Posterior shoulder instability: current concepts review
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Posterior shoulder instability has been difficult to diagnose and even more challenging to manage. However, it is being diagnosed and treated more frequently, particularly after sports injuries. The purpose of this article is to review literature concerning the management of these pathologies.
A literature review was carried out in the main medical databases to evaluate the several studies concerning the open and arthroscopic treatment of posterior shoulder instability.
Because of better awareness of the pathology, better technical investigations, and a better understanding of shoulder biomechanics, more and more mechanical factors that can cause posterior instability have been described. Structural abnormalities can be divided into bony abnormalities and soft-tissue abnormalities. Each group can also be divided into abnormalities caused by trauma (macro- or microtrauma) or congenital. These abnormalities can be treated with non-anatomic and anatomic stability procedures. During the last decades, the latter have been described more frequently, most of them arthroscopically.
For surgical treatment to be successful, the instability must be attributable to mechanical factors that can be modified by surgery. Because of better knowledge of the pathology, a more specific surgery can be performed. This lesion-specific surgery has improved clinical results compared to non-anatomic stability procedures, particularly when that surgery has been performed arthroscopically.
KeywordsPosterior shoulder instability Structural abnormalities Open treatment Arthroscopic treatment Review
We thank Jan Van Oyen MD Department of Orthopaedic Surgery and Traumatology, AZ Damiaan Oostende, Ostend, Belgium to provide Fig. 3, Peter MacDonald MD, Pan Am Clinic, Winnipeg, Canada to provide Figs. 4 and 6, and Iris Wojtowicz, Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium for her linguistic support.
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