Abstract
Posterior shoulder instability is a rare entity and accounts for 2–10 % of all shoulder instabilities. Diagnosing and managing of this pathology can be challenging due to unspecific symptoms reported by the patient. Thus a meticulous clinical exam of both shoulders is mandatory. Posterior instability can be caused by dysplasia of the posterior chondrolabral rim, bony glenoid retroversion or increased volume of the posteroinferior capsular pouch. To provide adequate therapy it is essential to understand the complexity of this pathology and its etiology, such as single traumatic events, repeated microtraumata or atraumatic causes. Each therapeutic approach should be started with physical therapy including muscle strengthening and proprioception. If this fails arthroscopic posterior stabilization is suggested for patients with isolated labral repair. In patients with failed arthroscopic management or higher grades of posterior laxity open stabilization should be favored. Patients with significant bone loss or glenoid retroversion benefit from open procedures like glenoid osteotomy or bone blocks. Considering defined therapeutic algorithm in combination with intensive physical therapy lead to good postoperative function with very low instability recurrence rates.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Ahlgren SA, Hedlund T, Nistor L (1978) Idiopathic posterior instability of the shoulder joint. Results of operation with posterior bone graft. Acta Orthopaedica Scandinavica 49:600–603
Antoniou J, Duckworth DT, Harryman DT 2nd (2000) Capsulolabral augmentation for the the management of posteroinferior instability of the shoulder. Am J Bone Joint Surg 82:1220–1230
Bottoni CR, Franks BR, Moore JH et al (2005) Operative stabilization of posterior shoulder instability. Am J Sports Med 33:996–1002
Boyd HB, Sisk TD (1972) Recurrent posterior dislocation of the shoulder. Am J Bone Joint Surg 54:779–786
Goubier JN, Iserin A, Duranthon LD et al. (2003) A 4-portal arthroscopic stabilization in posterior shoulder instability. J Shoulder Elbow Surg Am Shoulder Elbow Surg… [et al] 12:337–341
Mc Laughlin H (1952) Posterior dislocation of the shoulder. Am J Bone Joint Surg 24-A-3:584–590
Owens BD, Duffey ML, Nelson BJ et al (2007) The incidence and characteristics of shoulder instability at the United States Military Academy. Am J Sports Med 35:1168–1173
Provencher MT, Bell SJ, Menzel KA et al (2005) Arthroscopic treatment of posterior shoulder instability: results in 33 patients. Am J Sports Med 33:1463–1471
Provencher MT, Leclere LE, King S et al (2011) Posterior instability of the shoulder: diagnosis and management. Am J Sports Med 39:874–886
Robinson CM, Seah M, Akhtar MA (2011) The epidemiology, risk of recurrence, and functional outcome after an acute traumatic posterior dislocation of the shoulder. Am J Bone Joint Surg 93:1605–1613
Wolf EM, Eakin CL (1998) Arthroscopic capsular plication for posterior shoulder instability. J Arthrosc Relat Surg 14:153–163
Neer CS 2nd (1985) Involuntary inferior and multidirectional instability of the shoulder: etiology, recognition, and treatment. Instr Course Lect 34:232–238
Feely Bt MC (2011) Posterior Shoulder Stabilization. In: Fu FH (ed) Master technique in orthopaedic surgery sports medicine. Lippincott Williams & Wilkins, Philadelphia
Bey MJ, Hunter SA, Kilambi N et al. (2005) Structural and mechanical properties of the glenohumeral Joint posterior capsule. J Shoulder Elbow Surg Am Shoulder Elbow Surg… [et al] 14:201–206
Lintner SA, Levy A, Kenter K et al (1996) Glenohumeral translation in the asymptomatic athlete’s shoulder and its relationship to other clinically measurable anthropometric variables. Am J Sports Med 24:716–720
O’connell PW, Nuber GW, Mileski RA et al (1990) The contribution of the glenohumeral ligaments to anterior stability of the shoulder joint. Am J Sports Med 18:579–584
Turkel SJ, Panio MW, Marshall JL et al (1981) Stabilizing mechanisms preventing anterior dislocation of the glenohumeral joint. Am J Bone Joint Surg 63:1208–1217
Dewing CB, Mccormick F, Bell SJ et al (2008) An analysis of capsular area in patients with anterior, posterior, and multidirectional shoulder instability. Am J Sports Med 36:515–522
Kim SH, Noh KC, Park JS et al (2005) Loss of chondrolabral containment of the glenohumeral Jt in atraumatic posteroinferior multidirectional instability. Am J Bone Joint Surg 87:92–98
Matsen FA 3rd, Chebli C, Lippitt S et al (2006) Principles for the evaluation and management of shoulder instability. Am J Bone Joint Surg 88:648–659
Lévigne C (2008) Classification of posterior shoulder instability. In: Boileau P (ed) Shoulder concepts. Sauramps medical, Montpellier
Lichtenberg S, Habermeyer P (2009) Open and arthroscopic procedures for posterior shoulder instability. Der Orthopade 38:54–63
Robinson CM, Aderinto J (2005) Recurrent posterior shoulder instability. Am J Bone Joint Surg 87:883–892
Bradley JP, Forsythe B, Mascarenhas R (2008) Arthroscopic management of posterior shoulder instability: diagnosis, indications, and technique. Clin Sports Med 27:649–670
Millett PJ, Clavert P, Hatch GF 3rd et al (2006) Recurrent posterior shoulder instability. J Am Acad Orthop Surg 14:464–476
Fuchs B, Jost B, Gerber C (2000) Posterior-inferior capsular shift for the treatment of recurrent, voluntary posterior subluxation of the shoulder. Am J Bone Joint Surg 82:16–25
Burkhead WZ Jr, Rockwood CA Jr (1992) Treatment of instability of the shoulder with an exercise program. Am J Bone Joint Surg 74:890–896
Fronek J, Warren RF, Bowen M (1989) Posterior subluxation of the glenohumeral joint. Am J Bone Joint Surg 71:205–216
Schwartz E, Warren RF, O’brien SJ et al (1987) Posterior shoulder instability. Orthop Clin North Am 18:409–419
Hawkins RJ, Koppert G, Johnston G (1984) Recurrent posterior instability (subluxation) of the shoulder. Am J Bone Joint Surg 66:169–174
Lenart BA, Sherman SL, Mall NA et al (2012) Arthroscopic repair for posterior shoulder instability. Arthroscopy J Arthrosc Relat Surg 28:1337–1343
Pollock RG, Bigliani LU (1993) Recurrent posterior shoulder instability. Diagnosis and treatment. Clinical Orthop Relat Res 291:85–96
Wolf BR, Strickland S, Williams RJ et al (2005) Open posterior stabilization for recurrent posterior glenohumeral instability. J Shoulder Elbow Surg Am Shoulder Elbow Surg… [et al] 14:157–164
Hawkins RH (1996) Glenoid osteotomy for recurrent posterior subluxation of the shoulder: assessment by computed axial tomography. J Shoulder Elbow Surg Am Shoulder Elbow Surg… [et al] 5:393–400
Servien E, Walch G, Cortes ZE et al (2007) Posterior bone block procedure for posterior shoulder instability. Knee Surg Sports Traumatol Arthrosc 15:1130–1136
Cofield RH, Irving JF (1987) Evaluation and classification of shoulder instability. With special reference to examination under anesthesia. Clin Orthop Relat Res 223:32–43
Blasier RB, Soslowsky LJ, Malicky DM et al (1997) Posterior glenohumeral subluxation: active and passive stabilization in a biomechanical model. Am J Bone Joint Surg 79:433–440
Kim SH, Park JS, Jeong WK et al (2005) The Kim test: a novel test for posteroinferior labral lesion of the shoulder—a comparison to the jerk test. Am J Sports Med 33:1188–1192
Gerber C, Ganz R (1984) Clinical assessment of instability of the shoulder. With special reference to anterior and posterior drawer tests. Br J Bone Joint Surg 66:551–556
Hewitt M, Getelman MH, Snyder SJ (2003) Arthroscopic management of multidirectional instability: pancapsular plication. Orthop Clin North Am 34:549–557
Lichtenberg S, Habermeyer P, Magosch P (2007) Arthroscopic treatment of posterior shoulder instability. Operative Orthopadie und Traumatologie 19:115–132
Gerber C, Ganz R, Vinh TS (1987) Glenoplasty for recurrent posterior shoulder instability. An anatomic reappraisal. Clin Orthop Relat Res 216:70–79
Karas SG, Creighton RA, Demorat GJ (2004) Glenohumeral volume reduction in arthroscopic shoulder reconstruction: a cadaveric analysis of suture plication and thermal capsulorrhaphy. J Arthrosc Relat Surg 20:179–184
Scott DJ Jr (1967) Treatment of recurrent posterior dislocations of the shoulder by glenoplasty. Report of three cases. Am J Bone Joint Surg 49:471–476
Auffarth A, Schauer J, Matis N et al (2008) The J-bone graft for anatomical glenoid reconstruction in recurrent posttraumatic anterior shoulder dislocation. Am J Sports Med 36:638–647
Bradley JP, Baker CL 3rd, Kline AJ et al (2006) Arthroscopic capsulolabral reconstruction for posterior instability of the shoulder: a prospective study of 100 shoulders. Am J Sports Med 34:1061–1071
Williams RJ 3rd, Strickland S, Cohen M et al (2003) Arthroscopic repair for traumatic posterior shoulder instability. Am J Sports Med 31:203–209
Savoie FH 3rd, Holt MS, Field LD et al (2008) Arthroscopic management of posterior instability: evolution of technique and results. J Arthrosc Relat Surg 24:389–396
Radkowski CA, Chhabra A, Baker CL 3rd et al (2008) Arthroscopic capsulolabral repair for posterior shoulder instability in throwing athletes compared with nonthrowing athletes. Am J Sports Med 36:693–699
Tibone J, Ting A (1990) Capsulorrhaphy with a staple for recurrent posterior subluxation of the shoulder. Am J Bone Joint Surg 72:999–1002
Tibone JE, Bradley JP (1993) The treatment of posterior subluxation in athletes. Clin Orthop Relat Res 291:124–137
Graichen H, Koydl P, Zichner L (1998) Value of glenoid osteotomy in treatment of posterior shoulder instability. Zeitschrift fur Orthopadie und ihre Grenzgebiete 136:238–242
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 ISAKOS
About this chapter
Cite this chapter
Seppel, G., Braun, S., Imhoff, A.B. (2013). Surgical Management of Posterior Shoulder Instability. In: Brockmeier, S., Miller, M., Arce, G. (eds) Surgery of Shoulder Instability. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-38100-3_8
Download citation
DOI: https://doi.org/10.1007/978-3-642-38100-3_8
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-38099-0
Online ISBN: 978-3-642-38100-3
eBook Packages: MedicineMedicine (R0)