The masterclass by Anju Jaggie, a consultant physiotherapist with over 25 years of experience, focuses on managing shoulder instability. She discusses the classification of shoulder instability into traumatic and atraumatic categories, with the Stanmore classification being particularly highlighted. The masterclass explores the causes, symptoms, and classifications of shoulder instability, touch upon the importance of considering psychosocial factors alongside traditional biomechanical models. It outlines the Stanmore classification’s three polar groups: type one (traumatic “torn loose”), type two (atraumatic multidirectional “born loose”), and type three (“born and pulled loose”), each with distinct characteristics and management strategies. Jaggie also discusses associated injuries, diagnostic tests, and the importance of assessing muscular function in addition to structural laxity.

The masterclass further delves into treatment and rehabilitation strategies for both traumatic and atraumatic shoulder instability. For traumatic cases, decisions around surgical intervention depend on the extent of soft tissue versus bony damage, with procedures like the Latarjet being common for significant bone loss. Rehabilitation evidence for non-surgical interventions is limited, and Jaggie highlights the need for more robust trials. For atraumatic instability, physiotherapy remains the primary treatment, with evidence supporting exercise programs like the Derby and Watson programs. The masterclass emphasizes the need for a biopsychosocial approach, especially for patients with psychological comorbidities, and concludes by stressing the importance of individualized rehabilitation strategies for returning patients to their desired level of activity.

Anju Jaggi is a physio consultant shoulder specialist at the royal national orthopedic hospital in Stanmore, UK. She’s a past president of the European Society of Shoulder & Elbow Rehabilitation (EUSSER) and a published researcher with a particular interest in shoulder instability.