Clinical, Diagnostic, and Therapeutic Characteristics of Posterior Glenohumeral Instability

Document Type : CURRENT CONCEPTS REVIEW

Authors

Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA

10.22038/abjs.2024.81046.3697

Abstract

Posterior shoulder instability (PSI) is a shoulder pathology that is challenging to diagnose, leading to 
treatment delay and exacerbation of symptoms. Etiology can be both traumatic and atraumatic, and a 
comprehensive clinical history plays a significant role in achieving diagnosis. Imaging in the setting of 
PSI can reveal a reverse-Bankart lesion, a reverse Hill-Sachs lesion, posterior labral cysts, and 
potentially glenoid or lesser tuberosity fractures. Both conservative and surgical options exist for 
patients with PSI, and management often depends on case severity, extent of bone loss, and patient 
goals and expectations. Holistic patient education regarding the etiologies, mechanisms and possible 
treatment options available is pivotal for achieving high levels of patient satisfaction and optimal 
outcomes.
 Level of evidence: IV

Keywords

Main Subjects

References

  1. Xu W, Huang L-X, Guo JJ, Jiang D-H, Zhang Y, Yang H-L. Neglected posterior dislocation of the shoulder: A systematic literature review. J Orthop Translat. 2015; 3(2):89-94. doi: 10.1016/j.jot.2015.02.004.
  2. Doehrmann R, Frush TJ, eds. Posterior shoulder instability. 1st ed. Treasure Island (FL): StatPearls Publishing; 2024.
  3. Swan ER, Lynch TB, Sheean AJ, Schmitz MR, Dickens JF, Patzkowski JC. High Incidence of Combined and Posterior Labral Tears in Military Patients with Operative Shoulder Instability. Am J Sports Med. 2022; 50(6):1529-1533. doi: 10.1177/03635465221078609.
  4. Woodmass JM, Lee J, Wu IT, et al. Incidence of posterior shoulder instability and trends in surgical reconstruction: a 22-year population-based study. J Shoulder Elbow Surg. 2019; 28(4):611-616. doi: 10.1016/j.jse.2018.08.046.
  5. Dimock R, Memon K, Consigliere P, Polyzois I, Imam MA, Narvani A. Posterior Shoulder Instability: The Augmented McLaughlin Procedure. Arch Bone Jt Surg. 2020; 8(6):729-733. doi: 10.22038/abjs.2020.44481.2224.
  6. Alkaduhimi H, Hilgersom NFJ, Eygendaal D, van den Bekerom MPJ, Oh L. The Outcomes of Soft-Tissue Repair for Posterior Shoulder Instability Surgery. Arch Bone Jt Surg. 2022; 10(1):45-51. doi: 10.22038/ABJS.2021.41491.2121.
  7. Castropil W, Mauad JR, Amorim FHB. Arthroscopic Coracoid Bone Block for Posterior Glenohumeral Instability: Description of Surgical Technique and a Case Report. Arch Bone Jt Surg. 2023; 11(9):591-594. doi: 10.22038/ABJS.2023.71320.3334.
  8. Bitar AC, Medina G, Ribas L, Smid J, Adoni T. Arthroscopic Reverse Remplissage in a Bilateral Seizure-related Posterior Shoulder Dislocation: Technique Description and 3-Year Follow-up Case Report. Arch Bone Jt Surg. 2021; 9(3):350-

 

  1. doi: 10.22038/abjs.2020.49649.2467.
  2. Festbaum C, Minkus M, Akgün D, et al. Conservative treatment of acute traumatic posterior shoulder dislocations (Type A) is a viable option especially in patients with centred joint, low gamma angle, and middle or old age. Knee Surg Sports Traumatol Arthrosc. 2022; 30(7):2500-2509. doi: 10.1007/s00167-022-06883-x.
  3. Kammel KR, El Bitar Y, Leber EH,eds. Posterior shoulder dislocations. 1st ed. Treasure Island (FL): StatPearls Publishing; 2024.
  4. Provencher MT, LeClere LE, King S, et al. Posterior instability of the shoulder: diagnosis and management. Am J Sports Med. 2011; 39(4):874-86. doi: 10.1177/0363546510384232.
  5. Robinson CM, Aderinto J. Recurrent Posterior Shoulder Instability. J Bone Joint Surg Am. 2005; 87(4):883-92. doi: 10.2106/JBJS.D.02906.
  6. Maalouly J, Aouad D, Ayoubi R, Dib N, El Rassi G. Posterior shoulder instability due to isolated reverse HAGL lesion in a young gymnast: A rare mechanism of injury and surgical technique. Trauma Case Rep.2020:28:100312. doi: 10.1016/j.tcr.2020.100312.
  7. George MS, Khazzam M, Kuhn JE. Humeral Avulsion of Glenohumeral Ligaments. J Am Acad Orthop Surg. 2011; 19(3):127-33. doi: 10.5435/00124635-201103000-00001.
  8. Betz ME, Traub SJ. Bilateral posterior shoulder dislocations following seizure. Intern Emerg Med. 2007; 2(1):63-5. doi: 10.1007/s11739-007-0017-y.
  9. Atwan Y, Wang A, Labrum JTt, et al. Management of Shoulder Instability in Patients with Seizure Disorders. Curr Rev Musculoskelet Med. 2023; 16(5):201-210. doi: 10.1007/s12178-023-09833-3.
  10. Nie J, Jin M, Fang T, Li J. [Bilateral posterior shoulder dislocation with associated reverse Hill-Sachs lesions after electrical injury]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2022; 40(7):527-529. doi: 10.3760/cma.j.cn121094-20210311-00137.
  11. Ippolito G, Zitiello M, De Marinis G, et al. Posterior Shoulder Dislocation with Engaging Reverse Hill-Sachs Lesion: A Retrospective Study of Ten Patients Treated with Arthroscopy or Open Reduction and Stabilization. J Clin Med.2021; 10(7):1410. doi: 10.3390/jcm10071410.
  12. Tuite MJ, Pfirrmann CW. Shoulder: instability. In: Musculoskeletal Diseases 2021-2024: Diagnostic Imaging. 1th ed. Hodler J, Kubik-Huch RA, von Schulthess GK, eds. Cham (CH): Springer; 2021.
  13. Spek RWA, Schoolmeesters BJA, den Haan C, Jaarsma RL, Doornberg JN, van den Bekerom MPJ. What are the patient-reported outcomes, functional limitations, and complications after lesser tuberosity fractures? A systematic review of 172 patients. JSES Int. 2021; 5(4):754-764. doi: 10.1016/j.jseint.2021.02.016.
  14. Jana M, Gamanagatti S. Magnetic resonance imaging in glenohumeral instability. World J Radiol. 2011; 3(9):224-32. doi: 10.4329/wjr.v3.i9.224.
  15. Ruiz Santiago F, Martínez Martínez A, Tomás Muñoz P, Pozo Sánchez J, Pérez AZ. Imaging of shoulder instability. Quant Imaging Med Surg. 2017; 7(4):422-433. doi: 10.21037/qims.2017.08.05.
  16. Tannenbaum E, Sekiya JK. Evaluation and management of posterior shoulder instability. Sports Health. 2011; 3(3):253-63. doi: 10.1177/1941738111400562.
  17. Moroder P, Scheibel M. ABC classification of posterior shoulder instability. Obere Extrem. 2017; 12(2):66-74. doi: 10.1007/s11678-017-0404-6.
  18. Kodali P, Jones MH, Polster J, Miniaci A, Fening SD. Accuracy of measurement of Hill-Sachs lesions with computed tomography. J Shoulder Elbow Surg.2011; 20(8):1328-34. doi: 10.1016/j.jse.2011.01.030.
  19. Burkhead WZ,Rockwood CA. Treatment of instability of the shoulder with an exercise program. J Bone Joint Surg Am.1992; 74(6):890-6.
  20. Fronek J, Warren RF, Bowen M. Posterior subluxation of the glenohumeral joint. J Bone Joint Surg Am.1989; 71(2):205-16.
  21. Lanzi JT, Chandler PJ, Cameron KL, Bader JM, Owens BD. Epidemiology of Posterior Glenohumeral Instability in a Young Athletic Population. Am J Sports Med. 2017; 45(14):3315-3321. doi: 10.1177/0363546517725067.
  22. Sadi J, Torchia E, Faber KJ, et al. Posterior Shoulder Instability Classification, Assessment, and Management: An International Delphi Study. J Orthop Sports Phys Ther. 2020; 50(7):373-380. doi: 10.2519/jospt.2020.9225.
  23. Bottoni CR, Franks BR, Moore JH, DeBerardino TM, Taylor DC, Arciero RA. Operative Stabilization of Posterior Shoulder Instability. Am J Sports Med.2005; 33(7):996-1002. doi: 10.1177/0363546504271509.
  24. Vopat ML, Coda RG, Giusti NE, et al. Differences in Outcomes Between Anterior and Posterior Shoulder Instability After Arthroscopic Bankart Repair: A Systematic Review and Meta-analysis. Orthop J Sports Med.2021; 9(5):23259671211006437. doi: 10.1177/23259671211006437.
  25. Fares MY, Boufadel P, Daher M, Koa J, Khanna A, Abboud JA. Anterior shoulder instability and open procedures: history, indications, and clinical outcomes. Clin Orthop Surg.2023; 15(4):521-533. doi: 10.4055/cios23018.
  26. Ernstbrunner L, Häller T, Waltenspül M, Wieser K, Gerber C. Posterior open-wedge osteotomy and glenoid concavity reconstruction using an implant-free, J-shaped iliac crest bone graft in atraumatic posterior instability with pathologic glenoid retroversion and dysplasia: a preliminary report. Clin Orthop Relat Res.2021; 479(9):1995-2005. doi: 10.1097/CORR.0000000000001757.
  27. Schwartz DG, Goebel S, Piper KJ, Kordasiewicz B, Boyle S, Lafosse L. Arthroscopic Posterior Bone Block Augmentation in Posterior Shoulder Instability. J Shoulder Elbow Surg.2013; 22(8):1092-101. doi: 10.1016/j.jse.2012.09.011.
  28. Brilakis E, Malahias M-A, Patramani M, et al. All-Arthroscopic McLaughlin's Procedure in Patients with Reverse Hill-Sachs Lesion Caused by Locked Posterior Shoulder Dislocation. Joints.2019; 7(3):71-77. doi: 10.1055/s-0039-3401820.
  29. Sperling JW, Pring M, Antuna SA, Cofield RH. Shoulder arthroplasty for locked posterior dislocation of the shoulder. J Shoulder Elbow Surg.2004; 13(5):522-7. doi: 10.1016/j.jse.2004.02.012.

 

 

 

 

 

 

The Archives of Bone and Joint Surgery
Volume 12, Issue 12
December 2024
Pages 820-825

Files

History

  • Receive Date: 10 July 2024
  • Revise Date: 02 September 2024
  • Accept Date: 23 September 2024

Share

How to cite

Statistics