MANAGING SHOULDER INSTABILITY IN THE OVERHEAD ATHLETE
Figure 1 - Shoulder MRI (1) of anterior labral tear with chondral delamination. Arthroscopic images before (2) and after (3) surgical repair.
Purpose of review: Shoulder instability in the overhead athlete is a difficult problem because of the balance between necessary laxity for athletic movements and stability of the joint. The purpose of this review is to provide an overview of the clinical evaluation of shoulder instability in the overhead athlete and present evidence-based management strategies for each subtype of shoulder instability, including novel techniques and outcomes.
Recent findings: Recent investigation has shown that throwers and other overhead athletes are more likely to present with subtle subluxation events rather than discrete dislocations as their primary symptom. While overhead athletes with discrete anterior dislocation events are likely to begin with non-operative management, many progress on to surgical intervention. Surgical management of glenohumeral joint instability continues to pose challenges due to the potential for over-tensioning for the sake of stability at the expense of the adaptive laxity that often confers performance benefits in the overhead athlete. Novel, individualized, and sport/position specific approaches are needed to address this complex issue. The optimal management of shoulder instability in the overhead athlete continues to be a controversial topic due to the complex work-up, an increasing number of surgical options with varying indications, and low volume of high-quality studies comparing any of the treatment options. The Anterior Shoulder Instability International Consensus Group guidelines from February 2022 offer the most updated guidelines on work-up and management. Overall, high-quality randomized controlled trials are required to determine the optimal treatment for specific pathologies and aid in creating patient-centered management plans.
Conclusions: Shoulder instability in the overhead athlete encompasses multiple pathologies with complex evaluation and management. While expert opinion consensus studies and longer-term outcome studies have been recently published, there remains a need for high-quality, randomized studies of overhead athletes so that shoulder instability can be treated in an evidence-based manner that does not rely on studies with small sample sizes or surgeon preference. Until that time, a non-operative approach with a focus on physical therapy and rehabilitation is the mainstay of treatment as surgical treatment is reserved for cases failing non-operative management or for athletes with substantial concomitant shoulder pathology.
Figure 2 - MRI of posterior labral tear (1). Intra-operative arthroscopic image of tear (2) and after repair (3).
Click on the link for the full print article:
Managing Shoulder Instability in the Overhead Athlete - PMC (nih.gov)
Published December 2022 in Current Reviews in Musculoskeletal Medicine (Volume 15 - Issue 6).