Shoulder Instability Treatment, Prevention and Rehabilitation | Orthopedic Lecture, Training
Shoulder Instability Treatment, Prevention and Rehabilitation | Orthopedic Lecture, Training
First-Time Traumatic Anterior Shoulder Dislocation: Evidence-Based Surgical and Rehabilitation Perspectives
Jonathan Ticker, MD | James Paci, MD | Christopher Bux, DPT
In this comprehensive lecture series presented through the Orlin and Cohen Orthopedic Group, Jonathan Ticker, MD leads an in-depth, evidence-based discussion on the evaluation and management of first-time traumatic anterior glenohumeral dislocation, with a focus on early surgical stabilization, risk stratification, and durable clinical outcomes. The series integrates surgical technique and rehabilitation principles through a multidisciplinary lens, reinforcing best practices across the continuum of care.
Dr. Jonathan Ticker’s Perspective: Indications for Early Surgical Stabilization:
Dr. Ticker anchors the series by outlining how contemporary management of shoulder instability has evolved beyond historical “wait-and-see” paradigms. Drawing from long-term clinical data, military population studies, and recent systematic reviews, he emphasizes that select first-time dislocations benefit from early arthroscopic repair, particularly younger, active patients with identifiable risk factors.
Key clinical considerations highlighted by Dr. Ticker include:
Associated pathology on imaging (Bankart lesion, ALPSA lesion, HAGL lesion)
Early signs of glenoid or humeral bone loss
Dr. Ticker underscores that recurrent instability drives progressive bone loss, increasing surgical complexity and long-term risk of glenohumeral osteoarthritis. Preventing recurrence, therefore, remains central to optimizing outcomes.
Evidence Supporting Arthroscopic Repair After First-Time Dislocation:
The lecture reviews clinical and economic evidence supporting early arthroscopic stabilization:
Significantly lower recurrence rates compared to nonoperative management
Improved disease-specific quality of life scores
Reduced need for revision surgery
Favorable cost-effectiveness in young and high-risk patient populations
Higher return-to-sport rates when performed in appropriately selected patients
Dr. Ticker emphasizes that while not all patients require surgery after a first dislocation, risk stratification and individualized decision-making are essential.
Surgical Technique and Pathology Considerations:
(Presented by Dr. James Paci with commentary aligned to Dr. Ticker’s framework)
The series provides detailed arthroscopic instruction focused on restoring native anatomy and achieving stable fixation:
Pathologies addressed include:
Anterior Bankart and bony Bankart lesions
ALPSA lesions requiring careful mobilization and translation
HAGL lesions of the inferior glenohumeral ligament
Hill-Sachs lesions, including on-track vs off-track assessment
Technical principles emphasized:
Meticulous capsulolabral release to allow superior and lateral translation
Anchor placement on the glenoid face to recreate labral height
Use of ≥3 anchors for anatomic stabilization
Knotless and knot-tying techniques based on surgeon preference
Remplissage for engaging Hill-Sachs lesions without significant glenoid bone loss
Rehabilitation and Return-to-Play Strategy
(Presented by Christopher Bux, DPT)
Rehabilitation principles are aligned with surgical goals and tissue healing timelines. Emphasis is placed on:
Protection of healing capsulolabral structures
Restoration of scapulothoracic mechanics and neuromuscular control
Progressive strengthening and proprioceptive training
Sport-specific functional testing prior to return to play
Avoidance of premature return that increases recurrence risk
The series highlights the need for individualized return-to-play criteria, particularly in contact and collision athletes.
Preventing recurrence is critical to minimizing bone loss and long-term arthropathy
Arthroscopic Bankart repair remains the gold standard in appropriately selected patients
Recognizing and addressing associated pathology (HAGL, ALPSA, Hill-Sachs) is essential
Surgical preparation is as important as repair technique
Outcomes improve when surgery, rehabilitation, and timing are aligned
This lecture series reflects Dr. Jonathan Ticker’s thoughtful, evidence-driven approach to shoulder instability, combining decades of surgical experience with modern arthroscopic technique and collaborative care. It serves as a valuable educational resource for orthopaedic surgeons, sports medicine specialists, and shoulder and elbow surgeons seeking to refine their approach to first-time anterior shoulder dislocation.
Jonathan Ticker, MD | James Paci, MD | Christopher Bux, DPT
In this comprehensive lecture series presented through the Orlin and Cohen Orthopedic Group, Jonathan Ticker, MD leads an in-depth, evidence-based discussion on the evaluation and management of first-time traumatic anterior glenohumeral dislocation, with a focus on early surgical stabilization, risk stratification, and durable clinical outcomes. The series integrates surgical technique and rehabilitation principles through a multidisciplinary lens, reinforcing best practices across the continuum of care.
Dr. Jonathan Ticker’s Perspective: Indications for Early Surgical Stabilization:
Dr. Ticker anchors the series by outlining how contemporary management of shoulder instability has evolved beyond historical “wait-and-see” paradigms. Drawing from long-term clinical data, military population studies, and recent systematic reviews, he emphasizes that select first-time dislocations benefit from early arthroscopic repair, particularly younger, active patients with identifiable risk factors.
Key clinical considerations highlighted by Dr. Ticker include:
Dr. Ticker underscores that recurrent instability drives progressive bone loss, increasing surgical complexity and long-term risk of glenohumeral osteoarthritis. Preventing recurrence, therefore, remains central to optimizing outcomes.
Evidence Supporting Arthroscopic Repair After First-Time Dislocation:
The lecture reviews clinical and economic evidence supporting early arthroscopic stabilization:
Dr. Ticker emphasizes that while not all patients require surgery after a first dislocation, risk stratification and individualized decision-making are essential.
Surgical Technique and Pathology Considerations:
(Presented by Dr. James Paci with commentary aligned to Dr. Ticker’s framework)
The series provides detailed arthroscopic instruction focused on restoring native anatomy and achieving stable fixation:
Pathologies addressed include:
Technical principles emphasized:
Rehabilitation and Return-to-Play Strategy
(Presented by Christopher Bux, DPT)
Rehabilitation principles are aligned with surgical goals and tissue healing timelines. Emphasis is placed on:
The series highlights the need for individualized return-to-play criteria, particularly in contact and collision athletes.
Key Takeaways for Orthopaedic Surgeons:
This lecture series reflects Dr. Jonathan Ticker’s thoughtful, evidence-driven approach to shoulder instability, combining decades of surgical experience with modern arthroscopic technique and collaborative care. It serves as a valuable educational resource for orthopaedic surgeons, sports medicine specialists, and shoulder and elbow surgeons seeking to refine their approach to first-time anterior shoulder dislocation.