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From the American Academy of Orthopaedic Surgeons

Shoulder Surgery

Shoulder Pain

Dislocated Shoulder

Anterior Glenohumeral Instability
by William N. Levine, MD; Louis U. Bigliani, MD

Anterior dislocations account for nearly 95% of all shoulder dislocations. This typically occurs in athletes who are 25 years old and younger. Males are much more commonly affected than are females.The most common mechanism of injury is a fall onto an outstretched arm. The extremity is typically in an externally rotated and abducted position. The history and physical examination are crucial elements in the treatment of shoulder instability. The diagnosis is usually not subtle if the patient sustains an acute dislocation, but may be much more difficult in overhead athletes who may have subtle subluxation episodes.

This article reviews the pathophysiology and clinical presentation of anterior glenohumeral instability, and reviews management options for treating anterior glenohumeral instability, including nonsurgical intervention. The article reviews considerations in surgical management and presents two surgical techniques in depth: open anteroinferior capsular shift and arthroscopic Bankart repair. Video is available.

Keywords: anterior shoulder instability, shoulder laxity, recurrent dislocation, traumatic dislocation, Bankart lesion, shoulder pain, dislocated shoulder, shoulder dislocation, joint dislocation, recurrent anterior glenohumeral instability, acute anterior glenohumeral instability, incidence, mechanism of injury, etiology, classification, diagnosis, patient history, physical examination, apprehension test, anterior release test, anterior load and shift test, posterior load and shift test, sulcus test, active compression test, imaging, radiography, differential diagnosis, management, nonsurgical treatment, immobilization, surgical treatment, surgical techniques, anteroinferior capsular shift, arthroscopic Bankart procedure, indications, contraindications, outcomes, complications, rehabilitation

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