Shoulder Instability in Contact and Collision Athletes: A Focused Review on Assessment, Management, and Treatment

Glenohumeral instability is a common injury affecting contact and collision athletes. Male sex, younger age at time of first dislocation, and contact sports participation are risk factors for recurrent instability. MRI is the gold standard to evaluate soft tissue structures, while CT is beneficial in quantifying glenoid bone loss and identifying on-track and off-track Hill-Sachs lesions. The management of shoulder instability in contact athletes is a nuanced, individualized process, taking into consideration the athlete's sport and playing position, hand dominance, timing of the in-season injury, and athlete's long-term goals. Shared decision-making is essential. Nonoperative management may allow athletes to return to sport the same season but carries a high risk of recurrent instability events and subsequent glenoid bone loss. Operative management confers a higher success rate in return to play but prevents in-season return to competition. Surgical approach is dependent on soft tissue damage, glenoid bone loss, and humeral head injury.