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Context:Posterior shoulder instability is a commonly misdiagnosed disorder in many competitive athletes.Type of Study:Clinical review.Evidence Acquisition:Relevant studies on posterior shoulder instability from 1950 to 2010 in PubMed and Cochrane databases were reviewed.Results:A total of 107 studies were reviewed.Conclusion:Patients who have undergone at least 6 months of physical therapy and still experience instability symptoms should be considered for surgical stabilization directed at their underlying pathology.

The purpose of this study was to compare the acetabular version between male and female pelvises. We hypothesized that female acetabula would demonstrate more retroversion because Pincer-type femoroacetabular impingement (FAI) is associated with acetabular retroversion, which is more commonly observed in females. 120 bony pelvic specimens were randomly collected. The version was measured at three different axial sections of each acetabuli: cranial, central, and caudal. Males demonstrated significantly less anteversion than females in every section. The global version (the average of all three measurements) was also significantly different between males and females (16°±7° and 19°±8° respectively, p<0.001). Of the 240 examined acetabuli, 21 demonstrated cranial retroversion (16 males & 5 females). The data showed no significant difference (p=0.353) between global version of African Americans (18°±9°) and Caucasians (17°±7°). The results of this study suggest that symptomatic FAI in the female population likely reflects a complex interplay of femoral and acetabular dysmorphology and cannot be explained by differences in acetabular version alone.

Background Often, anteroposterior (AP) pelvic radiographs are performed with the patient positioned supine. However, this may not represent the functional position of the pelvis and the acetabulum, and so when assessing patients for conditions like femoroacetabular impingement (FAI), it is possible that standing radiographs better incorporate the dynamic influences of periarticular musculature and sagittal balance. However, this thesis remains largely untested. Questions/purposes The purpose of this study was to determine the effect of supine and standing pelvic orientation on (1) measurements of acetabular version and common radiographic signs of FAI as assessed on two-and three-dimensional (3-D) imaging; and (2) on terminal hip range of motion (ROM). Methods Preoperative pelvic CT scans of 50 patients (50 hips) who underwent arthroscopic surgery for the treatment of FAI between July 2013 and October 2014 were analyzed. The mean age of the study population was 29 ± 10 years (range, 15-50 years) and 70% were male. All patients had a standing AP pelvis radiograph, a reconstructed supine radiograph from the CT data, and a 3-D model created to allow manipulation of pelvic tilt and simulate ROM to osseous contact. Acetabular version was measured and the presence of the crossover sign, prominent ischial spine sign, and posterior wall sign were recorded on simulated plain radiographs. Measurements of ROM to bony impingement were made during (1) simulated hip flexion; (2) simulated internal rotation in 90°of flexion (IRF); and (3) simulated internal rotation in 90°of flexion and 15°adduction (FADIR), and the location of bony One or more of the authors has received funding outside of submitted work from Smith & Nephew (Andover, MA, USA) (JJN); Smith & Nephew and A3 Surgical (La Tronche, France) (CML); and Smith & Nephew, A3 Surgical, and Pivot (Sunnyvale, CA, USA) (BTK, AB). During the study period, an amount less than USD 10,000 was received. One or more of the authors has stock/stock options in A3 Surgical (CML, AB) and A3 Surgical and Pivot (BTK Clin Orthop Relat Res (2015) 473:1267-1273 DOI 10.1007/s11999-014-4104-x Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons®contact between the proximal femur and acetabular rim was defined. These measurements were calculated for supine and standing pelvic orientations. A paired Student's t-test was used for comparison of continuous variables, whereas chi square testing was used for categorical variables. A p value of \ 0.05 was considered significant. Results When changing from supine to the standing radiographs, both mean cranial and central version increased by 2°± 4°(95% confidence interval [CI], 1°-3°) and 2°± 3°(95% CI, 1°-3°), respectively (both p \ 0.001). However, with the numbers available, there were no changes in the proportion of positive crossover, posterior wall, and prominent ischial spine signs. Standing pelvic position tilt resulted in an increased hip flexion of 3°( 95% CI, 2°-4°) as well as an i...

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