Management of the unstable shoulder.

What are the risk factors for an unstable shoulder? In a large epidemiological study of 8940 shoulder dislocations, males were over 2.5 times more likely to experience a dislocation, and when the incidence rates were calculated according to age the results illus‐ trated a bimodal distribution, peaking in the third and ninth decades of life. More recently, a case series of 31 patients with shoulder dislocation found deregulated expression of collagen genes across the joint capsule suggesting a genetic role in instability. Box 3 illus‐ trates other i ndependent risk factors for an unstable s houlder. 4 6 8‐ 11