Arthroscopic findings in atraumatic shoulder instability

Arthroscopy. 2004 Mar;20(3):268-72. doi: 10.1016/j.arthro.2003.11.037.


Purpose: The goal of this study was to evaluate the intra-articular pathology in patients with atraumatic shoulder instability who did not respond to conservative treatment.

Type of study: Prospective case series.

Methods: Of 226 patients treated for shoulder instability over a 2-year-period, 43 patients (average age, 27.5 years; 26 men and 17 women) were classified as having atraumatic instability. None had responded to physiotherapy. The intra-articular pathology was documented during diagnostic arthroscopy before the definitive surgical procedure.

Results: Three types of lesions of the capsulolabral complex were defined: incomplete labral lesions, pathologic elongation of the capsule or "non-Bankart lesions" (type I), classic Bankart lesions (type II), and complex lesions of the labrum and capsule (type III). Type I was found in 19 patients (44.2%); type II lesions were seen in 13 (30.2%); and type III in 11 (25.6%) patients. Hill-Sachs lesions were found in 26 shoulders (60.5%). Chondral lesions of the glenoid were seen in 10 shoulders (23%); SLAP lesions in 5 (11.7%); and partial, articular-side defects of the supraspinatus tendon in 3 (6.9%) patients.

Conclusions: Atraumatic onset of shoulder instability does not imply the absence of intra-articular lesions, at least in patients not showing a response to physiotherapy. Arthroscopy is helpful to diagnose the definite intra-articular pathology.

Level of evidence: Level IV.

MeSH terms

  • Adult
  • Arthroscopy*
  • Female
  • Humans
  • Joint Instability / classification
  • Joint Instability / pathology*
  • Joint Instability / surgery
  • Male
  • Prospective Studies
  • Shoulder Dislocation / classification
  • Shoulder Dislocation / pathology*
  • Shoulder Dislocation / surgery
  • Shoulder Injuries
  • Shoulder Joint / pathology*
  • Shoulder Joint / surgery