic is patients with connective tissue disorders (CTD) such as Ehlers-Danlos syndrome (EDS), in whom shoulder pathologies are exacerbated owing to ligamentous laxity. Features of this laxity can present as both anterior and posterior shoulder instability, which are problematic sources of shoulder pain. Read More

Orthop Clin North Am 2020 Apr 31;51(2):241-258. Epub 2020 Jan 31.

Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 West Harrison Street, Chicago, IL 60612, USA. Electronic address: https://twitter.com/Grant_Garrigues.

The glenohumeral joint is prone to instability. Patients with instability should have a physical examination. Imaging studies can provide additional information. Read More

Physiotherapy 2020 06 28;107:11-18. Epub 2019 Jun 28.

Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.

Objectives: To examine whether patients, diagnosed with the hypermobility type of the Ehlers-Danlos syndrome (hEDS) or Hypermobility Spectrum Disorder (HSD), with multidirectional shoulder instability (MDI) have increased humeral head translations compared to healthy controls and to describe the direction of the humeral translations during five exercises.

Design: Observational study.

Setting: Ghent University Hospital. Read More

Orthop J Sports Med 2019 Dec 27;7(12):2325967119890103. Epub 2019 Dec 27.

Department of Orthopedic Surgery, Tufts University School of Medicine, Boston, Massachusetts, USA.

Background: Circumferential tears of the glenohumeral labrum are an uncommon injury, comprising 2.4% of all labral lesions. Currently, the clinical outcomes of arthroscopic circumferential labral repair for patients with instability and combined anterior, posterior, and superior labral tears are not well-known. Read More

J Shoulder Elbow Surg 2020 Mar 16;29(3):600-608. Epub 2019 Oct 16.

Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.

Objective: The objective of the study was to compare the acromiohumeral distance (AHD) between patients diagnosed with hypermobility type of the Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorder (HSD) and healthy controls by evaluating the relative amount the tendon occupies in the subacromial area. Furthermore, the aim was to evaluate if there was a change in AHD with arm elevation within and between groups.

Methods: Twenty-nine female patients with hEDS/HSD (aged 34 ± 12. Read More

Am J Sports Med 2019 10 9;47(12):2795-2802. Epub 2019 Sep 9.

Department of Shoulder Surgery, Concordia Hospital for Special Surgery, Rome, Italy.

Background: Patients with recurrent anterior glenohumeral instability after a failed Latarjet procedure remain a challenge to address. Complications related to this procedure include large amounts of bone loss, bone resorption, and issues with retained hardware that necessitate the need for revision surgery.

Purpose: To determine the outcomes of patients who underwent revision surgery for a recurrent shoulder instability after a failed Latarjet procedure with fresh distal tibial allograft. Read More

Arthrosc Tech 2019 Jun 16;8(6):e561-e565. Epub 2019 May 16.

The Steadman Clinic, Vail, Colorado, U.S.A.

Coracohumeral ligament pathology arises from acute trauma, capsular thickening, or congenital connective tissue disorders within the glenohumeral joint. Recent studies have highlighted the significance of this pathology in multidirectional shoulder instability because insufficiency of the rotator interval has become increasingly recognized and attributed to failed shoulder stabilization procedures. The diagnosis and subsequent treatment of coracohumeral ligament pathology can be challenging, however, because patients usually present with a history of failed surgical stabilization and persistent laxity. Read More

Am J Sports Med 2019 07 31;47(8):1909-1914. Epub 2019 May 31.

Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.

Background: Shoulder instability has been well described in young men; however, few studies have specifically evaluated the pathoanatomy and unique spectrum of injuries in women with shoulder instability.

Purpose: To describe the pathoanatomy of operative shoulder instability in a collegiate female cohort.

Study Design: Case series; Level of evidence, 4. Read More

Am J Sports Med 2019 03 30;47(3):682-687. Epub 2019 Jan 30.

The Steadman Clinic, Vail, Colorado, USA.

Background: Anterior and posterior shoulder instabilities are entirely different entities. The presenting complaints and symptoms vastly differ between patients with these 2 conditions, and a clear understanding of these differences can help guide effective treatment.

Purpose: To compare a matched cohort of patients with anterior and posterior instability to clearly outline the differences in the initial presenting history and overall outcomes after arthroscopic stabilization. Read More

J Shoulder Elbow Surg 2019 Jan 19;28(1):95-101. Epub 2018 Oct 19.

Vanderbilt Sports Medicine, Nashville, TN, USA.

Hypothesis: The purpose of this multicenter epidemiologic study was to determine the distribution of patients within the Frequency, Etiology, Direction, and Severity (FEDS) classification system to determine which categories are of clinical importance.

Methods: Shoulder instability patients were identified using International Classification of Diseases, Ninth Revision coding data from 3 separate institutions from 2005-2010. Data were collected retrospectively. Read More

Biomed Res Int 2018 18;2018:8961805. Epub 2018 Jul 18.

Shoulder and Elbow Unit, "D. Cervesi" Hospital, Cattolica-AUSL della Romagna, Ambito Rimini, Italy.

Background: Recurrent shoulder dislocations occur much more frequently in adolescents than in the older population but a clear explanation of this incidence does not exist. The aim of the present study was to define the age-related distribution of the elastic fibers (EFs) in the shoulder capsule's extracellular matrix as a factor influencing shoulder instability.

Materials And Methods: Biopsy specimens were obtained from the shoulder capsule of patients divided preoperatively into three groups: Group 1 consisted of 10 male patients undergoing surgery for unidirectional traumatic anterior instability (TUBS); Group 2 consisted of 10 male patients undergoing surgery for multidirectional instability (MDI); Group 3 represents the control, including 10 patients with no history of instability. Read More

J Orthop Trauma 2018 Aug;32 Suppl 1:S4-S5

Cooper University Hospital, Camden, NJ.

Purpose: The purpose of this video is to demonstrate the surgical technique of a shoulder arthrodesis for a patient with multidirectional instability and multiple failed previous surgeries.

Methods: A 25-year-old woman with a long history of left shoulder multidirectional instability in the setting of Ehlers-Danlos syndrome is shown undergoing a shoulder arthrodesis. The video demonstrates intraoperative patient positioning, approach, shoulder osseous and articular preparation, implant placement (narrow 4. Read More

Am J Sports Med 2018 08 9;46(10):2449-2456. Epub 2018 Jul 9.

Investigation performed at the Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.

Background: Intra-articular glenohumeral joint changes frequently occur after shoulder instability events.

Purpose: (1) To compare demographic characteristics, baseline patient-reported outcomes, and intraoperative findings for patients undergoing primary or revision shoulder stabilization surgery and (2) to determine the incidence of glenohumeral bone and cartilage lesions in this population while identifying factors independently associated with these lesions.

Study Design: Cross-sectional study; Level of evidence, 3. Read More

J Am Acad Orthop Surg 2018 Mar;26(6):204-213

From Elite Sports Medicine, Connecticut Children's Medical Center, Farmington, CT (Dr. Gelber), the Cleveland Indians Professional Baseball Organization, Cleveland, OH (Dr. Soloff), the Cleveland Clinic Sports Health Center, and the Orthopedic and Rheumatologic Institute, Cleveland (Dr. Schickendantz).

Overhead athletes subject their shoulders to extreme repetitive torque, compression, distraction, and translation stresses, resulting in adaptive changes of the soft tissues and osseous structures within and around the glenohumeral joint. These anatomic adaptations result in biomechanical enhancements, which improve performance. Understanding the difference between necessary and adaptive changes and pathologic findings is critical when making treatment decisions. Read More

J Shoulder Elbow Surg 2018 Apr 18;27(4):624-634. Epub 2017 Dec 18.

Sports Medicine & Shoulder Service, Hospital for Special Surgery, New York, NY, USA.

Background: Shoulder capsular plication aims to restore the passive stabilization of the glenohumeral capsule; however, high reported recurrence rates warrant concern. Improving our understanding of the clinical laxity assessment across 2 dimensions, capsular integrity and shoulder position, can help toward the standardization of clinical tools. Our objectives were to test and describe glenohumeral laxity across 5 capsular tension levels and 4 humeral position levels and describe tension-position interplay. Read More

Am J Sports Med 2018 01 19;46(1):87-97. Epub 2017 Oct 19.

Department of Rehabilitation, Nutrition and Sport, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.

Background: The recommended initial treatment for multidirectional instability (MDI) of the shoulder is a rehabilitation program, yet there is very low-quality evidence to support this approach. Purpose/Hypothesis: The purpose was to compare the Watson MDI program and Rockwood Instability program among patients with nontraumatic, nonstructural MDI. The hypothesis was that the Watson MDI program would produce clinically and statistically superior outcomes over the Rockwood Instability program. Read More

Ann Phys Rehabil Med 2018 Jan 5;61(1):46-53. Epub 2017 Oct 5.

Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.

Background: The global range of motion of the arm is the result of a coordinated motion of the shoulder complex including glenohumeral (GH), scapulothoracic, sternoclavicular and acromioclavicular joints.

Methods: This study is a non-systematic review of kinematic patterns in degenerated shoulders. It is a based on our own research on the kinematics of the shoulder complex and clinical experience. Read More

Open Orthop J 2017 31;11:826-847. Epub 2017 Aug 31.

Department of Trauma and Orthopaedic Surgery, Hospital Universitario y Politécnico La Fe, Valencia, Spain.

Background: It is estimated that approximately 5% of glenohumeral instabilities are posterior. There are a number of controversies regarding therapeutic approaches for these patients.

Methods: We analyse the main surgery alternatives for the treatment of the posterior shoulder instability. Read More

J Shoulder Elbow Surg 2018 Jan 22;27(1):104-111. Epub 2017 Sep 22.

La Trobe Sport and Exercise Medicine Centre, La Trobe University, VIC, Australia. Electronic address:

Background: Conservative management is commonly recommended as the first-line treatment for multidirectional instability (MDI) of the shoulder. Despite this, the evidence for efficacy of treatment is limited, and until recently, guidance for clinicians on conservative rehabilitation programs has been inadequate. This study evaluated the effectiveness of a physiotherapy-led exercise program for participants with MDI. Read More

Sports Med Arthrosc Rev 2017 Sep;25(3):123-130

*Department of Orthopaedic Surgery, Walter Reed National Military Medical Center †Uniformed Services University of Health Sciences, Bethesda, MD.

The glenohumeral joint is one of the most frequently dislocated joints and occurs with increasing frequency in collision and contact athletes, especially those in sports that repeatedly place the glenohumeral joint in a position of vulnerability. Nonoperative management of shoulder instability especially in young contact athletes results in unacceptably high recurrence rates; thus, early surgical stabilization has become commonplace. Surgical stabilization typically yields acceptable outcomes. Read More