scholarly journals Arthroscopic Repair of a Posterior Midcapsular Rupture Causing Posterior Shoulder Instability

2021 ◽  
Vol 1 (6) ◽  
pp. 263502542110319
Author(s):  
Gautam P. Yagnik ◽  
Kevin West ◽  
Bhavya K. Sheth ◽  
Luis Vargas ◽  
John W. Uribe
Keyword(s):  
Shoulder Instability ◽  
Arthroscopic Repair ◽  
Labral Tear ◽  
Labral Repair ◽  
Posterior Capsule ◽  
Posterior Shoulder Instability ◽  
Posterior Instability ◽  
Difficult Condition ◽  
Posterior Shoulder ◽  
Diagnostic Arthroscopy

Background: Gross posterior instability is rare and when found likely has an injury or deficiency to the posterior static restraints of shoulder associated with it. Traditionally, injuries to the posterior capsule have been difficult to diagnose and visualize with magnetic resonance imaging preoperatively, and very little literature regarding arthroscopic repair of posterior capsular tears exists currently. Indications: We present a repair of a posterior midcapsular and posterior labral tear in a 26-year-old man with recurrent left posterior shoulder instability using a novel all–arthroscopic technique. Technique Description: We performed a shoulder arthroscopy in a lateral decubitus position with the arm at 45° of abduction using standard posterior viewing and anterior working portals. Diagnostic arthroscopy revealed a large posterior midcapsular rupture approximately 2 cm lateral to the glenoid with an associated posterior labral tear. We created an accessory posterolateral portal with needle localization that was outside the capsular defect yet allowed access to the posterior labrum. Anatomic closure of the capsular tear was achieved arthroscopically with 3 interrupted No. 2 nonabsorbable sutures in a side–to–side fashion. Posterior labral repair and capsular shift were done to further address the instability using 2 knotless all–suture anchors percutaneously placed at the 7 o'clock and 9 o'clock position. We closed the posterior portal with a combination of curved and penetrating suture passers. Incisions were closed with interrupted 4-0 nylon. Postoperatively, the patient was placed in an ultra–sling for 4 weeks before physical therapy. We allowed light strengthening at 8 weeks, full strengthening at 12 weeks, and estimated return to sport at 4 months. Results: At 6 months postoperatively, the patient has regained symmetric motion, full strength, and has no residual pain or instability. Conclusion: Gross posterior instability is a rare and difficult condition to diagnose and manage. If no significant labral injuries are identified, injury to the posterior capsule must be considered and full assessment should be done when visualizing from the anterior portal. Repair of the posterior capsule is necessary and can be achieved all arthroscopically with this technique.

scholarly journals Differences in Outcomes Between Anterior and Posterior Shoulder Instability After Arthroscopic Bankart Repair: A Systematic Review and Meta-analysis

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110064
Author(s):  
Matthew L. Vopat ◽  
Reed G. Coda ◽  
Nick E. Giusti ◽  
Jordan Baker ◽  
Armin Tarakemeh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Shoulder Instability ◽  
Anterior Shoulder Instability ◽  
Posterior Shoulder Instability ◽  
Anterior Instability ◽  
Posterior Instability ◽  
Female Patients ◽  
Posterior Shoulder ◽  
Male Patients ◽  
Postoperative Instability

Background: The glenohumeral joint is one of the most frequently dislocated joints in the body, particularly in young, active adults. Purpose: To conduct a systematic review and meta-analysis to evaluate and compare outcomes between anterior versus posterior shoulder instability. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed using the PubMed, Cochrane Library, and MEDLINE databases (from inception to September 2019) according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were included if they were published in the English language, contained outcomes after anterior or posterior shoulder instability, had at least 1 year of follow-up, and included arthroscopic soft tissue labral repair of either anterior or posterior instability. Outcomes including return-to-sport (RTS) rate, postoperative instability rate, and pre- and postoperative American Shoulder and Elbow Surgeons (ASES) scores were recorded and analyzed. Results: Overall, 39 studies were included (2077 patients; 1716 male patients and 361 female patients). Patients with anterior instability had a mean age of 23.45 ± 5.40 years (range, 11-72 years), while patients with posterior instability had a mean age of 23.08 ± 8.41 years (range, 13-61 years). The percentage of male patients with anterior instability was significantly higher than that of female patients (odds ratio [OR], 1.36; 95% CI, 1.04-1.77; P = .021). Compared with patients with posterior instability, those with anterior instability were significantly more likely to RTS (OR, 2.31; 95% CI, 1.76-3.04; P < .001), and they were significantly more likely to have postoperative instability (OR, 1.53; 95% CI, 1.07-2.23; P = .018). Patients with anterior instability also had significantly higher ASES scores than those with posterior instability (difference in means, 6.74; 95% CI, 4.71-8.77; P < .001). There were no significant differences found in postoperative complications between the anterior group (11 complications; 1.8%) and the posterior group (3 complications; 1.6%) (OR, 1.12; 95% CI, 0.29-6.30; P = .999). Conclusion: Patients with anterior shoulder instability had higher RTS rates but were more likely to have postoperative instability compared with posterior instability patients. Overall, male patients were significantly more likely to have anterior shoulder instability, while female patients were significantly more likely to have posterior shoulder instability.

Posterior shoulder instability: a systematic review

2020 ◽  
Vol 134 (1) ◽  
pp. 34-53
Author(s):  
Umile Giuseppe Longo ◽  
Mauro Ciuffreda ◽  
Joel Locher ◽  
Carlo Casciaro ◽  
Nicholas Mannering ◽  
...  
Keyword(s):  
Systematic Review ◽  
Soft Tissue ◽  
Shoulder Instability ◽  
Optimal Treatment ◽  
Treatment Modalities ◽  
Posterior Shoulder Instability ◽  
Posterior Instability ◽  
Posterior Shoulder ◽  
Comprehensive Search ◽  
Tissue Abnormalities

Abstract Introduction This review aims to provide information on outcomes of surgical procedures for soft tissue or bony glenoid and/or humeral abnormalities in case of posterior shoulder instability. Source of data A systematic review of the literature according to the PRISMA guidelines was performed. A comprehensive search of PubMed, Medline, CINAHL, Cochrane, Embase, Ovid and Google Scholar databases using various combinations of the keywords ‘shoulder’, ‘posterior instability’, ‘dislocation’, ‘reversed bony bankart’, ‘reversed Hill Sachs’, and ‘capsulolabral’ was performed. Areas of agreement A total of 847 shoulders in 810 patients were included. A redislocation event occurred in 33 (8.7%) of 411 shoulders with soft tissue abnormalities and in 12 (9.1%) of 132 shoulders with bony abnormalities of the glenoid, humeral head or both. Areas of controversy The optimal treatment modalities for posterior shoulder dislocation remain to be defined. Growing points Operative stabilization for posterior shoulder instability should be lesion-specific and should correct all components of the posterior instability. Areas timely for developing research Future prospective studies should aim to establish the optimal treatment modalities for posterior shoulder instability.

scholarly journals Posterior Shoulder Instability in the Patients with Bilateral Congenital Absence of Long Head of Biceps Tendon: A Case Report

2018 ◽  
Vol 21 (4) ◽  
pp. 240-245
Author(s):  
Sung Hyun Yoon ◽  
Kang Heo ◽  
Jae Sung Yoo ◽  
Sung Joon Kim ◽  
Joong Bae Seo
Keyword(s):  
Shoulder Instability ◽  
Biceps Tendon ◽  
Magnetic Resonance Images ◽  
Labral Tear ◽  
Congenital Absence ◽  
Posterior Shoulder Instability ◽  
First Case ◽  
Posterior Shoulder ◽  
Long Head ◽  
Glenoid Dysplasia

Rare cases of a congenital absence of the long head of the biceps tendon (LHBT) have been reported, and its incidence is unknown. In a literature review of the congenital absence of the LHBT, only 1 case was associated with posterior shoulder instability and severe posterior glenoid dysplasia. This paper reports the first case of a patient with a bilateral congenital absence of the LHBT with posterior shoulder instability without glenoid dysplasia or posterior glenoid tilt. The patient experienced a traffic accident while holding the gear stick with his right hand. After the accident, a posteroinferior labral tear with paralabral cysts was detected on the magnetic resonance images. The congenital absence of the LHBT was assumed to have affected the posterior instability that possibly increased the susceptibility to a subsequent traumatic posterior inferior labral tear. This case was identified as a posterior inferior tear caused by a traumatic ‘gear stick injury’.

A Prospective Analysis of Patients With Anterior Versus Posterior Shoulder Instability: A Matched Cohort Examination and Surgical Outcome Analysis of 200 Patients

2019 ◽  
Vol 47 (3) ◽  
pp. 682-687 ◽  
Author(s):  
Andrew S. Bernhardson ◽  
Colin P. Murphy ◽  
Zachary S. Aman ◽  
Robert F. LaPrade ◽  
Matthew T. Provencher
Keyword(s):  
Shoulder Instability ◽  
Matched Cohort ◽  
Arthroscopic Stabilization ◽  
Mechanism Of Injury ◽  
Posterior Shoulder Instability ◽  
Anterior Instability ◽  
Posterior Instability ◽  
Medical Provider ◽  
Posterior Shoulder

Background: Anterior and posterior shoulder instabilities are entirely different entities. The presenting complaints and symptoms vastly differ between patients with these 2 conditions, and a clear understanding of these differences can help guide effective treatment. Purpose: To compare a matched cohort of patients with anterior and posterior instability to clearly outline the differences in the initial presenting history and overall outcomes after arthroscopic stabilization. Study Design: Cohort study; Level of evidence, 2. Methods: Consecutive patients with either anterior or posterior glenohumeral instability were prospectively enrolled; patients were excluded if they had more than 10% anterior or posterior glenoid bone loss, multidirectional instability, neurologic injury, or prior surgery. Patients were assigned to anterior or posterior shoulder instability groups based on the history and clinical examination documenting the primary direction of instability, with imaging findings to confirm a labral tear associated with the specific direction of instability. Preoperative demographic data, injury history, and overall clinical outcome scores (American Shoulder and Elbow Surgeons [ASES], Single Assessment Numeric Evaluation [SANE], and Western Ontario Shoulder Index [WOSI]) were assessed and compared statistically between the 2 cohorts. Patients were indicated for surgery if they elected to proceed with surgical management or did not respond to a course of nonoperative management. Results: The study included 103 patients who underwent anterior stabilization (mean age, 23.5 years; range, 18-36 years) and 97 patients who underwent posterior stabilization (mean age, 24.5 years; range, 18-36 years). The mean follow-up was 39.7 months (range, 24-65 months), and there were no age or sex differences between the groups. No patients were lost to follow-up. The primary mechanism of injury in the anterior cohort was a formal dislocation event (82.5% [85/103], of which 46% [39/85] required reduction by a medical provider), followed by shoulder subluxation (12%, 12/103), and “other” (6%, 6/103; no forceful injury). No primary identifiable mechanism of injury was found in the posterior cohort for 78% (75/97) of patients; lifting and pressing (11%, 11/97) and contact injuries (10% [all football blocking], 10/97) were the common mechanisms that initiated symptoms. Only 10 patients (10.3%) in the posterior cohort sustained a dislocation. The most common complaints for patients with anterior instability were joint instability (80%) and pain with activities (32%). In the posterior cohort, the most common complaint was pain (90.7%); only 13.4% in this cohort reported instability as the primary complaint. Clinical outcomes after arthroscopic stabilization were significantly improved in both groups, but the anterior cohort had significantly better outcomes in all scores measured: ASES (preoperative: anterior 58.0, posterior 60.0; postoperative: anterior 94.2 vs posterior 87.7, P < .005), SANE (preoperative: anterior 50.0, posterior 60.0; postoperative: anterior 92.9 vs posterior 84.9, P < .005), and WOSI (preoperative: anterior 55.95, posterior 60.95; postoperative: anterior 92% of normal vs posterior 84%, P < .005). Conclusion: This study outlines clear distinctions between anterior and posterior shoulder instability in terms of presentation and clinical findings. Patients with anterior instability present primarily with an identifiable mechanism of injury and complaints of instability, whereas most patients with classic posterior instability have no identifiable mechanism of injury and their primary symptom is pain. Anterior instability outcomes in this matched cohort were superior in all domains versus posterior instability after arthroscopic stabilization, which further highlights the differences between anterior and posterior instability.

The Addition of Rotator Interval Closure after Arthroscopic Repair of Either Anterior or Posterior Shoulder Instability

2008 ◽  
Vol 36 (6) ◽  
pp. 1123-1131 ◽  
Author(s):  
Timothy S. Mologne ◽  
Kristin Zhao ◽  
Michio Hongo ◽  
Anthony A. Romeo ◽  
Kai-Nan An ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Arthroscopic Repair ◽  
Rotator Interval ◽  
Posterior Shoulder Instability ◽  
Posterior Shoulder

Arthroscopic Repair for Posterior Shoulder Instability

2012 ◽  
Vol 28 (10) ◽  
pp. 1337-1343 ◽  
Author(s):  
Brett A. Lenart ◽  
Seth L. Sherman ◽  
Nathan A. Mall ◽  
Eric Gochanour ◽  
Stacy L. Twigg ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Arthroscopic Repair ◽  
Posterior Shoulder Instability ◽  
Posterior Shoulder

Incidence of Posterior Shoulder Instability in the United States Military: Demographic Considerations From a High-Risk Population

2020 ◽  
pp. 036354652097614
Author(s):  
Steven L. Bokshan ◽  
Halle M. Kotchman ◽  
Lambert T. Li ◽  
Steven F. DeFroda ◽  
Kenneth L. Cameron ◽  
...  
Keyword(s):  
United States ◽  
Shoulder Instability ◽  
Military Service ◽  
The United States ◽  
Posterior Shoulder Instability ◽  
Posterior Instability ◽  
Us Military ◽  
Posterior Shoulder ◽  
Significant Difference ◽  
Adjusted Rate

Background: Relatively little is known about the true incidence of posterior shoulder instability in the United States. Purpose/Hypothesis: The purpose of this study was to characterize the incidence of posterior shoulder instability in the US military population and to examine which characteristics place these patients at highest risk. We hypothesized that the rate of posterior instability in this cohort of patients would be higher than previously reported. Study Design: Descriptive epidemiology study. Methods: All initial cases of posterior shoulder dislocation and subluxation in the Defense Medical Epidemiology Database were screened between 2016 and 2018 using the relevant International Classification of Diseases–Tenth Revision-Clinical Modification codes. Incidences were calculated, and multivariate Poisson regression was used to calculate adjusted rate ratios for the effects of sex, race, age, military service branch, rank, and year. Results: The overall unadjusted incidence was 0.032 per 1000 person-years for posterior dislocations, 0.064 per 1000 person-years for posterior subluxations, and 0.096 per 1000 person-years for all cases of posterior shoulder instability. The total incidence of all shoulder instability was 1.84 per 1000 person-years, with posterior shoulder instability accounting for 5.2% of total cases. For posterior subluxation, significant differences between groups were found in the unadjusted and adjusted rate ratio (ARR) for sex (ARR, 3.31; 95% CI, 1.85-5.93 for men), race (ARR, 0.458; 95% CI, 0.294-0.714 for Black servicemembers and ARR, 0.632; 95% CI, 0.421-0.948 for servicemembers of other race), age (ARR, 3.69; 95% CI, 1.56-8.70 for patients aged 30-34 years), and military service branch (ARR, 0.663; 95% CI, 0.460-0.955 for Air Force servicemembers). For posterior shoulder dislocations, a significant difference was found only between men and women (ARR, 4.55; 95% CI, 1.85-11.2 for men). Conclusion: The incidence of posterior shoulder instability among US military personnel is higher than previously reported in the general US population, with a majority of cases due to subluxation. This increased incidence is likely reflective of a young and highly active population along with improvements in awareness and diagnosis of posterior instability in recent years.

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