Managing patients with shoulder instability

The shoulder is the most mobile joint in the body but, as a consequence is also the most unstable. Stability is aided by boney, ligamentous and muscular structures and as a result may be related to trauma, hyper mobility or muscle patterning. Acute management requires careful history and examination with gentle reduction by a number of means and then may be treated conservatively or surgically. There is a high rate of recurrence with the conservatively treated shoulder in the younger population. Over 150 surgical procedures have been described to treat recurrent shoulder instability and these range from open 'anatomic' repair to tightening procedures though bone/coracoid ligament transfers and arthroscopic procedures. Several factors have been identified to help guide decision-making and these are summarized in the ISIS score which can be used to aid decision-making in these challenging patients.