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Posterior shoulder instability

Surgical versus conservative results with evaluation of glenoid version

Cleveland Clinic Foundation, Cleveland, Ohio

Thomas E. Anderson, MD

Cleveland Clinic Foundation, Cleveland, Ohio

William Dear, LPT

Cleveland Clinic Foundation, Cleveland, Ohio

Jack T. Andrish, MD

Cleveland Clinic Foundation, Cleveland, Ohio

John A. Bergfeld, MD

Cleveland Clinic Foundation, Cleveland, Ohio

Garron G. Weiker, MD

Cleveland Clinic Foundation, Cleveland, Ohio

We conducted a retrospective study on 50 patients with recurrent posterior shoulder instability. Twenty- five patients were treated conservatively with a specific rehabilitation program strengthening the rotator cuff. The other 25 patients, who did not improve with reha bilitation, underwent surgical reconstruction, the major ity of these being soft tissue repairs. Recurrence in the surgically treated group averaged 72% while that in the conservatively treated group was 96%. However, 50% of those patients treated surgically and 68% of those treated conservatively felt their symptoms were im proved.

In view of the high recurrence rate with soft tissue reconstruction, computed tomography scans were ob tained to evaluate glenoid version. Those patients with posterior shoulder instability were found to have in creased glenoid retroversion when compared to an uninjured population (P < 0.05). Our conclusions based on this study were that 1) specific therapy in the form of rotator cuff strengthening should be the initial form of treatment in patients with posterior shoulder insta bility, 2) soft tissue surgery has a high rate of recur rence, 3) the return to sports is variable, 4) there appears to be an increased incidence of glenoid retro version in this patient population, and 5) the incidence of posttraumatic arthritis is low.

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