What question did this study set out to answer?

The review aims to summarize current understanding and management strategies for atraumatic shoulder instability.

May 10, 2026

Up to date comprehensive review of atraumatic shoulder instability: anatomy, causes, management, and psychosocial considerations

KVKayaththery VARATHANBarts Health NHS Trust AHAli HAMADBarts Health NHS Trust RDRory DYKEWhipps Cross University Hospital

Puntos clave

The review aims to summarize current understanding and management strategies for atraumatic shoulder instability.
Literature review conducted to gather current treatment approaches for atraumatic shoulder instability.
Highlights exercise-focused therapy, particularly the Watson Instability Program, emphasizing muscle strengthening.
Discusses various surgical interventions and their indications, outcomes, and comparative effectiveness.
Exercise-focused therapy shows promise in restoring shoulder control through muscle strengthening.
Surgical options, including capsular shift and plication, are compared for effectiveness and patient outcomes.
Psychosocial factors are critical in ASI management, advocating for a multidisciplinary treatment approach.

Resumen

Atraumatic shoulder instability (ASI) poses a significant challenge in orthopedic practice, characterized by functional and anatomical deficits in the glenohumeral joint (GHJ) resulting from chronic overuse rather than acute trauma. This review aims to provide a comprehensive summary of the current understanding of ASI, covering its anatomy, etiology, the influence of psychosocial factors and primarily focusing on management strategies. The management of ASI is a central focus for restoring normal biomechanical and anatomical function of the injured upper extremity. A literature review was conducted, seeking to further understand the current treatment approaches of this condition. The management of ASI employs differing combinations of physiotherapy, rehabilitation and surgery, with treatment dictated by patient stratification models and patient reported outcome measures (PROMs). Clinical stratification of patients along a diagnostic continuum aid devising appropriate patient-centered treatment and is based on the extent of anatomical disruption. Exercise-focused therapy, particularly the Watson Instability Program, is highlighted as a promising approach, emphasizing scapular and rotator cuff muscle strengthening to restore active shoulder control. Surgical interventions, such as open inferior capsular shift, arthroscopic capsular plication, and electrothermal arthroscopic capsulorrhaphy, are discussed in detail, with emphasis on their indications, outcomes, and comparative effectiveness. We also shed a light on the psychosocial factors role in ASI management outcomes, underscoring the importance of a multidisciplinary approach in patient care. In summary, ASI management necessitates a holistic approach that integrates anatomical understanding, tailored treatment protocols, and consideration of psychosocial factors. Further research is warranted to refine treatment strategies, validate rehabilitation programs, and explore the interplay between psychological factors and physical outcomes in ASI patients.

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