Traumatic shoulder instability. Nonsurgical management versus surgical intervention.

Shoulder instability is classified as either traumatic or atraumatic based on the mechanism of injury. Traditional treatment for both forms of instability involves a nonsurgical approach, consisting of immobilization, rehabilitation, and a delay in the return to vigorous activities. This treatment is often quite successful in preventing recurrent dislocations in the patient with atraumatic instability. However, those patients with traumatic instability often experience further dislocations or subluxations, with recurrence rates as high as 94% in patients younger than 20 years. These recurrent episodes of instability can result in injuries to the capsulolabral structures (Bankart lesions), humeral head (Hill Sachs defect), and neurologic structures. Open surgical reconstructions for anterior instability have been reported to be 94-100% successful in preventing recurrence. Arthroscopic stabilization procedures are successful in preventing recurrence in 80-90% of patients and result in low morbidity. However, the most common form of initial treatment for traumatic anterior shoulder instability remains immobilization, supervised rehabilitation, and gradual return to full activity, despite significantly inferior results when compared to operative intervention. This article addresses the treatment options available to the nurse practitioner when managing the patient with traumatic anterior instability.