Clinicians › General-Health

Shoulder Clicking, Popping and Instability

Why a shoulder clicks, pops or feels like it slips — from harmless noises to labral tears and instability — what it means, and when it needs attention.

68 citationsUpdated Oct 2026

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Shoulder instability encompasses a spectrum of conditions ranging from posttraumatic recurrent pain to complex multidirectional laxity. In most cases, posttraumatic recurrent shoulder pain is caused by symptomatic glenohumeral instability [10]. Multidirectional instability (MDI) is a complex entity characterized by symptomatic global laxity of the glenohumeral joint [90], yet it remains a poorly understood problem where precise definition, classification, cause, and optimal treatment remain elusive [7]. Postero-inferior instability is specifically associated with capsular laxity and well-defined pathological lesions of the gleno-labral concavity [15]. In young overhead athletes with symptomatic instability, secondary impingement generally develops on the intraarticular part of the rotator cuff [83]. The rotator cuff should be considered globally, rather than individually, in preventing posterior instability [36].

Diagnostic accuracy is high for anterior pathology; in 20 shoulders (87%), findings of the anterior labrum in anterior shoulder instability accorded between MR arthrography and arthroscopy [1]. Natural history data indicate that approximately 20% of the general population shows unilaterally increased scaphoid mobility, with more than half of these individuals being totally asymptomatic [8]. Roughly one-third of subjects with rotary subluxation of the scaphoid had associated symptoms [8]. A cohort of 573 cases of atraumatic shoulder instability was followed for 3 years or more [6].

Management strategies vary by context and etiology. NHL team physicians strongly favor nonoperative management in-season for initial posterior instability events [5]. Surgical intervention for recurrent posterior glenohumeral instability improved both subjective symptoms and objective posterior instability in 8 out of 9 shoulders (89%) [4]. Arthroscopic resection of the superomedial corner of the scapula is useful for patients whose pain and clicking are clinically localized and who have failed conservative measures [9]. Release of the scarred portion of the scapholunate ligament was associated with widening of the scapholunate joint space to normal dimensions and cessation of the clicking phenomenon [2]. Arthroscopic repair of recurrent anterior shoulder instability yielded 25 excellent, 2 good, 1 fair, and 1 poor result in a prospective study of 29 shoulders with a minimum of 26 months’ follow-up (mean, 36 months) [25]. The short-term outcome of arthroscopic revision surgery is described as challenging and encouraging [21]. Open capsular shift with Achilles allograft augmentation demonstrated low rates of recurrent instability and improved clinical outcomes in patients with Ehlers-Danlos Syndrome [3]. However, there is a high prevalence of osteoarthritis in patients with shoulder instability who have been operated on with a staple capsulorrhaphy [40]. Rates of recurrent instability in published reports are generally higher with arthroscopic stabilization, and other complications occur [11]. Complications in arthroscopic shoulder instability surgery are frequently technique-specific and can be prevented by familiarity with the common pitfalls inherent in each arthroscopic repair procedure [22]. As knowledge of the basic science behind the pathophysiology of shoulder instability improves and more clinical reports emerge, the exact indications for arthroscopic stabilization are gradually being refined [13]. Spin is highly prevalent in abstracts of systematic reviews and meta-analyses investigating free bone block procedures for glenohumeral instability [34].

Background & Causes

Definitions and Classification

Posterior shoulder instability (PSI) is defined as a pathologic state characterized by dynamic, recurrent, and symptomatic partial or total loss of posterior joint contact [23]. This condition arises when a patient experiences pain and/or dysfunction resulting from the humeral head repeatedly translating posteriorly on the glenoid [28]. The trauma-instability-voluntarism classification serves as a useful framework for comparing pathogenesis and treatment outcomes in patients with glenohumeral instability [37].

Pathophysiology and Etiology

In posttraumatic anteroinferior shoulder instability, the appearance of an additional lesion with each recurrence explains the intraarticular disease [16]. While weakness of muscle was a primary cause of shoulder instability in cases of progressive muscular dystrophy [29], no significant difference in muscle contraction latency was detected between stable and unstable shoulders, suggesting no significant defect in muscular reflex activity in anterior shoulder instability [46]. Alteration of scapular position and motion is common in association with symptoms and dysfunction from glenohumeral instability [14].

In the throwing shoulder, injuries are often secondary to the accumulation of repetitive microtrauma which causes attrition and gradual failure [49]. Injury to the thrower’s shoulder joint occurs most commonly in the late cocking or early acceleration phases [49]. A combination of abnormal scapulothoracic and glenohumeral motion can injure the superior and posterosuperior labrum as well as the undersurface of the rotator cuff and posterior capsule in throwers [49]. Typical sites of pathoanatomy in the throwing shoulder include: * The superior and posterosuperior labrum [49] * The articular surface of the supraspinatus and infraspinatus [49] * The posterior capsule [49]

The approach to the treatment of shoulder instability should be based on a pathogenetic principle, as demonstrated in cases where rotator cuff tears manifested by recurrent anterior instability [27].

Bony and Radiographic Findings

Focal cortical bone loss at the inferior aspect of the glenoid appears to be a new radiographic sign of damage to the anterior capsular mechanism [31]. A shallow Hill-Sachs lesion was indicative of a greater degree of anterior instability of the shoulder [87]. Conversely, there are little predisposing osseous factors in traumatic anterior instability of the shoulder [88]. Bony changes of the glenoid resulting from shoulder instability do not support prophylactic shoulder stabilization to avoid the development of arthritic changes of a generalized and major degree [30].

Atraumatic and Specific Populations

A study followed 573 cases of atraumatic shoulder instability for 3 years or more [6].

Symptoms & Presentation

Shoulder Instability

Posterior shoulder instability is defined by dynamic, recurrent and symptomatic partial or total loss of posterior joint contact [23]. In most cases, posttraumatic recurrent shoulder pain is caused by symptomatic glenohumeral instability [10]. Clinically, shoulder instability can present as a symptom and sign of syringomyelia [72]. Awake side-to-side comparison of patients with anterior shoulder instability demonstrates slightly increased anterior translation on the affected side [35]. CINE MRI appears useful to confirm the clinical evaluation of shoulder instability [79].

In adolescents presenting with anterior shoulder instability, one-third had bipolar bone loss at the initial evaluation [80]. Male sex and ≥5 prior dislocations serve as independent predictors for this bone loss [80].

Snapping and Clicking

Subluxation of the annular ligament should be considered in the differential diagnosis of the clicking elbow [78].

Management

Non-Operative Management

Patients with multidirectional instability (MDI) require extensive physical therapy for 6 to 9 months before surgical consideration [45]. This regimen focuses on rotator cuff strengthening, scapular kinematics, and proprioceptive training [45]. Prescribed shoulder-strengthening exercises represent a useful treatment option for MDI [47]. The primary objective of treating the instability continuum is to halt progression before anatomic damage occurs through a specific and intense exercise program [62]. For atraumatic shoulder instability, nonsurgical treatment is the initial approach; surgery is reserved for patients who fail conservative management with persistent or worsening symptoms lasting at least 6 months [48]. Following a single traumatic injury causing posterior instability, the arm must be immobilized in neutral rotation with the elbow in adduction for 1 to 2 weeks, followed by therapy [52]. Most cases of AMBRI-type instability are managed nonoperatively through patient education and rehabilitation [54].

Operative Management: Anterior Instability

Arthroscopic repair for recurrent anterior shoulder instability demonstrated 25 excellent, 2 good, 1 fair, and 1 poor result in a series of 29 shoulders with a minimum of 26 months' follow-up, with the poor result attributed to recurrence [25]. For shoulders with a high rate of recurrency that are not suitable for arthroscopy, a combined Bankart repair and anterior capsular shift provides good long-term stability [33]. The Latarjet-Patte triple-locking procedure exhibits a recurrence rate lower than previously reported series, potentially due to systemic capsular retensioning on a coracoacromial ligament flap [38]. Open anterior capsular reconstruction using a tibialis anterior allograft serves as a feasible salvage procedure to avoid more invasive options like glenohumeral joint fusion [57]. Subscapularis and capsule augmentation is a safe technique for instability associated with capsule-labral deficit [58]. In the Caspari operation, 76% of patients continued sporting activities [59]. In a series of 18 patients undergoing repair of anterior-inferior instability, 11 (61%) maintained symmetric motion, while others experienced minimal loss of external rotation compared to the contralateral shoulder [66].

Arthroscopic free bone block transfer using iliac crest autograft with anchor-button fixation aims to reduce recurring instability and improve long-term outcomes for glenohumeral instability with glenoid bone loss [63]. Arthroscopic congruent-arc distal tibial allograft bone augmentation with cerclage fixation addresses anterior instability with bone loss by creating a bony 'ramp' to prevent anterior translation [69]. Recent randomized trials and systematic reviews have not shown the superiority of modern arthroscopic techniques compared with open repairs [54]. Open repair resulted in a significantly lower risk of recurrence regarding patient quality of life, potentially recommending it for younger male patients with a Hill-Sachs lesion to reduce recurrent instability risk [54]. Arthroscopic and open repair techniques yield comparable results when selected based on pathologic findings at surgery [54]. Available evidence indicates arthroscopic approaches are not as effective as open approaches in preventing recurrent instability or enabling return to work [54].

Misplaced suture anchors during arthroscopic repairs can cause secondary degenerative joint disease or "anchor arthropathy" [54]. Intra-articular infusion of local antibiotics via a pain pump after arthroscopic repairs carries a risk of glenohumeral chondrolysis [54]. Healing time for labral reattachment is likely equivalent to subscapularis tenotomy healing, so return-to-activity timelines should not differ between arthroscopic and open approaches [54]. For traumatic anterior instability in non-lax shoulders, an anatomic repair usually suffices; additional capsular tightening or shifting can result in stiffness [54]. For lax shoulders with relatively less-traumatic instability, management may require combined labral augmentation and capsular tightening, with care to avoid excessive and asymmetrical tightening [54]. Routine bone transfers for glenohumeral instability without major glenoid bone loss are not advisable due to increased risks of arthritis, screw-related problems, subscapularis damage, and revision difficulty [54]. In AMBRI-type instability, the redundant capsule can augment the labrum to create a deeper stabilizing concavity rather than risking overtightening with capsular plication [54]. Rotator interval closure may be a useful adjunct for AMBRI-type instability [54].

Operative Management: Posterior Instability

Surgical treatment for recurrent posterior glenohumeral instability improved both subjective symptoms and objective posterior instability in 8 of 9 shoulders (89%) [4]. No progressive radiographic signs of glenohumeral arthritis were observed up to 22 years after open posterior stabilization [18]. No complications or recurrences were noted in 11 patients treated with 4-portal arthroscopic stabilization for posterior shoulder instability [20]. Following anterior capsular shift reconstruction for symptomatic posterior glenohumeral instability, five shoulders were graded excellent, three good, and one fair [39]. The surgical goal is to repair posterior capsulolabral structures and re-tension the posterior capsule to prevent recurrent instability [52].

Soft-tissue procedures include open or arthroscopic labral repair and posterior capsular shift, with some authors recommending rotator interval plication [52]. Options for an engaging reverse Hill-Sachs lesion include structural bone graft to the humeral head, the McLaughlin or modified McLaughlin procedure, or resurfacing arthroplasty [52]. Options for posterior glenoid bone loss include distal tibial allograft or autograft reconstruction using posterior acromion, iliac crest, or distal clavicle [52]. Recurrence is the most common complication, reported at 8.5% in the general population [52]. Recurrence rates are highest in overhead athletes and increase with posterior glenoid bone loss >20%, which is a contraindication to arthroscopic soft-tissue stabilization alone [52]. Shoulder stiffness or adhesive capsulitis is a concern with rotator interval plication [52]. Overtightening of the posterior capsule can lead to anterior subluxation or coracoid impingement [52]. In arthroscopic labral repair, a high lateral portal provides better access than a standard posterior portal [52].

Postoperatively, the shoulder is placed in a rigid immobilizer with the arm abducted to 30° in neutral rotation [52]. Strengthening exercises begin at 12 weeks postoperatively [52]. Patients may return to heavy labor or contact sports 6 months after surgery [52]. The pooled published rate of return to any sport is 91%, and to preinjury level of sport is 67% [52].

Operative Management: Multidirectional Instability

Surgery for MDI is appropriate for patients with pain and instability interfering with normal or sport-related activity who have failed extensive nonsurgical treatment [45]. Approximately 20% of patients with MDI fail nonsurgical management [45]. Surgery is contraindicated for voluntary dislocators and patients who have not attempted physical therapy [45]. Arthroscopic pancapsular plication ± rotator interval closure is a surgical technique, with anterior or posterior labral repair indicated if labral pathology is encountered [45]. To avoid asymmetric tightening, capsulorrhaphy should address inferior redundancy in a balanced fashion [45]. Open anterior-inferior capsular shift is another surgical technique for MDI [45]. Recurrence of MDI is reported at 7% for both open and arthroscopic techniques [45]. Complications include axillary nerve injury, stiffness (rare), and subscapularis insufficiency (after open procedure) [45].

A study demonstrated low rates of recurrent instability and improved clinical outcomes in patients with MDI treated with open capsular shift with Achilles allograft augmentation, including those with Ehlers-Danlos syndrome [3]. Achilles allograft stabilization is currently the only treatment with any success rate for multidirectional glenohumeral instability in patients with Ehlers-Danlos syndrome [32]. The long-term effectiveness of arthroscopic capsular shift in treating multidirectional shoulder instability has been shown [64].

Salvage and End-Stage Procedures

Shoulder arthrodesis eliminated recurrent instability and provided a relative decrease in pain and increase in function [17]. Osteoarticular allograft reconstruction of a large glenoid and humeral head defect in recurrent shoulder instability resulted in the patient being asymptomatic and living an active lifestyle with a 10/10 satisfaction on the University of Pennsylvania Shoulder Score, though long-term follow-up may not be as favorable [26]. Total shoulder arthroplasty (TSA) and glenohumeral arthrodesis (GHA) are viable options in treating end-stage recurrent shoulder instability [70].

Key Considerations

Diagnostic and Pathological Findings

Accurate diagnosis relies on correlating imaging with arthroscopic findings. In 87% of 20 shoulders, anterior labrum pathology identified on MR arthrography accorded with arthroscopic findings [1]. The rotator cuff must be considered globally rather than individually when preventing posterior instability [36]. Pathological evolution in posttraumatic anterior shoulder instability is characterized by the appearance of an additional lesion in the labrum-ligament complex with each recurrence [16]. Furthermore, humeral and glenoid detachment of the anterior inferior glenohumeral ligament is a specific cause of anterior shoulder instability [19].

Surgical Outcomes and Complications

Surgical intervention for recurrent posterior glenohumeral instability improved both subjective symptoms and objective instability in 89% of 9 shoulders [4]. Following repair of humeral and glenoid detachment of the anterior inferior glenohumeral ligament, no patients experienced instability at an average follow-up of 26 months [19]. Arthroscopic management of a failed instability repair provides similar success to open reconstruction when proper indications are selected [61]. In a prospective study of 29 shoulders with a minimum of 26 months' follow-up, arthroscopic repair for recurrent anterior shoulder instability yielded 25 excellent, 2 good, 1 fair, and 1 poor result due to recurrence of instability [25]. Arthroscopic treatment of bidirectional glenohumeral instability resulted in 91% of patients (49 of 54) rating good to excellent on the Rowe Scale at final follow-up, whereas no patients achieved this rating preoperatively [75]. Anterior capsular reconstruction using a dermal allograft maintained shoulder stability with no recurrent dislocations at a final follow-up of 24 months [77].

Operative technique significantly influences recurrence rates and long-term stability. The Latarjet-Patte Triple-locking Procedure demonstrates a lower recurrence rate than previous series, potentially reflecting the beneficial effect of systemic capsular retensioning on a flap of coracoacromial ligament [38]. For shoulders with a high rate of recurrency that are not successful candidates for arthroscopic procedures, Bankart repair combined with anterior capsularshift provides good long-term stability [33]. Publication period subgroup analysis suggests that historical instability differences between arthroscopic and open Bankart repair were driven primarily by earlier studies, whereas contemporary studies show comparable instability and functional outcomes [86]. Complications in arthroscopic shoulder instability surgery are frequently technique-specific and can be prevented by familiarity with common pitfalls inherent in each repair procedure [22]. In cases of arthritis following instability surgery, glenohumeral arthroplasty resulted in satisfactory outcomes for 77% of patients (13) and unsatisfactory results for 23% (4) at an average follow-up period of 3 years [82].

Patient Management and Prognosis

Prognosis and management strategies vary by etiology and patient profile. The natural course of atraumatic shoulder instability was followed in 573 cases for 3 years or more [6]. Patients with Ehlers-Danlos syndrome undergoing open capsular shift with Achilles allograft augmentation for multidirectional shoulder instability demonstrated low rates of recurrent instability and improved clinical outcomes [3]. The short-term outcome in a small series of arthroscopic revision surgery in shoulder instability is challenging and encouraging [21]. Distinguishing the type of instability allows development of an appropriate treatment plan and explanation to the patient of options and anticipated outcomes [56].

Key Evidence

• [L4] In another 20 shoulders (87%), both findings accorded. [1] (10.1016/s1058-2746(95)80288-6)
• [L5] Release of the scarred portion of the scapholunate ligament was associated with widening of the scapholunate joint space to normal dimensions and cessation of the clicking phenomenon. [2] (10.1016/s0363-5023(79)80003-9)
• [L4] The study demonstrated low rates of recurrent instability and improved clinical outcomes in this high-risk population. [3] (10.1016/j.jse.2026.05.024)
• [L4] In 8 / 9 shoulders (89%), both subjective symptoms and objective posterior instability were improved. [4] (10.1016/s1058-2746(96)80550-7)
• [L4] NHL team physicians strongly favor nonoperative management in-season for initial posterior instability events of the shoulder. [5] (10.1177/23259671261440208)
• [L3] We followed 573 cases of atraumatic shoulder instability for 3 years or more. [6] (10.1067/mse.2001.111962)
• [L5] Multidirectional instability (MDI) of the shoulder is a complex problem that is not yet well understood, with the precise definition, classification, cause, and optimal method of treatment remaining elusive. [7] (10.1016/s1058-2746(10)80009-6)
• [L4] Roughly one-third of these subjects had associated symptoms, and it is useful to know that approximately 20% of the general population shows unilaterally increased scaphoid mobility and that more than half of these are totally asymptomatic. [8] (10.1016/0266-7681(93)90199-p)
• [L4] Arthroscopic resection of the superomedial corner of the scapula is a useful technique in patients whose pain and clicking can be clinically localized and who have failed to respond to conservative measures. [9] (10.1016/s1058-2746(99)90056-3)
• [L4] In most cases posttraumatic recurrent shoulder pain caused by symptomatic glenohumeral instability. [10] (10.1016/s1058-2746(96)80239-4)
• [Paper] Rates of recurrent instability in published reports are generally higher with arthroscopic stabilization, and other complications occur. [11] (10.1016/s0278-5919(05)70182-4)
• [Paper] As the knowledge of the basic science behind the pathophysiology of shoulder instability improves and as more clinical reports emerge, the exact indications for arthroscopic stabilization are gradually being refined. [13] (10.1016/s0278-5919(05)70294-5)
• [Paper] Alteration of scapular position and motion is common in association with symptoms and dysfunction from glenohumeral instability. [14] (10.1097/00132589-200309000-00001)
• [L3] Postero-inferior shoulder instability is associated with capsular laxity and well defined pathological lesions of the gleno-labral concavity. [15] (10.1016/s1058-2746(98)90088-x)
• [L3] By delineating the appearance of an additional lesion with each recurrence, we hope to have created an explanation of intraarticular disease in posttraumatic anteroinferior shoulder instability. [16] (10.1016/s1058-2746(99)90058-7)
• [L4] Shoulder arthrodesis eliminated recurrent instability and provided a relative decrease in pain and increase in function. [17] (10.1016/s1058-2746(02)86883-5)
• [L4] No progressive radiographic signs of glenohumeral arthritis were seen up to 22 years after surgery. [18] (10.1016/j.jse.2004.06.008)
• [L4] None of the patients has had instability after an average follow-up of 26 months. [19] (10.1016/s1058-2746(97)90064-1)
• [L4] No complication or recurrence of instability was noted in the 11 patients. [20] (10.1016/s1058-2746(03)00039-9)
• [L4] The short-term outcome in this small series of arthroscopic revision surgery in shoulder instability is challenging and encouraging. [21] (10.1016/s1058-2746(96)80315-6)
• [L5] Complications are frequently technique-specific and can be prevented by familiarity with the common pitfalls inherent in each arthroscopic repair procedure. [22] (10.1016/s0278-5919(05)70183-6)
• [L5] Posterior shoulder instability (PSI) is defined by dynamic, recurrent and symptomatic partial or total loss of posterior joint contact. [23] (10.1016/j.otsr.2024.104061)
• [L3] The prospective study of an initial series of 29 shoulders with a minimum of 26 months’ follow-up (mean, 36 months) shows 1 poor result because of the recurrence of instability (arthroscopic revision has had a successful outcome), 1 fair result, 2 good, and 25 excellent results (according to the Duplay scale). [25] (10.1097/00132589-200112000-00002)
• [L5] The results in our patient are short term and that long-term follow-up may not be as favorable; however, the patient is currently asymptomatic and living an active lifestyle with a 10/10 satisfaction on the University of Pennsylvania Shoulder Score. [26] (10.1097/bte.0b013e318057fb1a)
• [L4] The results obtained in our patients testify that the approach to the treatment of the shoulder instability should be based on a pathogenetic principle. [27] (10.1016/s1058-2746(96)80199-6)
• [L5] Posterior shoulder instability is a pathologic state that arises when a patient has pain and/or dysfunction that occurs when the humeral head repeatedly translates posteriorly on the glenoid. [28] (10.1097/01.bte.0000171162.82430.5a)
• [L4] We feel weakness of muscle was one of the main causes of shoulder instability in these cases. [29] (10.1016/s1058-2746(96)80440-x)
• [L4] These findings do not support prophylactic shoulder stabilization to avoid the development of arthritic changes of a generalized and major degree. [30] (10.1016/s1058-2746(96)80056-5)
• [L4] This pattern of bone loss, although small and uncommon, appears to be a new radiographic sign of damage to the anterior capsular mechanism. [31] (10.1016/1058-2746(92)90092-h)
• [L4] Currently, it is the only treatment with any success rate for multidirectional glenohumeral instability in patients with Ehlers-Danlos syndrome. [32] (10.1097/bte.0b013e31816938da)
• [L4] This combined procedure provides good long term stability for shoulders with high rate of recurrency and which seem to be not a successful case for an arthroscopic procedure. [33] (10.1016/s1058-2746(95)80098-0)
• [L4] Spin is highly prevalent in abstracts of systematic reviews and meta-analyses investigating FBB for glenohumeral instability. [34] (10.1177/03635465251338079)
• [L4] Awake side-to-side comparison of patients with anterior shoulder instability demonstrated slightly increased anterior translation on the affected side. [35] (10.1016/s1058-2746(99)90153-2)
• [L5] The rotator cuff should be considered globally and not individually in preventing posterior instability of the shoulder. [36] (10.1016/s1058-2746(95)80169-3)
• [L4] This classification is very useful to compare pathogenesis and results of treatment in patients with glenohumeral instability. [37] (10.1016/s1058-2746(05)80051-5)
• [L4] The recurrence rate reported in this study is lower than that reported in previously series and may reflect the beneficial effect of systemic capsular retensioning on a flap of coracoacromial ligament. [38] (10.1097/bte.0b013e3182961957)
• [L4] Five shoulders were graded as excellent, three good, and one fair. [39] (10.1016/s1058-2746(96)80372-7)
• [L4] There is a high prevalence of osteoarthritis in patients with shoulder instability who have been operated on with a staple capsulorrhaphy. [40] (10.1016/s1058-2746(96)80203-5)
• [L4] No significant difference in muscle contraction latency was detected between the stable and unstable shoulders suggesting that there was no significant defect in muscular reflex activity. [46] (10.1016/s1058-2746(97)90036-7)
• [L3] The prescribed shoulder-strengthening exercise represents a useful treatment option for patients with multidirectional shoulder instability. [47] (10.1016/s1058-2746(02)86886-0)
• [L5] Being able to distinguish the type of instability then allows development of an appropriate treatment plan and explanation to the patient of options and anticipated outcomes. [56] (10.1016/s0894-1130(12)80078-0)
• [L4] The presented technique of open anterior capsular reconstruction of the shoulder for chronic instability using a tibialis anterior allograft is a feasible salvage procedure that can help in avoiding much more invasive and lifestyle-limiting procedures such as fusion of the glenohumeral joint. [57] (10.1097/bte.0b013e31817303e6)
• [Paper] The subscapularis and capsule augmentation is a safe and relatively easy technique for the treatment of shoulder instability. [58] (10.1016/j.eats.2024.103313)
• [L4] Majority (76%) of the patients could continue their sporting activities. [59] (10.1016/s1058-2746(96)80382-x)
• [L4] Arthroscopic management of a failed instability repair provides similar success to open reconstruction if one selects proper indications. [61] (10.1097/00132589-200212000-00008)
• [L5] The crux of treatment is to halt the instability before anatomic damage occurs by means of a specific and intense exercise program. [62] (10.1016/s0894-1130(12)80106-2)
• [L5] This technique with an anchor-button unit attempts to reduce recurring instability and improve long-term outcomes for patients with glenohumeral instability accompanying glenoid bone loss. [63] (10.1002/atn2.70250)
• [L4] The study shows the long-term effectiveness of arthroscopic capsular shift in the treatment of multidirectional shoulder instability. [64] (10.1016/s1058-2746(99)90158-1)
• [L4] Of the 18 patients, 11 (61%) maintained symmetric motion; the others had minimal loss of external rotation compared with that of the contralateral shoulder. [66] (10.1016/s1058-2746(95)80019-0)
• [L5] The technique aims to address anterior shoulder instability with bone loss by creating a bony 'ramp' that prevents anterior translation. [69] (10.1016/j.eats.2024.103344)
• [L2] TSA and GHA are viable options in treating end-stage recurrent shoulder instability. [70] (10.1016/j.jseint.2025.101429)
• [L4] Shoulder instability can be a presenting symptom and sign of syringomyelia. [72] (10.1016/1058-2746(92)90094-j)
• [L4] At final follow-up, 91% (49 of 54 patients) rated good to excellent according to the Rowe Scale, whereas no patients rated good to excellent preoperatively. [75] (10.1067/mse.2001.109324)
• [L5] The shoulder remained stable with no recurrent dislocations at a final follow-up of 24 months. [77] (10.1097/bte.0000000000000172)
• [L4] Subluxation of the annular ligament should be considered in the differential diagnosis of the clicking elbow. [78] (10.1016/s1058-2746(00)90012-0)
• [Paper] The CINE MRI appears useful to confirm the clinical evaluation of shoulder instability. [79] (10.1016/s1058-2746(96)80178-9)
• [L3] One-third of adolescents in our series presenting with anterior shoulder instability had bipolar bone loss at the initial evaluation, with male sex and ≥5 prior dislocations as independent predictors. [80] (10.1177/03635465261483327)
• [L4] At an average follow-up period of 3 years, 13 (77%) satisfactory results and four (23%) unsatisfactory results were obtained. [82] (10.1016/s1058-2746(05)80060-6)
• [L4] In the majority of the cases secondary impingement gets developed, generally on the intraarticular part of the rotator cuff. [83] (10.1016/s1058-2746(95)80143-x)
• [L4] Publication period subgroup analysis suggests that historical instability differences were driven primarily by earlier studies, whereas contemporary studies show comparable instability and functional outcomes between approaches. [86] (10.1177/03635465261443999)
• [L4] A shallow Hill-Sachs lesion was indicative of a greater degree of anterior instability of the shoulder. [87] (10.1067/mse.2000.106920)
• [L4] The authors consider that there are little predisposing osseous factors in traumatic anterior instability. [88] (10.1016/s1058-2746(95)80233-9)
• [L5] Multidirectional instability (MDI) of the shoulder is a complex entity characterized by symptomatic global laxity of the glenohumeral joint. [90] (10.1016/s0278-5919(05)70207-6)

See Also

• Osteoarthritis

References

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[2] A cause of painful clicking wrist: A case report. The Journal of Hand Surgery. 1979. DOI: 10.1016/s0363-5023(79)80003-9

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[5] Treatment of Posterior Shoulder Instability in National Hockey League Players: A Survey of NHL Team Physicians. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671261440208

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[7] Multidirectional instability: Current concepts. Journal of Shoulder and Elbow Surgery. 1995. DOI: 10.1016/s1058-2746(10)80009-6

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[9] Arthroscopic partial resection of the scapula for snapping scapula: A new technique. Journal of Shoulder and Elbow Surgery. 1999. DOI: 10.1016/s1058-2746(99)90056-3

[10] Arthroscopic findings in posttraumatic-progressive anterior shoulder instability in professional atheletes. Journal of Shoulder and Elbow Surgery. 1996. DOI: 10.1016/s1058-2746(96)80239-4

[11] OPEN SHOULDER INSTABILITY SURGERY. Clinics in Sports Medicine. 1999. DOI: 10.1016/s0278-5919(05)70182-4

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