Posterior Instability of the Shoulder

Abstract

Well-defined and uniform shoulder outcome measures to assess posterior shoulder instability are lacking throughout the literature. However, arthroscopic procedures are shown to be an effective and reliable treatment for unidirectional posterior glenohumeral instability with respect to outcome scores, patient satisfaction, and return to play. Despite similar results of outcome measures to the overall athletic population, throwing athletes are less likely to return to their preinjury levels of sport compared with contact athletes or the overall athletic population. Evidence also indicates that arthroscopic stabilization procedures using suture anchors result in fewer recurrences and revisions than anchorless repairs in young adults engaging in highly demanding physical activity. Furthermore, the literature suggests that patients treated arthroscopically have superior outcomes compared with patients who undergo open procedures with respect to stability, recurrence of instability, patient satisfaction, return to sport, and return to previous level of play.

Arthroscopic Labral Repair in the Setting of Recurrent Posterior Shoulder Instability

“…Although nonoperative management should be considered the first line of treatment in low-demand patients, unfavorable results after conservative management in younger, more active male patients have been shown. 2 , 3 , 4 , 9 Early reported outcomes after open and arthroscopic repair for treatment of posterior instability were discouraging, with reported failure rates of up to 70%. 3 However, more recently, modern arthroscopic techniques have developed into the “gold standard” of care for patients with pain or symptomatic instability.…”

“…Given that posterior shoulder instability accounts for only 10% to 12% of all instability cases, it may be overlooked in patients with nonspecific symptoms; however, posterior shoulder instability is prevalent among certain athlete populations, particularly in contact sport athletes. 1 , 2 , 3 , 4 Aside from its rarity and vague clinical presentation, posterior instability is also particularly challenging as a result of its inconsistent and, at times, complex etiology. This inconsistency across cases of posterior instability is due to the wide array of causes leading to posterior instability, including acute trauma, 5 repetitive microtrauma, 6 and chronic insidious onset.…”

Posterior shoulder instability in the athletic population: Variations in assessment, clinical outcomes, and return to sport

“…Postoperatively, increased range of motion, shorter rehabilitation, and less pain and morbidity have been reported in arthroscopic procedures compared to more invasive techniques [24] . A recent metaanalysis for the treatment of unidirectional posterior shoulder instability conducted by DeLong et al [26] evaluated 27 arthroscopic studies and 26 open studies and identified a trend in the current literature of arthroscopic techniques having superior outcomes compared to open techniques for stability, recurrence, patient satisfactions, return to sport and previous level of play. Ultimately, less comorbidity associated with arthroscopic surgical procedures may allow athletes to return sport faster and with less complications [24] .…”

Posterior Shoulder Instability

“…3,10,11,24 In the largest prospective study to date for isolated posterior instability, Bradley et al 4 reported excellent results in 200 patients undergoing labral repair with or without capsular plication; 94% of patients were satisfied with the results and would undergo surgery again, 90% of patients returned to sports—although only 64% returned at the same level of play—and 7% of patients reported persistent instability after surgery (62.5% of those patients had signs of multidirectional instability at the time of revision surgery). Contact athletes had similar outcomes to noncontact athletes in this population.…”

“…2 A recent large meta-analysis also suggested that patients treated arthroscopically have superior outcomes compared with patients who undergo open procedures with respect to stability, recurrence of instability, patient satisfaction, return to sport, and return to previous level of play. 11 …”