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Review
. 2017 Dec;10(4):411-424.
doi: 10.1007/s12178-017-9432-5.

The Epidemiology and Natural History of Anterior Shoulder Instability

Joseph W Galvin  1 , Justin J Ernat  1 , Brian R Waterman  2 , Monica J Stadecker  3 , Stephen A Parada  4
Affiliations
Review

The Epidemiology and Natural History of Anterior Shoulder Instability

Joseph W Galvin et al. Curr Rev Musculoskelet Med. 2017 Dec.

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. 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.

Keywords: Anterior glenohumeral instability; Anterior shoulder instability; Natural history; Nonoperative instability.

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Conflict of interest statement

Conflict of Interest

All authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Fig. 1
Fig. 1
Anteroposterior radiograph of an anteriorly dislocated left glenohumeral joint. Note the oblique angle of the radiograph which is common due to patient discomfort and difficulty with positioning
Fig. 2
Fig. 2
Anteroposterior radiograph of the same patient from Fig. 1 after a successful reduction
Fig. 3
Fig. 3
Axillary radiograph of the same patient from Fig. 1 after a successful reduction. This radiograph is essential in confirming a congruent joint after reduction and should not be deferred due to perceived difficulty in obtaining it
Fig. 4
Fig. 4
Axial cut of an MR arthrogram of a patient who sustained an anterior glenohumeral dislocation demonstrating a large anterior labral tear with fluid extravasation under the anterior labrum (arrow)
Fig. 5
Fig. 5
Axial cut of a CT scan of a patient who has sustained multiple anterior glenohumeral dislocations demonstrating the chronic finding of anterior glenoid bone loss (arrow)
Fig. 6
Fig. 6
Three-dimensional reconstructions of a CT scan of a patient who has sustained multiple anterior glenohumeral dislocations demonstrating the finding of significant anterior glenoid bone loss. The en-face view (a) demonstrates the anterior bone loss as well as the medialized bone (arrow). A rotated view (b) better demonstrates the medialized anterior bone (arrow)
Fig. 7
Fig. 7
a, b Clinical photographs of a patient wearing an external rotation immobilizer
Fig. 8
Fig. 8
Clinical photograph of a patient wearing a neoprene shoulder brace designed to decrease subsequent anterior glenohumeral instability events after returning to sport (Courtesy of Brett D. Owens, MD)
Fig. 9
Fig. 9
An algorithm to guide the management of first-time dislocators
See this image and copyright information in PMC

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