Evaluation and Management of Posterior Shoulder Instability

Abstract

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.

Pitch-side management of acute shoulder dislocations: a conceptual review

“…Static stabilisation within the shoulder is collectively provided by the bony congruency of the joint surfaces, the glenoid labrum, the joint capsule and ligaments, and the negative intra-articular pressure generated within the joint. 1 11 19 The orientation of the articular surface of the scapula relative to the glenohumeral head provides resistance against postero-inferior instability. 20 21 Although the glenoid fossa is relatively shallow, the presence of the glenoid labrum increases the humeral contact area from 25% to about 35%.…”

“…The shoulder, specifically the glenohumeral joint, by virtue of its anatomical characteristics and biomechanics is one of the most unstable joints within the body. 1 The bony architecture confers a large range of movement, but ultimately lacks inherent stability. It is therefore one of the most commonly dislocated joints in the body, with an incidence density rate (IDR) estimated to be between 23.9 and 26.9 per 100 000 person-years within the general population.…”

Inestabilidad posterior del hombro

“…Los ejercicios de rehabilitación isocinéticos y de electroestimulación enfocados a los estabilizadores dinámicos (músculo subescapular, infraespinoso, redondo menor, deltoides posterior y estabilizadores de la escápula), que puedan compensar el déficit de las estructuras estáticas en pacientes con síntomas leves a moderados, tienen resultados satisfactorios en 65 a 89% de los casos; sin embargo, las tasas de satisfacción en pacientes con antecedentes de inestabilidad por un macrotraumatismo único que evoluciona a subluxaciones recurrentes son de 11 a 16%, con un tratamiento sólo de rehabilitación. 13,28,42,43,44,45 Tratamiento quirúrgico por cirugía abierta Recordando la clasificación ya mencionada previamente como preferida por este autor, se mencionarán las indicaciones y resultados de los tipos de cirugía abierta con distintas técnicas, propuestas a partir de series pequeñas, debido a lo poco común de la patología.…”

Evidence-based conservative rehabilitation for posterior glenohumeral instability: A systematic review

“…32,33 Symptoms are usually aggravated by shoulder flexion, horizontal adduction, internal rotation or combinations thereof, such as a backhand in tennis or a bench press. 12,26 Presentation may also include a general decrease in athletic performance and function. 8 Considering the possible increased prevalence of posterior shoulder instability, especially in the young athletic population, the purpose of this paper was to conduct a structured, systematic search of the available literature to identify the best evidencedbased approach for conservative rehabilitation of patients with posterior glenohumeral instability.…”

“…11 Glenoid version, humeral retrotorsion and joint congruency also contribute to static glenohumeral stability. 12 Dynamically, the rotator cuff muscles are the most important stabilizers in the prevention of PI. 13 Contribution from both dynamic and static structures assist in stabilizing this otherwise extremely mobile joint.…”