Jones, Grant L; Kaeding, Christopher C
Purpose of review:
The diagnosis and treatment of posterior shoulder instability has been evolving during the past few years as more reliable radiographic techniques and more minimally invasive surgical techniques have been developing. This article reviews clinical and basic science investigations in the literature from this past year that have contributed to the development of these diagnostic and treatment options.
In terms of the classification of shoulder instability, one article demonstrates that the current, most commonly used systems are inconsistent and are not entirely reliable, which has an impact not only on the treatment of instability patients, but also on the reliability of investigations looking at the treatment of different instability groups. MR arthrography continues to evolve as a valuable tool in diagnosing posterior capsulolabral complex injuries as demonstrated in two recent studies. Posterior shoulder instability, which has in the past been viewed as predominately having an atraumatic etiology, is now being more frequently recognized as having a traumatic etiology. Surgical as well as nonsurgical treatment options continue to evolve. One article studies the use of an orthosis to be used in conjunction with a physical therapy program to aid in the nonsurgical management of atraumatic instability. Other studies describe and review the results of arthroscopic posterior labral repairs and capsulorrhaphy procedures to address traumatic posterior instability, and the results are encouraging. Finally, thermal capsulorrhaphy procedures have proved to be unreliable in the treatment of posterior and multidirectional instability.
With the recognition of a more common traumatic etiology for posterior instability and the ability of radiographic techniques such as MR arthrography to recognize reliably structural injury to the posterior labrum and capsule, orthopedists may become more aggressive in surgically treating recurrent posterior instability secondary to macrotrauma or repetitive microtrauma in the future. Although open procedures may still be the gold standard for treating recurrent posterior instability, arthroscopic procedures continue to evolve with reliable results.
Current Opinion in Orthopedics. 15(4):267-273, August 2004.