The management of recurrent posterior shoulder instability can be challenging. Although nonoperative measures, including exercises, nonsteroid antiinflamatory medications and activity restrictions often lead to some improvement, problems persist. Most patients with posterior instability will respond to an agressive exercise program, particularly patients with generalised ligamentous laxity and instability occcuring secondary to repetitive microtrauma. Patients who suffer repetitive macrotraumatic instability are less likely to be aided by an exercise program, although one should always be instituted initially. If patients` symptoms are disabling, surgical intervention is indicated. The choice of technique or combination of techniques should be based on present pathology, the degree and nature of the instability and activity level of the patient. Artroscopic techniques have recently demonstrated promise and are commonly used by the authors. Although these techniques are demanding, they are not always the best choice. Supplemental open stabilisation techniques are occasionally required.