Arthroscopic Treatment of Posterior Shoulder Instability

Abstract

Arthroscopic treatment of posterior shoulder instability is an effective means to improve symptoms associated with recurrent posterior subluxation of the shoulder. It can provide predictable success in the setting of unidirectional, nonvoluntary posterior instability without prior surgery.

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

“…Similarly, the retrospective level 4 investigation of 20 athletic shoulders by McIntyre et al [13] utilized an anchorless suture technique reported a high failure rate of 25% (5 of 20 shoulders). An additional level 4 report of 33 patients by Provencher et al [12] concluded that capsular plication rather than labral suture anchor repair had a higher chance of failure among their 7 reported failed cases (P = 0.10). Thus, arthroscopic posterior stabilization procedures utilizing suture anchors to address capsular pathology may provide the most consistent and favorable outcomes and return to sport [13,18,27,28] .…”

“…In a case series of 33 patients, Provencher et al [12] demonstrated that patients with voluntary instability resulted in worse outcomes. Specifically, they identified recurrent instability to be specific to patients with a voluntary instability component, whereas, all patients with involuntary instability were stable at followup (P = 0.025).…”

“…In particular, thermal capsulorrhaphy has been shown to result in failures and revisions. For instance, the level 4 retrospective case series of 33 patients by Provencher et al [12] determined that 71% (5 of 7) of their failures had undergone prior surgical procedures, such as thermal capsulorrhaphy (n = 3) and anterior stabilization (n = 2) and resulted in a higher chance of failure. Additionally, the level 4 retrospective investigation of 20 shoulders performed by McIntyre et al [13] utilized a multiple suture technique and reported 60% (3 of 5) of their DeLong JM et al .…”

Rehabilitation and Functional Outcomes in Collegiate Wrestlers Following a Posterior Shoulder Stabilization Procedure

“…Compared with magnetic resonance imaging (MRI), MRA can better define labral lesions and rotator interval lesions, as well as assess capsular volume. 28 MRA is currently the best method for imaging capsulolabral lesions. 36 Williams et al 42 recommend physical therapy as the primary treatment option for individuals with symptomatic posterior instability, with operative repair dependent on the extent of disability and desired level of activity.…”

“…The function subset (maximum score, 60) improved from a mean of 32 (range, 18-45) at the initial evaluation to a mean of 54 (range, 51-56) at discharge. At the initial physical therapy evaluation, the patients had a mean of 22 (range, 15-28) on the pain subset (maximum score, 30), and at discharge had a mean of 27 (range, [21][22][23][24][25][26][27][28][29]. The patients had a mean satisfaction subset (maximum score, 10) of 4 (range, 0-6) at the initial evaluation, 6 (range, 5-7) at discharge.…”