Management of Traumatic Anterior Shoulder Instability: A Literature Review

Background: Traumatic anterior shoulder instability (TASI) is the most common form of glenohumeral instability, particularly affecting young, physically active individuals. It often results from a traumatic episode involving forced abduction and external rotation, leading to disruption of static and dynamic stabilizers of the shoulder joint. Common associated injuries include Bankart lesions and Hill-Sachs defects, which predispose patients to recurrence, impaired function, and long-term complications such as glenohumeral osteoarthritis. This literature review aims to provide a comprehensive overview of TASI's current evidence-based management. Methods: This review synthesizes current literature and guidelines from orthopedic texts and peer-reviewed journals (2010–2024), focusing on anatomical, biomechanical, diagnostic, and therapeutic perspectives relevant to TASI. Sources include clinical trials, epidemiological studies, and expert consensus documents on shoulder instability management. Results: TASI mainly affects males under 25 involved in contact sports or high‑risk activities. First dislocation often causes labral tears or bone loss. Diagnosis combines clinical tests (Apprehension, Relocation, Load‑and‑Shift) with imaging (X‑ray, CT, MRI/MR arthrography) to assess soft tissue and bone lesions. Non‑operative care (immobilization, physiotherapy) can be used for first‑time dislocations in low‑demand patients but has high recurrence in young athletes. Surgical treatment is preferred for high‑risk or recurrent cases. Arthroscopic Bankart repair is standard for soft‑tissue lesions with minimal bone loss, while Latarjet or bone grafting is advised for >20–25% glenoid bone loss; remplissage or augmentation is added for large Hill‑Sachs lesions. Modern surgery yields good outcomes, but complications such as stiffness, nerve injury, hardware issues, or redislocation can occur. Management should be tailored to patient and lesion characteristics. Conclusion: Effective management of TASI requires thorough understanding of shoulder anatomy and biomechanics, accurate clinical and radiological assessment, and a patient-specific therapeutic approach. While conservative treatment may be appropriate for select cases, surgical repair—tailored to the type and severity of lesions—is essential in preventing recurrence and preserving function in high-risk populations. Continuous refinement of surgical techniques and proper identification of bone loss are crucial to optimizing long-term outcomes and minimizing complications. Keywords: Traumatic shoulder instability, Bankart lesion, Hill-Sachs defect, Latarjet procedure, shoulder dislocation