Sports Medicine and Arthroscopy Reviews: Shoulder Instability

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Excerpt

Historically, those affected by shoulder instability, predominantly young men engaged in upper extremity-dominant activities, have been required to give up or seriously modify their active lifestyles. As orthopedic surgery has evolved and advanced, techniques have become more refined. With more modern surgical techniques has come the ability to more closely mimic the original anatomy and function present before injury. Nowhere are these changes in the way a problem is treated and how assessment of outcome is measured more pronounced than in the diagnosis and treatment of shoulder instability.
In the current edition of Sports Medicine and Arthroscopy Reviews, we have been able to assemble the latest in the understanding of the pathophysiology, diagnosis, treatment, and outcomes of glenohumeral joint instability. The epidemiology of glenohumeral joint instability is described in detail. The chapter on physical examination findings correlates the preoperative findings on examination and imaging with those at the time of surgery.
Several of the chapters in this edition of Sports Medicine and Arthroscopy Reviews provide an excellent review of the increased role for arthroscopic management of anterior shoulder instability as well as posterior instability and other special conditions such as Superior Labrum Anterior Posterior tears and panlabral tears.
If there is one accepted paradigm in surgery it is that there is no “one” way to treat everything and that each patient’s condition must be treated as a unique situation. Recently, it has become apparent that, like all innovations, surgery through arthroscopic means does have its limitations. This edition of Sports Medicine and Arthroscopy Reviews commits significant attention to this evolving understanding of how best to determine whether arthroscopic or open techniques should be applied to patients with shoulder instability. The concept of the glenoid track is discussed and should be a concept that any shoulder surgeon should rely on in their diagnostic process. Knowledge about the mechanism of injury and the relationship of the number of recurrences with outcome are also well illustrated.
This edition of Sports Medicine and Arthroscopy Reviews includes an extensive chapter on rehabilitation of shoulder instability both when initially treated nonoperatively and postoperatively; it contains concepts and central rehabilitation tenets that reveal an evolution in thought over the years.
In sum, shoulder instability represents an orthopedic condition that has gone from very little understanding of its pathophysiology to one where a great understanding has developed. We now find ourselves in a new golden age of shoulder instability treatment that is not only represented by the development of advanced, arthroscopic techniques but is also represented by improved nuance regarding which techniques are best applied in each situation.

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