AANA Lab Course 912 - Arthroscopic Shoulder Solutions-Instability I_ Basics (Case Discussion)-Larry D. Field, M.D.

Instability I_ Basics (Case Discussion)-Larry D. Field, M.D.

Pdf Summary

This comprehensive overview on shoulder instability, presented by Dr. Larry D. Field, emphasizes the evolution, diagnosis, and management of anterior, posterior, and multidirectional instability (MDI) of the shoulder.<br /><br />Arthroscopic shoulder stabilization has progressed significantly since the 1980s, moving from metallic staples and transglenoid drilling to modern suture anchors and capsular tucks with refinements in instrumentation and understanding of pathoanatomy. Anterior instability often results from traumatic labral detachment ("Bankart lesion") and is commonly treated arthroscopically, which is now considered the gold standard under reasonable conditions due to comparable or superior clinical outcomes, low recurrence, and minimal complications compared to open techniques. Arthroscopic stabilization allows unparalleled joint assessment, preserves subscapularis integrity, and improves cosmesis. Positioning (lateral decubitus preferred) and surgical technique adjustments optimize outcomes.<br /><br />Posterior instability is more challenging to diagnose and often involves capsular laxity rather than discrete labral tears, with a higher prevalence among certain athletes (e.g., football linemen, rowers). Although less common than anterior dislocations, posterior instability requires careful history, physical examination, and imaging to identify associated pathologies like glenoid retroversion or combined labral and capsular lesions. Arthroscopic posterior stabilization shows high success rates (over 90% in multiple studies), with emphasis on capsular shift and addressing capsular laxity.<br /><br />MDI primarily involves capsular laxity rather than labral tears and responds well to extended non-operative treatment focused on scapular stability and physical therapy. Arthroscopic capsular plication is effective in selected failures of conservative treatment, balancing capsular tension to restore functional stability while preserving normal motion.<br /><br />In summary, arthroscopic stabilization is a reliable, technically demanding approach necessitating accurate diagnosis and individualized treatment strategies for anterior, posterior, and multidirectional shoulder instability to optimize outcomes and minimize recurrence.

Keywords

shoulder instability

arthroscopic shoulder stabilization

anterior instability

posterior instability

multidirectional instability

Bankart lesion

capsular laxity

capsular plication

shoulder arthroscopy techniques

shoulder joint management