Posterior Shoulder Instability


The past decade has seen heightened awareness and interest in posterior glenohumeral instability. In contrast to anterior shoulder instability, posterior instability most often presents with subtle manifestations and symptoms consisting primarily of pain with specific activities. The mechanism of injury may involve an acute traumatic event, but is more often a cumulative effect of repetitive microtrauma. Upon stability testing, patients with posterior shoulder instability have evidence of posterior translation. Radiographic evaluation normally reveals pathology of the posterior labrum, joint capsule, or both, which may be accompanied by bony abnormalities predisposing to posterior instability. Nonsurgical management is the initial treatment of choice, but if this approach fails, surgical intervention may be indicated. Although an open capsular posteroinferior shift has been the historical treatment of choice for posterior shoulder instability, arthroscopic techniques have become increasingly popular among surgeons, and most pathology associated with posterior instability can now be addressed arthroscopically. For patients with more significant deformities, an open procedure involving bone surgery, such as an osteotomy or graft reconstruction, may be necessary.

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