# Management of Posterior Shoulder Instability Among Football Players

## TL;DR

This paper reviews how football players with posterior shoulder instability are treated and when they can safely return to play.

## Contribution

It highlights the unique challenges of managing posterior shoulder instability in football and the lack of sport-specific return to play guidelines.

## Key findings

- Posterior shoulder instability is common in various football positions, not just offensive linemen.
- Arthroscopic repair has high return to play rates, but data is limited for bony augmentation and reverse Hill-Sachs lesions.
- Rehabilitation protocols for football players lack sport-specific guidelines.

## Abstract

Football players are at an increased risk for posterior shoulder instability compared to other sports due to certain sport-specific motions that involve posteriorly directed force on the shoulder in a vulnerable position. Management of posterior instability, both nonoperative and operative, is aimed at preventing recurrent instability. Regardless of treatment, timing of return to play revolves around avoiding reinjury and prioritizing player safety. This article provides a review of the current treatment modalities of posterior shoulder instability and the return to play criteria that must be met prior to releasing the player to competition.

Posterior shoulder instability was traditionally thought to occur predominately in offensive linemen. However, recent literature suggests it can also commonly be found in other players, including defensive linemen and quarterbacks. Current research reports high return to play rates for athletes that undergo arthroscopic posterior capsulolabral repair. Whereas, there is limited literature regarding return to play rates after posterior bony augmentation and management of reverse Hill-Sachs lesions. Rehabilitation and return to play protocols have been recommended but are nonspecific to American football.

Posterior shoulder instability has the potential to sideline young athletes for an extended time and presents a complex challenge to both the athlete and the treating physician. Although the ultimate goal is to facilitate return to play, the physician must balance this with minimizing the risk of re-injury.