This case series defines the unstable painful shoulder (UPS): anteroinferior instability that presents as pure pain, without any history or sensation of dislocation or subluxation. It asks whether such occult instability exists and whether arthroscopic stabilization relieves pain and restores sport. Twenty young hyperlax athletes with roll-over lesions were followed a mean of 38 months after arthroscopic repair.
When a young hyperlax overhead athlete has deep anterior shoulder pain that fails conservative care and no clear diagnosis, think occult anteroinferior instability before defaulting to SLAP, partial cuff tear, or internal impingement.
The key exam pattern: pain reproduced in abduction and external rotation, relieved by relocation, but no true apprehension. In UPS the pain is deep and anterior. In posterosuperior impingement or partial cuff tears it is typically posterior.
The diagnosis is not made on symptoms alone. You must confirm a roll-over lesion (Bankart, HAGL, glenoid fracture/erosion, Hill-Sachs, or capsular distension) on CT/MR arthrogram or at arthroscopy. Without an objective lesion you risk overtreating.
This is Level IV evidence from a single surgeon in 20 highly selected patients, so treat it as a diagnostic pattern to recognize, not a validated protocol. The proposed KST and palpation tests are unvalidated. Still, the practical message holds: once a roll-over lesion confirms instability, standard arthroscopic stabilization gives predictable pain relief and return to sport.
This case series defines the unstable painful shoulder (UPS): anteroinferior instability that presents as pure pain, without any history or sensation of dislocation or subluxation. It asks whether such occult instability exists and whether arthroscopic stabilization relieves pain and restores sport. Twenty young hyperlax athletes with roll-over lesions were followed a mean of 38 months after arthroscopic repair.
When a young hyperlax overhead athlete has deep anterior shoulder pain that fails conservative care and no clear diagnosis, think occult anteroinferior instability before defaulting to SLAP, partial cuff tear, or internal impingement.
The key exam pattern: pain reproduced in abduction and external rotation, relieved by relocation, but no true apprehension. In UPS the pain is deep and anterior. In posterosuperior impingement or partial cuff tears it is typically posterior.
The diagnosis is not made on symptoms alone. You must confirm a roll-over lesion (Bankart, HAGL, glenoid fracture/erosion, Hill-Sachs, or capsular distension) on CT/MR arthrogram or at arthroscopy. Without an objective lesion you risk overtreating.
This is Level IV evidence from a single surgeon in 20 highly selected patients, so treat it as a diagnostic pattern to recognize, not a validated protocol. The proposed KST and palpation tests are unvalidated. Still, the practical message holds: once a roll-over lesion confirms instability, standard arthroscopic stabilization gives predictable pain relief and return to sport.