Shoulder instability

Abstract

Shoulder instabilty management has evolved over the last decade as more understanding of the pathoanatomy and natural history has come to the fore.
The two main groups with the acronym of TUBS (Traumatic, Unidirectional,Bankart and Surgery) and AMBRI (Atraumatic, Multidirectional, Bilateral, Rehabilitation, Inferior capsular shift) still allow us to have a broad understanding of the problem and an approach to the management.
Conservative treatment is no longer the mainstay of treatment for the TUBS high risk group, which is those patients under the age of 30 who partake in high risk sports. Surgery is recommended because of the high recurrence rates and the increase risk of progressive tissue damage and increased incidence of ostoearthritis. Immobilisation in external rotation is under review as a treatment for decreasing the recurrence rate in this group of patients.
The AMBRI group continue to have physiotherapy as primary modality of treatment.
Surgical treatment in both groups have good surgical outcomes when there is careful selection of patients and the appropriate procedure is performed