Instability in the shoulder of the throwing athlete differs significantly from that of the collision athlete or the everyday non-athlete populations. The pathogenesis, clinical presentation, workup, diagnosis, and management of instability for the thrower have unique features and require a deeper understanding of the continuum from beneficial adaptive laxity to pathologic instability. Success rates for return to play after both non-operative and surgical management are much lower for throwers than for other athletes, due in no small part to the need to balance stabilization against over-constriction of the glenohumeral joint. Multiple nonoperative and surgical techniques exist and continue to evolve for management of this challenging condition.