Assessment and diagnosis of non-traumatic shoulder instability: A scoping review.

Background: Given its complexity, there is no consensus regarding the assessment of non-traumatic shoulder instability (NTSI) to this day. We, therefore, conducted a scoping review to map the existing white and grey literature regarding diagnostic and assessment tools for the NTSI population.

Method: We followed the Arksey and O'Malley five-stage guideline for the conduct of scoping reviews and searched through 12 electronic databases for English-language articles and reviews from 2000 to 2024 related to NTSI's diagnosis and assessment tools.

Results: Among the 3426 identified studies, 58 were included (describing 59 different interventions). Case-control studies (43.1%, 25/58) and narrative reviews (34.5%, 20/58) were the most prevalent. Diagnostic imaging was the most studied intervention (35.6%, 21/59). Twenty-seven studies specified a direction of instability, of which 59% (16/27) were multidirectional instability. Non-traumatic shoulder instability often affects young individuals, with complex symptoms, including neuromotor deficits, muscular imbalances and kinematic alterations, involving psycho-behavioural and somatosensory components.

Discussion: Non-traumatic shoulder instability's aetiologies and clinical manifestations are multifactorial. The prevalence and incidence of this dysfunction are probably underestimated. Clinical history is crucial to retrace a complex and chronic dysfunction. The use of orthopaedic shoulder tests and the routine use of imaging currently appear to have limited relevance as a first-line approach.