Shoulder Instability in the Skeletally Immature Athlete

Although clinically significant shoulder instability in the skeletally immature is uncommon, the management of instability in the skeletally immature athlete is particularly challenging. As in the skeletally mature athlete, a variety of instability patterns can exist, including traumatic, atraumatic, anterior, posterior, or multidirectional. The optimal course of and predicted response to treatment is dependent in part on the etiology and pattern of instability. Traumatic anterior dislocation often results in Bankart lesions and unacceptably high rates of recurrence with nonsurgical treatment, such as immobilization, rest, and rehabilitation. Surgical treatment, including labral repair or capsulolabral plication, may be required. Although traumatic posterior dislocations are less common and believed to have lower recurrence rates, surgical treatment may be necessary. Atraumatic shoulder instability can be even more challenging but may respond to extended periods of nonsurgical treatment. In recalcitrant cases, capsulorraphy may be required. In the event of surgical treatment for any pattern of instability, the postoperative rehabilitation process involves a lengthy course of physical therapy to restore shoulder range of motion and regain muscular strength. Return to sports is allowed after the athlete has achieved complete range of motion, normalized strength, and completed a progressive functional rehabilitation program.