Decision-Making, Bracing, and Other Adjuncts for Management of In-Season Contact Athletes With Shoulder Instability

In-season contact athletes experiencing shoulder instability have a wide range of options available that require careful consideration. These athletes, and the physicians who treat them, have consequential decisions to make when it comes to managing an in-season anterior instability event. Controversy continues to exist on the best course of action: nonoperative vs operative management. Many factors play into the decision, including the timing of the injury (early or late in the athlete's season), the presence of bony injury, including bony Bankart or large Hill-Sachs defect, athlete age, and whether they are involved in contact sports. If the athlete is experiencing a primary instability event with a soft tissue injury alone without glenoid bone loss, then nonoperative management including bracing and physical therapy may be recommended with an expected return to sport within 7-21 days. When an athlete is indicated for surgical intervention, either due to recurrent instability or other pathology associated with the injury, the physician has several options available. The purpose of this article is to explore the surgical decision-making process for an in-season contact athlete experiencing shoulder instability.