Shoulder instability


Shoulder instability is a relatively common injury. The incidence of traumatic shoulder instability in the athletic population is approximately two times greater than in the general population, especially amongst those involved in contact or overhead sports. Instability can be due to acute trauma, repetitive microtrauma or related to congenital issues like generalised laxity. 

Instability is a pathologic condition defined by excessive translation of the humeral head on the glenoid resulting in loss of function. This may manifest as subluxation or dislocation and symptoms include pain and apprehension.

Instability may be passive or active. It is distinct from hyperlaxity which involves the asymptomatic, passive translation of the humeral head on the glenoid and may be beneficial in a sporting environment. Anterior glenohumeral instability encompasses a broad spectrum of clinical symptoms and presentations. 

There are multiple factors that need to be considered when treating an athlete with a shoulder instability event, including:

  • soft tissue versus bony injury
  • primary versus recurrent events
  • timing in relation to the competitive season
  • age of the athlete.

Imaging is used to help quantify the pathological lesions and to guide management decisions. A primary instability event may progress to recurrent instability and decisions with regards to management aim to reduce the recurrence risk rate.

Management options include non-surgical immobilisation and exercise rehabilitation, or surgical repair as either an arthroscopic or open procedure. Each case should be addressed individually and the management plan discussed with risks of recurrence and treatment, as well as possible advantages with the athlete, their family and coach and training staff.

Objectives of this course:

  • Identify risk factors and mechanisms of injury for anterior shoulder instability in athletes. 
  • Be able to diagnose anterior shoulder instability based on a history and clinical examination
  • Be able to order appropriate investigations and understand the typical X-ray findings associated with anterior shoulder instability and indications for high tech imaging
  • Have an understanding of the management options for primary and recurrent anterior shoulder instability in the athlete, including immobilisation, rehabilitation, and open surgical repair.
  • Understand when to refer patients with anterior shoulder instability for further evaluation, including to a physiotherapist, sports medicine physician and orthopaedic surgeon.


Once you have completed this short course and quiz, please click 'submit' where you will be taken to the results page. From here you can print your certificate for 1 Continuing Professional Development (CPD) hour.


This content was created by Dr Helen Joyce Fulcher MBChB, DipPaed, PGCertHSc(Sports Med), in June 2016.

The material is presented by the Goodfellow Unit (GFU), an accredited continuing medical education/ continuing professional development (CME/CPD) provider for the Royal New Zealand College of General Practitioners and functions under a tripartite agreement between the Goodfellow Foundation, the College and the University of Auckland. The Unit is located within the Department of General Practice and Primary Health Care, and within the School of Population Health.


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