Certain injuries or conditions are sport specific, and the question of whether gender may play a role is recognized as an important issue. Generalized ligamentous laxity, and shoulder laxity specifically, have traditionally been associated with female athletes. Recent reviews, however, have failed to conclusively demonstrate a difference in shoulder laxity between men and women. This article reviews shoulder instability in the female athletic population, especially those involved in overhead activities. In the literature reviewed, of patients with unidirectional anterior instability, 22.3 are female. Of patients with multidirectional instability, 35.7 are female, and of patients with posterior instability, 27.1 are female. The higher incidence of shoulder instability in the male population may simply reflect the fact that men are still more likely than women to participate in high-risk activities and overhead sports. As for surgery, at this time, the most that can be said is that women are less likely than men to undergo surgery for stabilization of an unstable shoulder of any type. There is no strong evidence to suggest that the outcome of surgery is significantly different than that of men. Conclusions about the incidence of shoulder instability in female athletes using this type of review must be drawn with caution, due to the heterogeneity of the study populations. Data on the rate of shoulder instability per unit of exposure to high-risk activities are still not available.
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