Abstract
Purpose
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.
Methods
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.
Results
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.
Conclusion
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.
Similar content being viewed by others
References
Antoniou J, Duckworth DT, Harryman DT 2nd (2000) Capsulolabral augmentation for the the management of posteroinferior instability of the shoulder. J Bone Joint Surg Am 82:1220–1230
Assom M, Castoldi F, Rossi R, Blonna D, Rossi P (2006) Humeral head impression fracture in acute posterior shoulder dislocation: new surgical technique. Knee Surg Sports Traumatol Arthrosc 14:668–672
Bahk MS, Karzel RP, Snyder SJ (2010) Arthroscopic posterior stabilization and anterior capsular plication for recurrent posterior glenohumeral instability. Arthroscopy 26:1172–1180
Barbier O, Ollat D, Marchaland JP, Versier G (2009) Iliac bone-block autograft for posterior shoulder instability. Rev Chir Orthop Traumatol 95:100–107
Bhatia DN, de Beer JF (2007) The axillary pouch portal: a new posterior portal for visualization and instrumentation in the inferior glenohumeral recess. Arthroscopy 23:e1241–e1245
Bock P, Kluger R, Hintermann B (2007) Anatomical reconstruction for reverse Hill-Sachs lesions after posterior locked shoulder dislocation fracture: a case series of six patients. Arch Orthop Trauma Surg 127:543–548
Bottoni CR, Franks BR, Moore JH, DeBerardino TM, Taylor DC, Arciero RA (2005) Operative stabilization of posterior shoulder instability. Am J Sports Med 33:996–1002
Bradley JP, Baker CL 3rd, Kline AJ, Armfield DR, Chhabra A (2006) Arthroscopic capsulolabral reconstruction for posterior instability of the shoulder: a prospective study of 100 shoulders. Am J Sports Med 34:1061–1071
Bradley JP, Forsythe B, Mascarenhas R (2008) Arthroscopic management of posterior shoulder instability: diagnosis, indications, and technique. Clin Sports Med 27:649–670
Brewer BJ, Wubben RC, Carrera GF (1986) Excessive retroversion of the glenoid cavity. A cause of non-traumatic posterior instability of the shoulder. J Bone Joint Surg Am 68:724–731
Castagna A, Snyder SJ, Conti M, Borroni M, Massazza G, Garofalo R (2007) Posterior humeral avulsion of the glenohumeral ligament: a clinical review of 9 cases. Arthroscopy 23:809–815
Charalambous CP, Gullett TK, Ravenscroft MJ (2009) A modification of the mclaughlin procedure for persistent posterior shoulder instability: technical note. Arch Orthop Trauma Surg 129:753–755
Cheatham SA, Mair SD (2009) Arthroscopic technique for the evaluation and treatment of posterior shoulder instability. Orthopedics 32:194
Checchia SL, Santos PD, Miyazaki AN (1998) Surgical treatment of acute and chronic posterior fracture-dislocation of the shoulder. J Shoulder Elbow Surg 7:53–65
Chen L, Keefe D, Park J, Resnick D (2009) Posterior bony humeral avulsion of glenohumeral ligament with reverse bony Bankart lesion. J Shoulder Elbow Surg 18:e45–e49
Dewing CB, McCormick F, Bell SJ, Solomon DJ, Stanley M, Rooney TB, Provencher MT (2008) An analysis of capsular area in patients with anterior, posterior, and multidirectional shoulder instability. Am J Sports Med 36:515–522
Diklic ID, Ganic ZD, Blagojevic ZD, Nho SJ, Romeo AA (2009) Treatment of locked chronic posterior dislocation of the shoulder by reconstruction of the defect in the humeral head with an allograft. J Bone Joint Surg Br 92:71–76
Edelson JG (1995) Localized glenoid hypoplasia. An anatomic variation of possible clinical significance. Clin Orthop Relat Res 321:189–195
Finkelstein JA, Waddell JP, O’Driscoll SW, Vincent G (1995) Acute posterior fracture dislocations of the shoulder treated with the neer modification of the mclaughlin procedure. J Orthop Trauma 9:190–193
Fronek J, Warren RF, Bowen M (1989) Posterior subluxation of the glenohumeral joint. J Bone Joint Surg Am 71:205–216
Fuchs B, Jost B, Gerber C (2000) Posterior-inferior capsular shift for the treatment of recurrent, voluntary posterior subluxation of the shoulder. J Bone Joint Surg Am 82:16–25
Gavriilidis I, Magosch P, Lichtenberg S, Habermeyer P, Kircher J (2010) Chronic locked posterior shoulder dislocation with severe head involvement. Int Orthop 34:79–84
Gerber C, Lambert SM (1996) Allograft reconstruction of segmental defects of the humeral head for the treatment of chronic locked posterior dislocation of the shoulder. J Bone Joint Surg Am 78:376–382
Hawkins RJ, Neer CS 2nd, Pianta RM, Mendoza FX (1987) Locked posterior dislocation of the shoulder. J Bone Joint Surg Am 69:9–18
Hill JD, Lovejoy JF Jr, Kelly RA (2007) Combined posterior Bankart lesion and posterior humeral avulsion of the glenohumeral ligaments associated with recurrent posterior shoulder instability. Arthroscopy 23:e321–e323, e327
Hurley JA, Anderson TE, Dear W, Andrish JT, Bergfeld JA, Weiker GG (1992) Posterior shoulder instability. Surgical versus conservative results with evaluation of glenoid version. Am J Sports Med 20:396–400
Inui H, Sugamoto K, Miyamoto T, Yoshikawa H, Machida A, Hashimoto J, Nobuhara K (2002) Glenoid shape in atraumatic posterior instability of the shoulder. Clin Orthop Relat Res 403:87–92
Jia X, Ji JH, Petersen SA, Freehill MT, McFarland EG (2009) An analysis of shoulder laxity in patients undergoing shoulder surgery. J Bone Joint Surg Am 91:2144–2150
Johnston GH, Hawkins RJ, Haddad R, Fowler PJ (1984) A complication of posterior glenoid osteotomy for recurrent posterior shoulder instability. Clin Orthop Relat Res 187:147–149
Keppler P, Holz U, Thielemann FW, Meinig R (1994) Locked posterior dislocation of the shoulder: treatment using rotational osteotomy of the humerus. J Orthop Trauma 8:286–292
Kim SH (2004) Arthroscopic treatment of posterior and multidirectional instability. Oper Tech Sports Med 12:111–121
Kim SH, Ha KI, Park JH, Kim YM, Lee YS, Lee JY, Yoo JC (2003) Arthroscopic posterior labral repair and capsular shift for traumatic unidirectional recurrent posterior subluxation of the shoulder. J Bone Joint Surg Am 85-A:1479–1487
Kim SH, Ha KI, Yoo JC, Noh KC (2004) Kim’s lesion: an incomplete and concealed avulsion of the posteroinferior labrum in posterior or multidirectional posteroinferior instability of the shoulder. Arthroscopy 20:712–720
Kouvalchouk JF, Coudert X, Watin Augouard L, Da Silva Rosa R, Paszkowski A (1993) Treatment of posterior instability of the shoulder joint using an acromial stop with a pediculated deltoid flap. Rev Chir Orthop Reparatrice Appar Mot 79:661–665
Mair SD, Zarzour RH, Speer KP (1998) Posterior labral injury in contact athletes. Am J Sports Med 26:753–758
Matsen FA 3rd, Chebli C, Lippitt S (2006) Principles for the evaluation and management of shoulder instability. J Bone Joint Surg Am 88:648–659
Matsen FA 3rd, Lippitt SB, Alexander Rockwood Jr, Charles Wirth A, Michael A (2008) Glenohumeral instability vol 1. The shoulder, 4th edn. Saunders Elsevier, Philadelphia, pp 621–622
McFarland EG, Kim TK, Park HB, Neira CA, Gutierrez MI (2003) The effect of variation in definition on the diagnosis of multidirectional instability of the shoulder. J Bone Joint Surg Am 85-A:2138–2144
McLaughlin H (1952) Posterior dislocation of the shoulder. J Bone Joint Surg Am 24-A:584–590
Misamore GW, Facibene WA (2000) Posterior capsulorrhaphy for the treatment of traumatic recurrent posterior subluxations of the shoulder in athletes. J Shoulder Elbow Surg 9:403–408
Moeller JC (1975) Compound posterior dislocation of the glenohumeral joint. Case report. J Bone Joint Surg Am 57:1006–1007
Neviaser RJ, Neviaser TJ (1995) Recurrent instability of the shoulder after age 40. J Shoulder Elbow Surg 4:416–418
Ovesen J, Sojbjerg JO (1986) Posterior shoulder dislocation. Muscle and capsular lesions in cadaver experiments. Acta Orthop Scand 57:535–536
Page RS, Bhatia DN (2009) Arthroscopic repair of humeral avulsion of glenohumeral ligament lesion: anterior and posterior techniques. Tech Hand Up Extrem Surg 13:98–103
Pokabla C, Hobgood ER, Field LD (2010) Identification and management of “floating” posterior inferior glenohumeral ligament lesions. J Shoulder Elbow Surg 19:314–317
Pollock RG, Bigliani LU (1993) Recurrent posterior shoulder instability. Diagnosis and treatment. Clin Orthop Relat Res 291:85–96
Provencher MT, Mologne TS, Romeo AA, Bradley JP (2009) The use of rotator interval closure in the arthroscopic treatment of posterior shoulder instability. Arthroscopy 25:109–110
Robinson CM, Aderinto J (2005) Posterior shoulder dislocations and fracture-dislocations. J Bone Joint Surg Am 87:639–650
Robinson CM, Aderinto J (2005) Recurrent posterior shoulder instability. J Bone Joint Surg Am 87:883–892
Savoie FH 3rd, Holt MS, Field LD, Ramsey JR (2008) Arthroscopic management of posterior instability: evolution of technique and results. Arthroscopy 24:389–396
Schoenfeld AJ, Lippitt SB (2007) Rotator cuff tear associated with a posterior dislocation of the shoulder in a young adult: a case report and literature review. J Orthop Trauma 21:150–152
Servien E, Walch G, Cortes ZE, Edwards TB, O’Connor DP (2007) Posterior bone block procedure for posterior shoulder instability. Knee Surg Sports Traumatol Arthrosc 15:1130–1136
Shah N, Tung GA (2009) Imaging signs of posterior glenohumeral instability. AJR Am J Roentgenol 192:730–735
Simons P, Joekes E, Nelissen RG, Bloem JL (1998) Posterior labrocapsular periosteal sleeve avulsion complicating locked posterior shoulder dislocation. Skeletal Radiol 27:588–590
Steinitz DK, Harvey EJ, Lenczner EM (2003) Traumatic posterior dislocation of the shoulder associated with a massive rotator cuff tear: a case report. Am J Sports Med 31:1010–1012
Trout TE, Resnick D (1996) Glenoid hypoplasia and its relationship to instability. Skeletal Radiol 25:37–40
Walch G, Boileau P, Martin B, Dejour H (1990) Unreduced posterior luxations and fractures-luxations of the shoulder. Apropos of 30 cases. Rev Chir Orthop Reparatrice Appar Mot 76:546–558
Weinberg J, McFarland EG (1999) Posterior capsular avulsion in a college football player. Am J Sports Med 27:235–237
Weishaupt D, Zanetti M, Nyffeler RW, Gerber C, Hodler J (2000) Posterior glenoid rim deficiency in recurrent (atraumatic) posterior shoulder instability. Skeletal Radiol 29:204–210
Williams RJ 3rd, Strickland S, Cohen M, Altchek DW, Warren RF (2003) Arthroscopic repair for traumatic posterior shoulder instability. Am J Sports Med 31:203–209
Wirth MA, Lyons FR, Rockwood CA Jr (1993) Hypoplasia of the glenoid. A review of sixteen patients. J Bone Joint Surg Am 75:1175–1184
Wolf EM, Eakin CL (1998) Arthroscopic capsular plication for posterior shoulder instability. Arthroscopy 14:153–163
Wright RW, Paletta GA Jr (2004) Prevalence of the bennett lesion of the shoulder in major league pitchers. Am J Sports Med 32:121–124
Yoneda M, Nakagawa S, Hayashida K, Fukushima S, Wakitani S (2002) Arthroscopic removal of symptomatic bennett lesions in the shoulders of baseball players: arthroscopic bennett-plasty. Am J Sports Med 30:728–736
Yu JS, Ashman CJ, Jones G (2002) The POLPSA lesion: MR imaging findings with arthroscopic correlation in patients with posterior instability. Skeletal Radiol 31:396–399
Acknowledgments
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Van Tongel, A., Karelse, A., Berghs, B. et al. Posterior shoulder instability: current concepts review. Knee Surg Sports Traumatol Arthrosc 19, 1547–1553 (2011). https://doi.org/10.1007/s00167-010-1293-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-010-1293-z