Up to date comprehensive review of atraumatic shoulder instability: anatomy, causes, management, and psychosocial considerations

Atraumatic shoulder instability (ASI) poses a significant challenge in orthopedic practice, characterized by functional and anatomical deficits in the glenohumeral joint (GHJ) resulting from chronic overuse rather than acute trauma. This review aims to provide a comprehensive summary of the current understanding of ASI, covering its anatomy, etiology, the influence of psychosocial factors and primarily focusing on management strategies. The management of ASI is a central focus for restoring normal biomechanical and anatomical function of the injured upper extremity. A literature review was conducted, seeking to further understand the current treatment approaches of this condition. The management of ASI employs differing combinations of physiotherapy, rehabilitation and surgery, with treatment dictated by patient stratification models and patient reported outcome measures (PROMs). Clinical stratification of patients along a diagnostic continuum aid devising appropriate patient-centered treatment and is based on the extent of anatomical disruption. Exercise-focused therapy, particularly the Watson Instability Program, is highlighted as a promising approach, emphasizing scapular and rotator cuff muscle strengthening to restore active shoulder control. Surgical interventions, such as open inferior capsular shift, arthroscopic capsular plication, and electrothermal arthroscopic capsulorrhaphy, are discussed in detail, with emphasis on their indications, outcomes, and comparative effectiveness. We also shed a light on the psychosocial factors role in ASI management outcomes, underscoring the importance of a multidisciplinary approach in patient care. In summary, ASI management necessitates a holistic approach that integrates anatomical understanding, tailored treatment protocols, and consideration of psychosocial factors. Further research is warranted to refine treatment strategies, validate rehabilitation programs, and explore the interplay between psychological factors and physical outcomes in ASI patients.