• Posterior instability is defined as symptoms resulting from excessive posterior glenohumeral translation.1
• Posterior shoulder instability is less common than its anterior counterpart and is frequently difficult to diagnose.
• Patients with symptoms originating from excessive posterior translation of the shoulder rarely present with a history of dislocation requiring reduction.2,3 Instead, the patient with posterior instability more commonly presents with symptoms related to recurrent subluxation events.
• Posterior instability is more common in athletes who frequently place a posteriorly directed force on their shoulders, such as football offensive linemen and weight lifters.
• Treatment generally starts with a rehabilitation program, unless significant trauma initiates the instability.
• When rehabilitation fails, both open and arthroscopic surgical techniques are available. Recent studies have reported improved results for surgical posterior stabilization.
Figure 19-1 Magnetic resonance imaging shows detachment of the posterior labrum (reverse Bankart lesion) in a 20-year-old football lineman with posterior instability.
ligament, and capsule. Posterior labral detachment (the reverse Bankart lesion) has been described in approximately 50% of patients. This lesion is commonly more subtle and less displaced than the standard anterior Bankart lesion. With the advent of arthroscopy, subtle irregularity of the posterior labrum is more easily appreciated. Posterior capsular laxity or plastic deformation has been implicated in many patients with posterior instability, and tightening of the posterior capsule is a component of the many surgical procedures described for posterior instability.
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