Management of In-Season Anterior Instability and Return-to-Play Outcomes

Glenohumeral instability in young athletes is common and may lead to prolonged absence from sports participation. 1 Anterior dislocation of the glenohumeral joint most commonly occurs with the arm in a forward flexed, abducted, and externally rotated position. The broad spectrum of anterior shoulder instability in athletes ranges from complete dislocation requiring reduction to microinstability in the overhead athlete, which may be clinically harder to diagnose but equally challenging to treat. 2, 3 Most commonly, athletes experience traumatic shoulder subluxation events without sustaining a complete dislocation of the joint. 1, 4 The amount of external rotation required to place the shoulder at maximal risk has been debated. Tanaka et al 5 clinically evaluated the position of maximal anterior translation in sedated patients, and found that maximal anterior translation occurred with 90 degrees of abduction, but only 26 degrees of external rotation. Most likely, there is multifactorial variability in the exact position of risk for athletes.