High frequency of posterior and combined shoulder instability in young active patients

Song, Daniel J.; Cook, Jay B.; Krul, Kevin P.; Bottoni, Craig R.; Rowles, Douglas J.; Shaha, Steven H.; Tokish, John M.

doi:10.1016/j.jse.2014.06.053

Cited by 110 publications

(118 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Isolated posterior labral repairs constitute up to 24% of operative shoulder instability events, which may be higher than previously reported. 12,31,41 Injuries typically occur in athletes participating in high-demand, dynamic posterior loading activities, including weightlifters and football linemen. Recently, posterior instability has also been described in unique populations, including baseball players’ lead shoulders during batting and individuals who participate in rifle shooting.…”

Section: Epidemiologymentioning

confidence: 99%

“…21 In fact, in a series of 231 shoulder stabilizations for instability in a military population, isolated posterior stabilizations comprised 24% while combined injuries comprised 19% of shoulder stabilizations. 41 Consequently, military providers must have a heightened awareness for detecting posterior instability among military members. Glenoid retroversion beyond the average 5° to 10° has been shown to be a risk factor for developing subsequent posterior instability in a prospective study of healthy subjects.…”

Section: Pathoanatomymentioning

confidence: 99%

See 1 more Smart Citation

Posterior Shoulder Instability

2016

Self Cite

View full text Add to dashboard Cite

Context:Posterior shoulder instability has become more frequently recognized and treated as a unique subset of shoulder instability, especially in the military. Posterior shoulder pathology may be more difficult to accurately diagnose than its anterior counterpart, and commonly, patients present with complaints of pain rather than instability. “Posterior instability” may encompass both dislocation and subluxation, and the most common presentation is recurrent posterior subluxation. Arthroscopic and open treatment techniques have improved as understanding of posterior shoulder instability has evolved.Evidence Acquisition:Electronic databases including PubMed and MEDLINE were queried for articles relating to posterior shoulder instability.Study Design:Clinical review.Level of Evidence:Level 4.Results:In low-demand patients, nonoperative treatment of posterior shoulder instability should be considered a first line of treatment and is typically successful. Conservative treatment, however, is commonly unsuccessful in active patients, such as military members. Those patients with persistent shoulder pain, instability, or functional limitations after a trial of conservative treatment may be considered surgical candidates. Arthroscopic posterior shoulder stabilization has demonstrated excellent clinical outcomes, high patient satisfaction, and low complication rates. Advanced techniques may be required in select cases to address bone loss, glenoid dysplasia, or revision.Conclusion:Posterior instability represents about 10% of shoulder instability and has become increasingly recognized and treated in military members. Nonoperative treatment is commonly unsuccessful in active patients, and surgical stabilization can be considered in patients who do not respond. Isolated posterior labral repairs constitute up to 24% of operatively treated labral repairs in a military population. Arthroscopic posterior stabilization is typically considered as first-line surgical treatment, while open techniques may be required in complex or revision settings.

show abstract

Section: Epidemiologymentioning

confidence: 99%

Section: Pathoanatomymentioning

confidence: 99%

Posterior Shoulder Instability

2016

Self Cite

View full text Add to dashboard Cite

show abstract

“…Conversely, posterior instability has historically accounted for only a smaller fraction of all unstable shoulders, with approximately 2% to 10% reported[8-10]. More recent series indicate that isolated posterior instability may comprise over a quarter of patients with shoulder stabilization, and approximately 20% of additional patients will undergo surgery for combined or bidirectional instability[11]. Especially within young active patients, circumferential labral pathology may also be common with isolated or recurrent anterior shoulder instability[12,13], so there must be a high index of suspicion in the evaluation of these at-risk individuals.…”

Section: Introductionmentioning

confidence: 99%

Prevention and management of post-instability glenohumeral arthropathy

Waterman¹,

Kilcoyne²,

Parada³

et al. 2017

WJO

View full text Add to dashboard Cite

Post-instability arthropathy may commonly develop in high-risk patients with a history of recurrent glenohumeral instability, both with and without surgical stabilization. Classically related to anterior shoulder instability, the incidence and rates of arthritic progression may vary widely. Radiographic arthritic changes may be present in up to two-thirds of patients after primary Bankart repair and 30% after Latarjet procedure, with increasing rates associated with recurrent dislocation history, prominent implant position, non-anatomic reconstruction, and/or lateralized bone graft placement. However, the presence radiographic arthrosis does not predict poor patient-reported function. After exhausting conservative measures, both joint-preserving and arthroplasty surgical options may be considered depending on a combination of patient-specific and anatomic factors. Arthroscopic procedures are optimally indicated for individuals with focal disease and may yield superior symptomatic relief when combined with treatment of combined shoulder pathology. For more advanced secondary arthropathy, total shoulder arthroplasty remains the most reliable option, although the clinical outcomes, wear characteristics, and implant survivorship remains a concern among active, young patients.

show abstract

“…2,3,4,5,6,7,8,9 A recent retrospective study of 231 military personnel who underwent surgery for glenohumeral instability found 24% had isolated PI and 19% had combined instability. 10 Isolated PI included those with posterior or posteroinferior labral tears. Combined instability included panlabral tears, multidirectional instability, anterior and posterior instability and instability with superior labral pathology.…”

Section: Introductionmentioning

confidence: 99%