31 studies met inclusion/exclusion criteria. Notable studies included 4 systematic reviews, 7 RCT’s, 2 non-randomized control trials and 4 clinical trials with single-group repeated measures design. 3 of these studies were ranked of the highest quality with supporting evidence were reviewed and discussed. • Fair to moderate correlations have been indicated regarding instance of acute/chronic shoulder dysfunction and the presence of decreased core stability amongst collegiate overhead athletes when subjected to repeated measures design. • There is a significant risk of recurrent dislocation of the GHJ following first-time traumatic anterior GHJ dislocation as well as or with diagnosis of type II/III capsular or labral lesion within the first 48 months of initial injury when solely primary conservative treatment is utilized rather than initial primary repair. • Initial primary repair of such lesions is strongly indicated in those under the age of 25 years old and those who complete high intensity activities at the upper extremity of great frequency or duration as to avoid recurrent dislocations, residual shoulder instability and/or dysfunction. • It has been indicated that the use of both open and closed kinetic chain exercise interventions at the shoulder can significantly improve joint reposition sense and proprioceptive awareness from pre to post testing over a period of 6 weeks when used in a cohort of uninjured male military cadets who activity participate in multiple sports and average age of 16 years old.

## CLINICAL BOTTOM LINE

Evidence suggests a relationship between chronic shoulder dysfunction, instability, pain, stiffness, or restricted ROM with deficits in core strength and impaired ability to generate proximal feed forward stability at the trunk and scapulothoracic joint within youth or collegiate athletes. Implementation of CKC exercises (standard push-up) has been shown to increase shoulder proprioception and reposition sense at the joint, indicating implementation of CKC interventions geared to challenge proprioception and feed-forward proximal stability can possibly enhance long-term outcomes when paired with traditional modes of GHJ rehabilitation. For rock climbers who incur anterior/inferior dislocation of the GHJ with confirmed diagnosis of labral lesion, evidence based literature shows it is strongly indicated to undergo primary repair initially followed by extensive rehabilitation rather than solely conservative treatment. Rock climbing in essence, is dependent on quasi-static equilibrium between four points of contact. With the removal of one or more of these points the climber must generate coordinated and adequate amounts of core tension and directional shifting of his/her center of mass (COM) as to provide stress shielding and facilitate normal amounts of static and dynamic stability requirements at the STJ and GHJ. The high frequency, duration and intensity of climbing movements pose a significant and increased risk of GHJ/STJ overuse, muscle fatigue, GHJD, recurrent dislocation and poor long-term functional outcomes in climbers. Those who still elect to forgo surgery, it is recommended to adhere to rest- periods of adequate frequency and duration to better avoid overuse and fatigue of muscle-tendon units surrounding the GHJ and STJ as to provide optimal functional stability and hence, minimize further damage to intracapsular tissues as well as risk of future incidence of re-dislocation

This critically appraised topic has been individually prepared as part of a course requirement and has been peer-reviewed by one other independent course instructor

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