This study evaluated the clinical significance of traumatic anterior shoulder instability (TASI) classification using double-contrast computed tomography (CT) arthrography. Patient were randomly assigned to two groups: group 1 (n = 62); and group 2 (n = 63). TASI symptom severity in group 1 was assessed using physical signs of shoulder trauma and conventional X-ray, CT and magnetic resonance imaging; these patients received either conservative management (with physical rehabilitation) or standard surgery. Group 2 underwent doublecontrast CT arthrography to classify TASI; its findings formed the basis of subsequent management. At 24 months post-therapy, significant improvements in clinical outcomes were observed in group 2: Constant scores were higher and Western Ontario Shoulder Instability Index scores were lower. At 24 months, recurrence rates were 21.0% (13/62) in group 1 and 7.9% (5/63) in group 2. Findings suggested that TASI classification using double-contrast CT arthrography provided meaningful information thereby improving treatment efficacy.