Abstract
The management of shoulder instability has changed a great deal in the last five years due to a better understanding of the biomechanics of the shoulder and the use of arthroscopic surgery.
It is essential to understand the anatomy of the labrum and bony structures of the shoulder joint, as well as the contribution of these structures as well as the Rotator Cuff to stability in the different positions of the arm. The history and examination still remains the most important diagnostic tool and a thorough history and examination cannot be over-emphasised.
MR Arthrography is the investigation of choice in confirming the diagnosis of instability while a CT scan may be required if there is significant bony damage.
The most controversial topic is that of the first time dislocator. If there is a significant labral tear then the options of an arthroscopic labral repair or external rotation brace need to be considered. In the absence of a labral tear then physiotherapy is the treatment of choice.
For recurrent dislocators, the results of arthroscopic labral repairs with capsular plication techniques are approaching those of the gold standard open stabilisation. If, however, there is significant bony damage to the glenoid or humeral head then a bone block procedure may be the treatment of choice.
Rotator Cuff tears need to be excluded in older patients with instability and often in such cases an arthroscopic procedure to deal with the Rotator Cuff and Labrum can be done simultaneously.
