This 2005 Current Concepts Review by Robinson and Aderinto systematically covers recurrent posterior shoulder instability. It addresses epidemiology, classification by volition and direction, predisposing structural factors, and the full spectrum of operative and nonoperative treatments. The paper synthesizes Level-IV evidence to define which patients benefit from surgery and which technique yields the best results.
Posterior instability is frequently misdiagnosed or mismanaged because clinicians apply anterior instability decision-making to a fundamentally different condition. The authors identify that poor historical outcomes were driven by two specific failures: operating on the wrong patients (psychogenic dislocators) and using the wrong techniques (nonanatomic repairs).
When you see a young athlete with posterior shoulder pain and pain/instability in the flexed, adducted, internally rotated position, screen first for psychological features. If habitual psychogenic dislocation is present, surgery is absolutely contraindicated — refer for psychotherapy instead. For all other patients, run a minimum 6-month supervised rehabilitation program targeting rotator cuff and periscapular strengthening before offering the OR.
When surgery is indicated for unidirectional capsulolabral pathology, arthroscopic posterior labral repair with capsular retensioning gives the lowest recurrence rate (5%). Always look for and address the Kim lesion. For multidirectional patterns, treat all directions of instability in one setting.
Osseous procedures and thermal capsulorrhaphy should rarely if ever be primary interventions. Their complication profiles and recurrence rates do not justify routine use.
This 2005 Current Concepts Review by Robinson and Aderinto systematically covers recurrent posterior shoulder instability. It addresses epidemiology, classification by volition and direction, predisposing structural factors, and the full spectrum of operative and nonoperative treatments. The paper synthesizes Level-IV evidence to define which patients benefit from surgery and which technique yields the best results.
Posterior instability is frequently misdiagnosed or mismanaged because clinicians apply anterior instability decision-making to a fundamentally different condition. The authors identify that poor historical outcomes were driven by two specific failures: operating on the wrong patients (psychogenic dislocators) and using the wrong techniques (nonanatomic repairs).
When you see a young athlete with posterior shoulder pain and pain/instability in the flexed, adducted, internally rotated position, screen first for psychological features. If habitual psychogenic dislocation is present, surgery is absolutely contraindicated — refer for psychotherapy instead. For all other patients, run a minimum 6-month supervised rehabilitation program targeting rotator cuff and periscapular strengthening before offering the OR.
When surgery is indicated for unidirectional capsulolabral pathology, arthroscopic posterior labral repair with capsular retensioning gives the lowest recurrence rate (5%). Always look for and address the Kim lesion. For multidirectional patterns, treat all directions of instability in one setting.
Osseous procedures and thermal capsulorrhaphy should rarely if ever be primary interventions. Their complication profiles and recurrence rates do not justify routine use.