Instability

Shoulder instability is a common and debilitating condition, often resulting from traumatic injuries, repetitive strain, or underlying structural abnormalities. This chapter aims to provide a comprehensive review of the surgical treatment options available for the different types of shoulder instability, including anterior, posterior, and multidirectional instability as well as lesions of the long head of the biceps tendon. Anterior shoulder instability is the most prevalent form. Surgical interventions for anterior instability encompass both open and arthroscopic procedures, such as Bankart repair, remplissage, and Latarjet procedure. These techniques address the torn or stretched structures in the anterior capsule and labrum, promoting shoulder joint stability and preventing recurrent dislocations. Posterior shoulder instability, albeit less frequent, poses significant challenges to patients. Surgical management involves addressing posterior labral tears and capsular laxity through posterior Bankart repair or posterior capsular shift procedures, aiming to restore joint stability and alleviate symptoms. Multidirectional shoulder instability necessitates a tailored surgical approach. Capsular plication is commonly employed to tighten the joint capsule and stabilize the shoulder in these cases. The treatment of SLAP (superior labrum anterior to posterior) lesions typically depends on the severity of the injury. High grade lesions often require surgical intervention with arthroscopic procedures commonly employed to repair or reattach the torn labrum and stabilize the shoulder joint. In cases where a repair is not feasible, a tenodesis of the long head of the biceps can be performed alternatively.