Posterior instability of the shoulder remains a diagnostic and therapeutic challenge, with a growing incidence especially in athletes. Evaluation of the type of the instability, whether unidirectional or multidirectional, is very important with regard to treatment. Although many patients benefit from strengthening and balancing rotator cuff muscles and scapular stabilizers, surgical procedures may be required in those unresponsive to conservative treatment. Posterior capsular shift is the method of choice to eliminate redundancy of the posterior and inferior capsules; moreover, in the presence of bone defects relating to the head of the glenoid or humerus, bony procedures should be added to the treatment.