Abstract：
OBJECTIVE: The management of shoulder instability in throwing athletes remains a challenge given the delicate balance between physiologic shoulder laxity facilitating performance and the inherent need for shoulder stability. This review will discuss the evaluation and management of a throwing athlete with suspected instability with a focus on recent findings and developments.
RESULTS: The vast majority of throwing athletes with shoulder instability experience subtle microinstability as a result of repetitive microtrauma rather than episodes of gross instability. These athletes may present with arm pain, dead arms or reduced throwing velocity. Recent literature reinforces the fact that there is no \"silver bullet\" for the management of these athletes and an individualized, tailored approach to treatment is required. While initial nonoperative management remains the hallmark for treatment, the results of rehabilitation protocols are mixed, and some patients will ultimately undergo surgical stabilization. In these cases, it is imperative that the surgeon be judicious with the extent of surgical stabilization as overtightening of the glenohumeral joint is possible, which can adversely affect athlete performance. Managing shoulder instability in throwing athletes requires a thorough understanding of its physiologic and biomechanical underpinnings. Inconsistent results seen with surgical stabilization has led to a focus on nonoperative management for these athletes with surgery reserved for cases that fail to improve non-surgically. Overall, more high quality studies into the management of this challenging condition are warranted.
RESULTS: The vast majority of throwing athletes with shoulder instability experience subtle microinstability as a result of repetitive microtrauma rather than episodes of gross instability. These athletes may present with arm pain, dead arms or reduced throwing velocity. Recent literature reinforces the fact that there is no \"silver bullet\" for the management of these athletes and an individualized, tailored approach to treatment is required. While initial nonoperative management remains the hallmark for treatment, the results of rehabilitation protocols are mixed, and some patients will ultimately undergo surgical stabilization. In these cases, it is imperative that the surgeon be judicious with the extent of surgical stabilization as overtightening of the glenohumeral joint is possible, which can adversely affect athlete performance. Managing shoulder instability in throwing athletes requires a thorough understanding of its physiologic and biomechanical underpinnings. Inconsistent results seen with surgical stabilization has led to a focus on nonoperative management for these athletes with surgery reserved for cases that fail to improve non-surgically. Overall, more high quality studies into the management of this challenging condition are warranted.
摘要：
目的：考虑到促进表现的生理性肩部松弛和对肩部稳定性的内在需求之间的微妙平衡，投掷运动员肩部不稳定的管理仍然是一个挑战。这篇评论将讨论对怀疑不稳定的投掷运动员的评估和管理，重点是最近的发现和发展。
结果：绝大多数肩关节不稳定的投掷运动员由于重复的微创伤而经历了细微的微不稳定性，而不是严重不稳定的发作。这些运动员可能会出现手臂疼痛，死亡的手臂或降低投掷速度。最近的文献强调了这样一个事实，即没有“银弹”来管理这些运动员和个性化，需要量身定制的治疗方法。虽然最初的非手术治疗仍然是治疗的标志，康复方案的结果好坏参半，一些患者最终将接受手术稳定。在这些情况下,外科医生必须谨慎考虑手术稳定的程度，因为盂肱骨关节可能过度收紧，这会对运动员的表现产生不利影响。管理投掷运动员的肩膀不稳定需要对其生理和生物力学基础有透彻的了解。手术稳定所观察到的结果不一致，导致这些运动员的非手术治疗重点放在非手术治疗上，而手术仅限于无法改善非手术的情况。总的来说,有必要对这种具有挑战性的疾病的管理进行更多高质量的研究。
结果：绝大多数肩关节不稳定的投掷运动员由于重复的微创伤而经历了细微的微不稳定性，而不是严重不稳定的发作。这些运动员可能会出现手臂疼痛，死亡的手臂或降低投掷速度。最近的文献强调了这样一个事实，即没有“银弹”来管理这些运动员和个性化，需要量身定制的治疗方法。虽然最初的非手术治疗仍然是治疗的标志，康复方案的结果好坏参半，一些患者最终将接受手术稳定。在这些情况下,外科医生必须谨慎考虑手术稳定的程度，因为盂肱骨关节可能过度收紧，这会对运动员的表现产生不利影响。管理投掷运动员的肩膀不稳定需要对其生理和生物力学基础有透彻的了解。手术稳定所观察到的结果不一致，导致这些运动员的非手术治疗重点放在非手术治疗上，而手术仅限于无法改善非手术的情况。总的来说,有必要对这种具有挑战性的疾病的管理进行更多高质量的研究。
