Skip to main content
SpringerLink
Log in

Shoulder Instability

  • Living reference work entry
  • First Online:
Book cover Sports Injuries

  • 306 Accesses

Abstract

Traumatic anterior instability is the most common instability of the shoulder. Although Bankart and Hill-Sachs lesions are the most common pathology, capsulolabral tear can develop in other areas of the joint. While controversy remains regarding the initial first-time instability, early surgical stabilization is strongly recommended in active young patients who have a substantial high risk of recurrence. Currently, arthroscopic repair is a popular procedure and provides successful results. Suture anchors, especially bioabsorbable suture anchors, are most commonly used for capsulolabral repairs. A large bone loss at the glenoid or humeral head can be replaced with a bone graft. Distinct from multidirectional hyperlaxity, which is characterized by asymptomatic translation, multidirectional instability has symptoms related to increased translations. In asymptomatic multidirectional hyperlaxity, the increased capsular ligamentous laxity is the underlying initial pathology. However, repetitive subluxation overloads the posteroinferior glenoid labrum by excessive rim-loading of the humeral head. This excessive rim-loading eventually develops a posteroinferior labral lesion, which is an essential lesion that develops shoulder symptoms. During this stage, the shoulder pain originates from the labral lesion when the humeral head glides over the pathologic labrum. Four types of labral lesion have been reported. Kim’s lesion is a concealed and incomplete tear of the posteroinferior labrum characterized by loss of labral height and retroversion, marginal crack, and looseness of the deep portion of the labrum. The retroversion of the glenoid labrum decreases the containment function of the glenohumeral joint, which further increases the instability.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  • Arciero RA, St Pierre P (1995) Acute shoulder dislocation. Indications and techniques for operative management. Clin Sports Med 14(4):937–953

    CAS  PubMed  Google Scholar 

  • Arciero RA, Taylor DC (1998) Primary anterior dislocation of the shoulder in young patients. A ten-year prospective study. J Bone Joint Surg Am 80(2):299–300

    CAS  PubMed  Google Scholar 

  • Arciero RA, Wheeler JH, Ryan JB, McBride JT (1994) Arthroscopic Bankart repair versus nonoperative treatment for acute, initial anterior shoulder dislocations. Am J Sports Med 22(5):589–594

    Article  CAS  PubMed  Google Scholar 

  • Bigliani LU, Newton PM, Steinmann SP, Connor PM, McLlveen SJ (1998) Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder. Am J Sports Med 26(1):41–45

    CAS  PubMed  Google Scholar 

  • Boileau P, Bicknell RT, El Fegoun AB, Chuinard C (2007) Arthroscopic Bristow procedure for anterior instability in shoulders with a stretched or deficient capsule: the “belt-and-suspenders” operative technique and preliminary results. Arthroscopy 23(6):593–601

    Article  PubMed  Google Scholar 

  • Bottoni CR, Wilckens JH, DeBerardino TM, D’Alleyrand JC, Rooney RC, Harpstrite JK et al (2002) A prospective, randomized evaluation of arthroscopic stabilization versus nonoperative treatment in patients with acute, traumatic, first-time shoulder dislocations. Am J Sports Med 30(4):576–580

    PubMed  Google Scholar 

  • Bottoni CR, Smith EL, Berkowitz MJ, Towle RB, Moore JH (2006) Arthroscopic versus open shoulder stabilization for recurrent anterior instability: a prospective randomized clinical trial. Am J Sports Med 34(11):1730–1737

    Article  PubMed  Google Scholar 

  • Bradley JP, Baker CL 3rd, Kline AJ, Armfield DR, Chhabra A (2006) Arthroscopic capsulolabral reconstruction for posterior instability of the shoulder: a prospective study of 100 shoulders. Am J Sports Med 34(7):1061–1071

    Article  PubMed  Google Scholar 

  • Burkhart SS, De Beer JF (2000) Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy 16(7):677–694

    Article  CAS  PubMed  Google Scholar 

  • Burkhart SS, De Beer JF, Barth JR, Cresswell T, Roberts C, Richards DP (2007) Results of modified Latarjet reconstruction in patients with anteroinferior instability and significant bone loss. Arthroscopy 23(10):1033–1041

    Article  PubMed  Google Scholar 

  • Carreira DS, Mazzocca AD, Oryhon J, Brown FM, Hayden JK, Romeo AA (2006) A prospective outcome evaluation of arthroscopic Bankart repairs: minimum 2-year follow-up. Am J Sports Med 34(5):771–777

    Article  PubMed  Google Scholar 

  • Connolly J (1972) Humeral head defects associated with shoulder dislocation: their diagnostic and surgical significance. Instr Course Lect 21:42–54

    Google Scholar 

  • DeBerardino TM, Arciero RA, Taylor DC (1996) Arthroscopic stabilization of acute initial anterior shoulder dislocation: the West Point experience. J South Orthop Assoc 5(4):263–271

    CAS  PubMed  Google Scholar 

  • DeBerardino TM, Arciero RA, Taylor DC, Uhorchak JM (2001) Prospective evaluation of arthroscopic stabilization of acute, initial anterior shoulder dislocations in young athletes. Two- to five-year follow-up. Am J Sports Med 29(5):586–592

    CAS  PubMed  Google Scholar 

  • Duncan R, Savoie FH 3rd (1993) Arthroscopic inferior capsular shift for multidirectional instability of the shoulder: a preliminary report. Arthroscopy 9(1):24–27

    Article  CAS  PubMed  Google Scholar 

  • Edwards TB, Boulahia A, Walch G (2003) Radiographic analysis of bone defects in chronic anterior shoulder instability. Arthroscopy 19(7):732–739

    Article  PubMed  Google Scholar 

  • Itoi E, Lee SB, Berglund LJ, Berge LL, An KN (2000) The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: a cadaveric study. J Bone Joint Surg Am 82(1):35–46

    CAS  PubMed  Google Scholar 

  • Itoi E, Hatakeyama Y, Sato T, Kido T, Minagawa H, Yamamoto N et al (2007) Immobilization in external rotation after shoulder dislocation reduces the risk of recurrence. A randomized controlled trial. J Bone Joint Surg Am 89(10):2124–2131

    Article  PubMed  Google Scholar 

  • Kim SH, Ha KI (2002) Bankart repair in traumatic anterior shoulder instability: open versus arthroscopic technique. Arthroscopy 18(7):755–763

    Article  PubMed  Google Scholar 

  • Kim SH, Ha KI, Kim YM (2002) Arthroscopic revision Bankart repair: a prospective outcome study. Arthroscopy 18(5):469–482

    Article  PubMed  Google Scholar 

  • Kim SH, Ha KI, Cho YB, Ryu BD, Oh I (2003a) Arthroscopic anterior stabilization of the shoulder: two to six-year follow-up. J Bone Joint Surg Am 85-A(8):1511–1518

    PubMed  Google Scholar 

  • Kim SH, Ha KI, Park JH, Kim YM, Lee YS, Lee JY, Yoo JC (2003b) Arthroscopic posterior labral repair and capsular shift for traumatic unidirectional recurrent posterior subluxation of the shoulder. J Bone Joint Surg Am 85-A(8):1479–1487

    PubMed  Google Scholar 

  • Kim SH, Ha KI, Yoo JC, Noh KC (2004a) Kim’s lesion: an incomplete and concealed avulsion of the posteroinferiorlabrum in posterior or multidirectional posteroinferior instability of the shoulder. Arthroscopy 20(7):712–720

    Article  PubMed  Google Scholar 

  • Kim SH, Kim HK, Sun JI, Park JS, Oh I (2004b) Arthroscopic capsulolabroplasty for posteroinferior multidirectional instability of the shoulder. Am J Sports Med 32(3):594–607

    Article  PubMed  Google Scholar 

  • Kim SH, Park JC, Park JS, Oh I (2004c) Painful jerk test: a predictor of success in nonoperative treatment of posteroinferior instability of the shoulder. Am J Sports Med 32(8):1849–1855

    Article  PubMed  Google Scholar 

  • Kim SH, Noh KC, Park JS, Ryu BD, Oh I (2005a) Loss of chondrolabral containment of the glenohumeral joint in atraumaticposteroinferior multidirectional instability. J Bone Joint Surg Am 87(1):92–98

    Article  PubMed  Google Scholar 

  • Kim SH, Park JS, Jeong WK, Shin SK (2005b) The Kim test: a novel test for posteroinferiorlabral lesion of the shoulder–a comparison to the jerk test. Am J Sports Med 33(8):1188–1192

    Article  PubMed  Google Scholar 

  • Kim SH, Kwak JH, Shin JH, Lee MS (2009) Arthroscopic repair of combined capsular and Bankart lesions in traumatic anterior shoulder instability [abstract]. In: 28th AANA meeting, San Diego, 30 Apr–3 May 2009

    Google Scholar 

  • Lafosse L, Lejeune E, Bouchard A, Kakuda C, Gobezie R, Kochhar T (2007) The arthroscopic Latarjet procedure for the treatment of anterior shoulder instability. Arthroscopy 23(11):1242 e1–1242 e5

    Article  PubMed  Google Scholar 

  • Lazarus MD, Sidles JA, Harryman DT 2nd, Matsen FA 3rd (1996) Effect of a chondral-labral defect on glenoid concavity and glenohumeral stability. A cadaveric model. J Bone Joint Surg Am 78(1):94–102

    CAS  PubMed  Google Scholar 

  • Lintner SA, Levy A, Kenter K, Speer KP (1996) Glenohumeral translation in the asymptomatic athlete’s shoulder and its relationship to other clinically measurable anthropometric variables. Am J Sports Med 24(6):716–720

    Article  CAS  PubMed  Google Scholar 

  • Lo IK, Parten PM, Burkhart SS (2004) The inverted pear glenoid: an indicator of significant glenoid bone loss. Arthroscopy 20(2):169–174

    Article  PubMed  Google Scholar 

  • Marquardt B, Witt KA, Liem D, Steinbeck J, Potzl W (2006) Arthroscopic Bankart repair in traumatic anterior shoulder instability using a suture anchor technique. Arthroscopy 22(9):931–936

    Article  PubMed  Google Scholar 

  • McFarland EG, Campbell G, McDowell J (1996) Posterior shoulder laxity in asymptomatic athletes. Am J Sports Med 24(4):468–471

    Article  CAS  PubMed  Google Scholar 

  • Mizuno N, Yoneda M, Hayashida K, Nakagawa S, Mae T, Izawa K (2005) Recurrent anterior shoulder dislocation caused by a midsubstance complete capsular tear. J Bone Joint Surg Am 87(12):2717–2723

    Article  PubMed  Google Scholar 

  • Mochizuki Y, Hachisuka H, Kashiwagi K, Oomae H, Yokoya S, Ochi M (2007) Arthroscopic autologous bone graft with arthroscopic Bankart repair for a large bony defect lesion caused by recurrent shoulder dislocation. Arthroscopy 23(6):677 e1–677 e4

    Article  PubMed  Google Scholar 

  • Neer CS 2nd, Foster CR (1980) Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder. A preliminary report. J Bone Joint Surg Am 62(6):897–908

    PubMed  Google Scholar 

  • Neer CS 2nd, Welsh RP (1977) The shoulder in sports. Orthop Clin North Am 8(3):583–591

    PubMed  Google Scholar 

  • Provencher MT, Bell SJ, Menzel KA, Mologne TS (2005) Arthroscopic treatment of posterior shoulder instability: results in 33 patients. Am J Sports Med 33(10):1463–1471

    Article  PubMed  Google Scholar 

  • Radkowski CA, Chhabra A, Baker CL 3rd, Tejwani SG, Bradley JP (2008) Arthroscopic capsulolabral repair for posterior shoulder instability in throwing athletes compared with nonthrowing athletes. Am J Sports Med 36(4):693–699

    Article  PubMed  Google Scholar 

  • Rhee YG, Lee DH, Lim CT (2005) Posterior capsulolabral reconstruction in posterior shoulder instability: deltoid saving. J Shoulder Elbow Surg 14(4):355–360

    Article  PubMed  Google Scholar 

  • Richards DP, Burkhart SS (2004) Arthroscopic humeral avulsion of the glenohumeral ligaments (HAGL) repair. Arthroscopy 20(Suppl 2):134–141

    Article  PubMed  Google Scholar 

  • Robinson CM, Howes J, Murdoch H, Will E, Graham C (2006) Functional outcome and risk of recurrent instability after primary traumatic anterior shoulder dislocation in young patients. J Bone Joint Surg Am 88(11):2326–2336

    Article  PubMed  Google Scholar 

  • Rowe CR, Patel D, Southmayd WW (1978) The Bankart procedure: a long-term end-result study. J Bone Joint Surg Am 60(1):1–16

    CAS  PubMed  Google Scholar 

  • Savoie FH 3rd, Holt MS, Field LD, Ramsey JR (2008) Arthroscopic management of posterior instability: evolution of technique and results. Arthroscopy 24(4):389–396

    Article  PubMed  Google Scholar 

  • Sedeek SM, Tey IK, Tan AH (2008) Arthroscopic Bankart repair for traumatic anterior shoulder instability with the use of suture anchors. Singapore Med J 49(9):676–681

    CAS  PubMed  Google Scholar 

  • Wolf BR, Strickland S, Williams RJ, Allen AA, Altchek DW, Warren RF (2005) Open posterior stabilization for recurrent posterior glenohumeral instability. J Shoulder Elbow Surg 14(2):157–164

    Article  PubMed  Google Scholar 

  • Wolf EM, Pollack M, Smalley C (2007) Hill-Sach’s “remplissage”: an arthroscopic solution for the engaging Hill-Sachs lesion [abstract]. Arthroscopy 23(suppl):e1–e2

    Article  Google Scholar 

  • Yamamoto N, Itoi E, Abe H, Minagawa H, Seki N, Shimada Y, Okada K (2007) Contact between the glenoidand the humeral head in abduction, external rotation, and horizontal extension: a new concept of glenoid track. J Shoulder Elbow Surg 16(5):649–656

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Madi Hospital, 646 Samsung-ro, Gangnam-gu, Seoul, 135-060, South Korea

    Seung-Ho Kim

Authors
  1. Seung-Ho Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seung-Ho Kim .

Editor information

Editors and Affiliations

  1. Dept. Orthopedics & Traumatology, Hacettepe University Fac. Medicine, Ankara, Turkey

    Mahmut Nedim Doral

  2. Gothenburg, Sweden

    Jon Karlsson

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag Berlin Heidelberg

About this entry

Cite this entry

Kim, SH. (2015). Shoulder Instability. In: Doral, M., Karlsson, J. (eds) Sports Injuries. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-36801-1_21-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-36801-1_21-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Online ISBN: 978-3-642-36801-1

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation