The glenohumeral joint sacrifices stability for mobility — the humeral head is three times larger than the shallow glenoid fossa. This inherent instability is compensated by the rotator cuff (dynamic stabiliser), glenohumeral ligaments (static stabilisers), and the labro-ligamentous complex. Normal joint capsular volume is 10-35 mL; it contracts to 3-5 mL in adhesive capsulitis and expands to >35 mL in multidirectional instability.
Shoulder instability direction determines surgical approach: anterior instability (Bankart + MPFL reconstruction for labral tears; Latarjet coracoid transfer for bone loss >20-25%); posterior instability (posterior labral repair); multidirectional instability (capsular shift). The glenoid bone loss percentage determines whether soft tissue repair alone is sufficient.
Bankart lesion with labral detachment treated by arthroscopic Bankart repair; glenoid bone loss >25% requiring Latarjet coracoid transfer.
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