This case series reports long-term results of superior shift of the posteroinferior capsule for recurrent posterior glenohumeral instability that failed nonoperative treatment. It asks what the underlying lesion is and whether a soft-tissue shift works across the spectrum of posterior, bidirectional, and multidirectional instability. All patients had failed a strengthening program before surgery.
When a patient has recurrent posterior instability and a positive posterior stress test, think capsular redundancy first, not bony deformity. This series showed normal glenoid version in nearly every shoulder, so reach for a soft-tissue capsular shift rather than a glenoid osteotomy when the bone is normal.
The single most important number here is the primary-versus-revision gap: 96% success as a first operation versus 45% after prior surgery. Get the diagnosis and the first operation right.
The classic pitfall the paper documents: multidirectional instability misread as isolated anterior instability, then treated with a Putti-Platt, Bristow, or Magnuson-Stack that leaves inferior laxity uncorrected. Always assess all three directions and check the sulcus sign for an inferior component.
Tailor the shift to the pattern: less inferior dissection for pure posterior laxity, more for bidirectional or multidirectional disease.
This case series reports long-term results of superior shift of the posteroinferior capsule for recurrent posterior glenohumeral instability that failed nonoperative treatment. It asks what the underlying lesion is and whether a soft-tissue shift works across the spectrum of posterior, bidirectional, and multidirectional instability. All patients had failed a strengthening program before surgery.
When a patient has recurrent posterior instability and a positive posterior stress test, think capsular redundancy first, not bony deformity. This series showed normal glenoid version in nearly every shoulder, so reach for a soft-tissue capsular shift rather than a glenoid osteotomy when the bone is normal.
The single most important number here is the primary-versus-revision gap: 96% success as a first operation versus 45% after prior surgery. Get the diagnosis and the first operation right.
The classic pitfall the paper documents: multidirectional instability misread as isolated anterior instability, then treated with a Putti-Platt, Bristow, or Magnuson-Stack that leaves inferior laxity uncorrected. Always assess all three directions and check the sulcus sign for an inferior component.
Tailor the shift to the pattern: less inferior dissection for pure posterior laxity, more for bidirectional or multidirectional disease.