Advertisement

Posterior Glenohumeral Instability: Diagnosis and Management

      Abstract

      Posterior glenohumeral instability can manifest as posterior shoulder pain and dysfunction, particularly among athletes. Repetitive, posteriorly-directed axial loads, as commonly encountered by contact athletes (American football linemen, rugby players), result in microtrauma that can induce posteroinferior labral tears. Alternatively, SLAP tears commonly seen in throwing athletes may propagate in a posteroinferior direction (i.e., a type VIII SLAP tear), owing to a complex pathologic cascade involving glenohumeral capsular contracture and imbalances among the dynamic stabilizing muscles of both the glenohumeral joint and shoulder girdle. The diagnosis of posterior glenohumeral instability is elucidated by a thorough history and physical examination. Posterior shoulder pain is oftentimes insidious in onset. The throwing athlete with posterior glenohumeral instability may complain of diminished control, accuracy, and generalized shoulder discomfort. A number of provocative physical examination maneuvers have been described (Kim test, Jerk test), which load the humeral head against the labral lesion and recreate patients’ symptoms. Magnetic resonance imaging and magnetic resonance arthrography can be of value in demonstrating avulsions of the labrum from the posteroinferior glenoid, and computed tomography is useful for quantifying the location and amount of attritional glenoid bone loss, although in contradistinction to anterior glenohumeral instability, clearly defined thresholds that would otherwise guide treatment have not been established. In the absence of substantial bone loss, arthroscopic posterior capsulolabral repair remains the gold standard for the surgical management of symptoms refractory to nonoperative treatment, and excellent clinical outcomes have generally been reported. However, high rates of return to play at the previous level of participation, particularly among throwing athletes, have been less consistently observed. Risk factors for the need for revision stabilization include surgery on the dominant extremity, female sex, and capsulolabral repairs involving either anchorless techniques or the use of less than 4 anchors.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      Bibliography

        • Arner J.W.
        • McClincy M.P.
        • Bradley J.P.
        Arthroscopic stabilization of posterior shoulder instability is successful in American football players.
        Arthroscopy. 2015; 31: 1466-1471
        • Beaulieu-Jones B.R.
        • Peebles L.A.
        • Golijanin P.
        • et al.
        Characterization of posterior glenoid bone loss morphology in patients with posterior shoulder instability.
        Arthroscopy. 2019; 35: 2777-2784
        • Bradley J.P.
        • Arner J.W.
        • Jayakumar S.
        • Vyas D.
        Risk factors and outcomes of revision arthroscopic posterior shoulder capsulolabral repair.
        Am J Sports Med. 2018; 46: 2457-2465
        • Bradley J.P.
        • McClincy M.P.
        • Arner J.W.
        • Tejwani S.G.
        Arthroscopic capsulolabral reconstruction for posterior instability of the shoulder: A prospective study of 200 shoulders.
        Am J Sports Med. 2013; 41: 2005-2014
        • Burkhart S.S.
        • Morgan C.D.
        • Kibler W.B.
        The disabled throwing shoulder: Spectrum of pathology Part I: Pathoanatomy and biomechanics.
        Arthroscopy. 2003; 19: 404-420
        • Chang E.S.
        • Greco N.J.
        • McClincy M.P.
        • Bradley J.P.
        Posterior shoulder instability in overhead athletes.
        Orthop Clin North Am. 2016; 47: 179-187
        • de Groot S.J.
        • Arner J.W.
        • Smith C.N.
        • Bradley J.P.
        Arthroscopic SLAP IIb repair using knot-tying versus knotless suture anchors: Is there a difference?.
        Am J Orthop (Belle Mead NJ). 2018; 47
        • Dekker T.J.
        • Peebles L.A.
        • Goldenberg B.T.
        • Millett P.J.
        • Bradley J.P.
        • Provencher M.T.
        Location of the glenoid defect in shoulders with recurrent posterior glenohumeral instability.
        Am J Sports Med. 2019; 47: 3051-3056
        • DeLong J.M.
        • Jiang K.
        • Bradley J.P.
        Posterior instability of the shoulder: A systematic review and meta-analysis of clinical outcomes.
        Am J Sports Med. 2015; 43: 1805-1817
        • Fourman M.S.
        • Arner J.W.
        • Bayer S.
        • Vyas D.
        • Bradley J.P.
        Type VIII SLAP repair at midterm follow-up: Throwers have greater pain, decreased function, and poorer return to play.
        Arthroscopy. 2018; 34: 3159-3164
        • Frank R.M.
        • Romeo A.A.
        • Provencher M.T.
        Posterior glenohumeral instability: Evidence-based treatment.
        J Am Acad Orthop Surg. 2017; 25: 610-623
        • Hanypsiak B.T.
        • DeLong J.M.
        • Simmons L.
        • Lowe W.
        • Burkhart S.
        Knot strength varies widely among expert arthroscopists.
        Am J Sports Med. 2014; 42: 1978-1984
        • Hines A.
        • Cook J.B.
        • Shaha J.S.
        • et al.
        Glenoid bone loss in posterior shoulder instability: Prevalence and outcomes in arthroscopic treatment.
        Am J Sports Med. 2018; 46: 1053-1057
        • Kim S.H.
        • Crater R.B.
        • Hargens A.R.
        Movement-induced knot migration after anterior stabilization in the shoulder.
        Arthroscopy. 2013; 29: 485-490
        • Kim S.H.
        • Ha K.I.
        • Yoo J.C.
        • Noh K.C.
        Kim's lesion: An incomplete and concealed avulsion of the posteroinferior labrum in posterior or multidirectional posteroinferior instability of the shoulder.
        Arthroscopy. 2004; 20: 712-720
        • McClincy M.P.
        • Arner J.W.
        • Bradley J.P.
        Posterior shoulder instability in throwing athletes: A case-matched comparison of throwers and non-throwers.
        Arthroscopy. 2015; 31: 1041-1051
        • McClincy M.P.
        • Arner J.W.
        • Thurber L.
        • Bradley J.P.
        Arthroscopic capsulolabral reconstruction for posterior shoulder instability is successful in adolescent athletes.
        J Pediatr Orthop. 2020; 40: 135-141
        • Owens B.D.
        • Campbell S.E.
        • Cameron K.L.
        Risk factors for posterior shoulder instability in young athletes.
        Am J Sports Med. 2013; 41: 2645-2649