This retrospective comparative study asks whether surgery has a role in patients whose voluntary posterior shoulder instability began in childhood and later became involuntary and uncontrollable. It compares this group (VBI) against patients with primary involuntary posterior instability (I), all operated before age 18 and followed a mean of 7.7 years.
The teaching point here is a decision rule: pure voluntary posterior instability with normal imaging and possible psychiatric association is a surgical contraindication, but once that instability becomes involuntary, disabling, and fails at least six months of physiotherapy, surgery becomes reasonable.
The authors show the voluntary-became-involuntary group is anatomically similar to primary involuntary patients, often because a superimposed trauma damages the capsule, labrum, or posterior glenoid rim. Use CT to choose the procedure. No posterior glenoid erosion means posterior Bankart with posteroinferior capsular shift. Erosion means posterior bone block.
Watch for the high-risk triad of no trauma, bilateral instability, and multidirectional hyperlaxity, which predicts an 88% recurrence and should temper both patient expectations and your enthusiasm to operate.
This is a small retrospective series (40 shoulders) of a rare condition, so the 30% versus 15% recurrence difference was underpowered. Treat these numbers as directional rather than definitive.
This retrospective comparative study asks whether surgery has a role in patients whose voluntary posterior shoulder instability began in childhood and later became involuntary and uncontrollable. It compares this group (VBI) against patients with primary involuntary posterior instability (I), all operated before age 18 and followed a mean of 7.7 years.
The teaching point here is a decision rule: pure voluntary posterior instability with normal imaging and possible psychiatric association is a surgical contraindication, but once that instability becomes involuntary, disabling, and fails at least six months of physiotherapy, surgery becomes reasonable.
The authors show the voluntary-became-involuntary group is anatomically similar to primary involuntary patients, often because a superimposed trauma damages the capsule, labrum, or posterior glenoid rim. Use CT to choose the procedure. No posterior glenoid erosion means posterior Bankart with posteroinferior capsular shift. Erosion means posterior bone block.
Watch for the high-risk triad of no trauma, bilateral instability, and multidirectional hyperlaxity, which predicts an 88% recurrence and should temper both patient expectations and your enthusiasm to operate.
This is a small retrospective series (40 shoulders) of a rare condition, so the 30% versus 15% recurrence difference was underpowered. Treat these numbers as directional rather than definitive.