Nonoperative Management of Posterior Shoulder Instability: What Are the Long-Term Clinical Outcomes?

Abstract

Objective:To report the injury characteristics, radiographic findings, and long-term outcomes of nonoperative management for posterior shoulder instability (PSI).Design:A retrospective review of 143 patients with PSI using a large geographic database.Setting:Single county between January 1994 and July 2012.Patients:A clinical history and diagnosis of PSI, one confirmatory imaging study to support the diagnosis, and a minimum of 5 years follow-up were required for inclusion. Patients with seizure disorders, anterior-only instability, multidirectional instability, and superior labrum from anterior to posterior diagnosis were excluded.Interventions:Patients with PSI were managed nonoperatively or operatively.Main Outcome Measures:Pain, recurrent instability, and progression into glenohumeral osteoarthritis at long-term follow-up.Results:One hundred fifteen patients were identified. Thirty-seven (32%) underwent nonoperative management. Twenty (54%) patients were diagnosed with posterior subluxation, 3 (8%) with a single dislocation, and 7 (19%) with multiple dislocations. Symptomatic progression of glenohumeral arthritis was observed in 8% (3) of patients. Pain improved in 46% (17) of patients and worsened in 19% (7). Recurrent instability and progression to osteoarthritis occurred in 15% (3/20) of patients with a traumatic instability event compared with 0% of atraumatic patients after nonoperative management (P = 0.234). Pain at follow-up was more common in nonoperative than operative patients (P = 0.017).Conclusions:Nonoperative management is a viable option for many patients with posterior shoulder instability; however, many may continue to have posterior shoulder pain.

Minimum 10-Year Clinical Outcomes After Arthroscopic Capsulolabral Repair for Isolated Posterior Shoulder Instability

“…15,20 Even though an initial trial of nonoperative management is the first-line treatment approach, a high percentage of patients with posterior shoulder instability will experience persistent pain and dysfunction for which elective surgery is often pursued. 16,26 Arthroscopic capsulolabral repair for posterior shoulder instability has been shown to improve pain and stability, with .90% of patients capable of returning to sport at short-term to midterm follow-up. 10,19 However, despite arthroscopic stabilization, in certain populations, only two-thirds of patients return to sport (RTS) at the same preinjury level, and up to one-third experience persistent pain and/or instability, necessitating revision surgery.…”

“…15,20 Even though an initial trial of nonoperative management is the first-line treatment approach, a high percentage of patients with posterior shoulder instability will experience persistent pain and dysfunction for which elective surgery is often pursued. 16,26…”

The Cartilage Wear Index: a new evaluation method to improve patient selection in surgical treatment of recurrent posterior glenohumeral instability

“…In the case of recurrent, unidirectional, posterior shoulder instability, with image findings supporting the diagnosis, operative treatment has shown to be successful, with a return-to-sport rate of 86.9%, 25 and superior over nonoperative treatment in terms of pain relief. 22 Arthroscopic posterior labral repair with suture anchors has been described as an adequate technique for repair. However, little is known about outcome predictors regarding arthroscopic PGHI treatment.…”

Comprehensively Evaluate the Function of Shoulder Posterior Instability

“…In this study, 48.6% (18 of 37) patients in the nonoperative group and 60.3% (47 of 78) patients in the operative group participated in a sports. 1 However, the authors did not assess the rate of return to sport and recurrent instability based on the type of treatment (nonoperative vs surgical management). Therefore, the proportion of patients returning to their sport or preinjury competition level or the mean time to return to sport or preinjury competition should be assessed at the follow-up.…”

“…We appreciated reading the article by Lee et al 1 entitled “Nonoperative Management of Posterior Shoulder Instability: What Are the Long-Term Clinical Outcomes?” The main purpose of this study was to compare long-term outcomes after operative versus nonoperative treatment of posterior shoulder instability. We congratulate the authors for their excellent work.…”