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Managing Shoulder Instability in the Overhead Athlete

  • Injuries in Overhead Athletes (J Dines, Section Editor)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

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.

Summary

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.

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Authors and Affiliations

  1. Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, MN, USA

    Alexandra M. Arguello, Sara E. Till, Anna K. Reinholz, Kelechi R. Okoroha, Jonathan D. Barlow & Christopher L. Camp

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  1. Alexandra M. Arguello
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Correspondence to Christopher L. Camp.

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Conflict of Interest

Christopher L. Camp has received personal fees and non-financial support from Arthrex, personal fees and non-financial support from Zimmer Biomet, non-financial support from Stryker Corporation, and personal fees from Gemini Inc. Jonathan D. Barlow has received personal fees, non-financial support, and other from Arthrex; personal fees and other from Stryker Corporation; personal fees and other from Zimmer Biomet Holdings Inc.; and personal fees from DePuy Synthes Sales Inc. Kelechi R. Okoroha has received grants, personal fees, and other from Arthrex; personal fees and other from Stryker Corporation; personal fees and other from Zimmer Biomet Holdings Inc.; personal fees from Medical Device Business Services Inc.; personal fees from Smith & Nephew, Inc.; personal fees from Medtronics USA, Inc.; personal fees from Wright Medical Technology, Inc.; personal fees from Lilly USA, LLC; other from Pinnacle, Inc.; other from Medwest Associates; personal fees from Bioventus LLC; personal fees from Vericel Corporation; and other from Endo Pharmaceuticals, Inc. Alexandra M. Arguello, Sara E. Till, and Anna K. Reinholz declare that they have no conflict of interest.

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Arguello, A.M., Till, S.E., Reinholz, A.K. et al. Managing Shoulder Instability in the Overhead Athlete. Curr Rev Musculoskelet Med 15, 552–560 (2022). https://doi.org/10.1007/s12178-022-09796-x

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