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Instability can result from baseline intrinsic ligamentous laxity or a traumatic event\u2014often a dislocation that injures the stabilizing structures of the glenohumeral joint. Many cases involve soft\u2010tissue injury only and can be treated successfully with repair of the labrum and ligamentous tissues. Both open and arthroscopic approaches have been well described, with recent studies of arthroscopic soft\u2010tissue techniques reporting results equal to those of the more traditional open techniques. Over the last decade, attention has focused on the concept of instability of the shoulder mediated by bony pathology such as a large bony Bankart lesion or an engaging Hill\u2010Sachs lesion. Recent literature has identified unrecognized large bony lesions as a primary cause of failure of arthroscopic reconstruction for instability, a major cause of recurrent instability, and a difficult diagnosis to make. Thus, although such bony lesions may be relatively rare compared with soft\u2010tissue pathology, they constitute a critically important entity in the management of shoulder instability. Smaller bony lesions may be amenable to arthroscopic treatment, but larger lesions often require open surgery to prevent recurrent instability. This article reviews recent developments in the diagnosis and treatment of bony instability.<\/jats:p>","DOI":"10.1016\/j.arthro.2008.05.015","type":"journal-article","created":{"date-parts":[[2008,7,1]],"date-time":"2008-07-01T06:13:10Z","timestamp":1214892790000},"page":"1061-1073","source":"Crossref","is-referenced-by-count":118,"title":["Bony Instability of the Shoulder"],"prefix":"10.1002","volume":"24","author":[{"given":"Brandon D.","family":"Bushnell","sequence":"first","affiliation":[{"name":"Steadman\u2010Hawkins Clinic Denver Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. 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