The Management of Atraumatic Shoulder Instability

The definition of atraumatic shoulder instability is ‘abnormal motion or position of the shoulder that leads to pain, subluxations, dislocations and functional impairment…. Without any history of a significant preceding injury’. Atraumatic shoulder instability can be a severely disabling condition resulting in reduced quality of life, even simple daily tasks such as reaching for a glass may lead to subluxation and pain. The management of ASI remains a challenging and under-researched area. This is in part due to the multiple potential underlying causes which can co-exist in each presentation, and the strong association with psychosocial co-morbidities that can negatively impact engagement with treatment and post-operative outcomes. This review will detail the anatomical and biomechanical basis of ASI, the essential considerations in clinical assessment and investigation, as well as the current evidence and ongoing controversies regarding management.