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The imaging evaluation of an athlete with glenohumeral instability encompasses multiple modalities, including radiography, CT, and MRI. There remains an overall lack of agreement and consistency among the orthopedic community regarding techniques used to quantify glenohumeral bone loss. When a high level of clinical suspicion remains, advanced imaging techniques are strongly recommended to ensure reliable and accurate assessment of defect size and location.

The imaging evaluation of an athlete with glenohumeral instability encompasses multiple modalities, including radiography, CT, and MRI. There remains an overall lack of agreement and consistency among the orthopedic community regarding techniques used to quantify glenohumeral bone loss. When a high level of clinical suspicion remains, advanced imaging techniques are strongly recommended to ensure reliable and accurate assessment of defect size and location.

There is no doubt that the understanding of shoulder mechanics and pathology will continue to evolve. It is not appropriate to consider that all patients, especially young athletes, who have shoulder pain have "impingement." Rather, a careful evaluation will result in the correct diagnosis and the institution of the appropriate treatment. A step-by-step assessment and management scheme is necessary for each health care professional dealing with athletes. If surgery is deemed necessary, the correction of the anatomic abnormality with minimal disruption of normal anatomy will be the key to allowing the athlete to return to his or her chosen sport.

Treatment of the athlete’s shoulder is one of the greatest challenges facing the orthopedic specialist. Surgical procedures, and in particular, the open surgical techniques presented in this article, are always a last resort of treatment. The primary treatment is always nonoperative with a particular emphasis toward physiotherapy. In selected instances in which patients have failed rehabilitation, the techniques that are presented can achieve a relatively high degree of success if particular attention is paid to the specific indications, approaches, and details of each technique. Open surgical techniques for rotator cuff tendonitis, instability, and unusual problems in the athlete’s shoulder are presented.

There is no doubt that the understanding of shoulder mechanics and pathology will continue to evolve. It is not appropriate to consider that all patients, especially young athletes, who have shoulder pain have "impingement." Rather, a careful evaluation will result in the correct diagnosis and the institution of the appropriate treatment. A step-by-step assessment and management scheme is necessary for each health care professional dealing with athletes. If surgery is deemed necessary, the correction of the anatomic abnormality with minimal disruption of normal anatomy will be the key to allowing the athlete to return to his or her chosen sport.