Posterior shoulder instability

The treatment of posterior instability of the shoulder often is challenged by the difficulty in making a correct diagnosis. A nonoperative program directed at reducing pain and increasing stability through comprehensive shoulder-strengthening methods generally has been successful in treating recurrent posterior subluxation of the shoulder. Surgical options for treatment are reserved for patients who fail to recognize improvement after 6 months of therapy and have no evidence of a psychologic disturbance as the cause of the posterior instability. In patients in whom posterior instability was related to a specific traumatic event, a nonoperative program may be less successful, and these patients should be closely monitored during therapy.