Advertisement

Management of Failed Posterior and Multidirectional Instability Repair

  • Roman BrzóskaEmail author
  • Hubert Laprus
  • Paweł Ranosz
  • Patryk Kłaprocz
  • Tomasz Rynkiewicz
Chapter

Abstract

Posterior and multidirectional shoulder instability are relatively rare conditions but may be challenging to diagnose and treat. A vast number of factors may contribute to failure of initial treatment. Medical history, clinical examination, imaging, patient’s expectations, and compliance should be thoroughly revised when planning the treatment of a failed instability repair. General ligamentous laxity should be always assessed as a potential reason to treatment failure. Initial treatment is usually conservative and is associated with a relatively high recurrence rate especially in traumatic cases of posterior instability. Among surgical techniques, arthroscopic procedures have become superior to open methods. Each of operative techniques can be jeopardized with specific complications like painful hardware, lack of graft healing, limited range of motion, or neurological deficits. Osteoarthritis might be a result of an operative treatment as well as of neglecting of the surgery. Proper postoperative rehabilitation with passive motion should be applied in order to reduce risk of adhesive capsulitis. The most common techniques include posterior capsule-labral repair, modified McLaughlin procedure, open or arthroscopic bone block procedure, and scapula neck osteotomy and are described in this chapter.

Keywords

Shoulder instability Posterior instability Multidirectional instability Failure Revision 

References

  1. 1.
    Ahrens P. Arthroscopic treatment of posterior shoulder instability. Arthroscopy. 2015;31(3):555–60.CrossRefPubMedGoogle Scholar
  2. 2.
    Blomquist J, Solheim E, Liavaag S, Schroder CP, Espehaug B, Havelin LI. Shoulder instability surgery in Norway: the first report from a multicenter register, with 1-year follow-up. Acta Orthop. 2012;83(2):165–70.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Bradley JP, McClincy MP, Arner JW, Tejwani SG. Arthroscopic capsulolabral reconstruction for posterior instability of the shoulder: a prospective study of 200 shoulders. Am J Sports Med. 2013;41(9):2005–14.CrossRefPubMedGoogle Scholar
  4. 4.
    Chalmers PN, Hammond LJ, Juhan T, Romeo AA. Revision posterior shoulder stabilization. J Shoulder Elb Surg. 2013;22(9):1209–20.CrossRefGoogle Scholar
  5. 5.
    Robinson CM, Aderinto J. Recurrent posterior shoulder instability. J Bone Joint Surg Am. 2005;87(4):883–92.CrossRefPubMedGoogle Scholar
  6. 6.
    Fronek J, Warren RF, Bowen M. Posterior subluxation of the glenohumeral joint. J Bone Joint Surg Am. 1989;71:205–16.CrossRefPubMedGoogle Scholar
  7. 7.
    Robinson CM, Seah M, Akhtar MA. The epidemiology, risk of recurrence, and functional outcome after an acute traumatic posterior dislocation of the shoulder. J Bone Joint Surg Am. 2011;93(17):1605–13.CrossRefPubMedGoogle Scholar
  8. 8.
    Provencher MT, LeClere LE, King S, McDonald LS, Frank RM, Mologne TS, Ghodadra NS, Romeo AA. Posterior instability of the shoulder: diagnosis and management. Am J Sports Med. 2011;39(4):874–86.CrossRefPubMedGoogle Scholar
  9. 9.
    Bradley JP, Baker CL, Kline AJ, Armfield DR, Chhabra A. Arthroscopic capsulolabral reconstruction for posterior instability of the shoulder: a prospective study of 100 shoulders. Am J Sports Med. 2006;34(7):1061–71.CrossRefPubMedGoogle Scholar
  10. 10.
    Provencher MT, Bell SJ, Menzel KA, Mologne TS. Arthroscopic treatment of posterior shoulder instability: results in 33 patients. Am J Sports Med. 2005;33(10):1463–71.CrossRefPubMedGoogle Scholar
  11. 11.
    Kim SH, Park JS, Jeong WK, Shin SK. The Kim test: a novel test for posteroinferior labral lesion of the shoulder-- a comparison to the jerk test. Am J Sports Med. 2005;33(8):1188–92.CrossRefPubMedGoogle Scholar
  12. 12.
    Antosh IJ, Tokish JM, Owens BD. Posterior shoulder instability: current surgical management. Sports Health. 2016;8(6):520–6.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Johnson SM, Robinson CM. Shoulder instability in patients with joint hyperlaxity. J Bone Joint Surg Am. 2010;92(6):1545–57.CrossRefPubMedGoogle Scholar
  14. 14.
    Tillander B, Lysholm M, Norlin R. Multidirectional hyperlaxity of the shoulder: results of treatment. Scand J Med Sci Sports. 1998;8:421–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Barbier O, Ollat D, Marchaland JP, Versier G. Iliac bone-block autograft for posterior shoulder instability. Orthop Traumatol Surg Res. 2009;95(2):100–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Smith T, Goede F, Struck M, Wellmann M. Arthroscopic posterior shoulder stabilization with an iliac bone graft and capsular repair: a novel technique. Arthrosc Tech. 2012;1(2):e181–5.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Schwartz DG, Goebel S, Piper K, Kordasiewicz B, Boyle S, Lafosse L. Arthroscopic posterior bone block augmentation in posterior shoulder instability. J Shoulder Elb Surg. 2013;22(8):1092–101.CrossRefGoogle Scholar
  18. 18.
    Forsythe B, Ghodadra N, Romeo AA, Provencher MT. Management of the failed posterior/multidirectional instability patient. Sports Med Arthrosc. 2010;18(3):149–61.CrossRefPubMedGoogle Scholar
  19. 19.
    Bahu MJ, Trentacosta N, Vorys GC, Covey AS, Ahmad CS. Multidirectional instability: evaluation and treatment options. Clin Sports Med. 2008;27:671–89.CrossRefPubMedGoogle Scholar
  20. 20.
    Misamore GW, Sallay PI, Didelot W. A longitudinal study of patients with multidirectional instability of the shoulder with seven- to ten-year follow-up. J Shoulder Elb Surg. 2005;14:466–70.CrossRefGoogle Scholar
  21. 21.
    Wilk KE, Macrina LC, Reinold MM. Non-operative rehabilitation for traumatic and atraumatic glenohumeral instability. N Am J Sports Phys Ther. 2006;1(1):16–31.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Watson L, Warby S, Balster S, Lenssen R, Pizzari T. The treatment of multidirectional instability of the shoulder with a rehabilitation program: part 1. Shoulder Elbow. 2016;8(4):271–8.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Cools AM, Borms D, Castelein B, Vanderstukken F, Johansson FR. Evidence-based rehabilitation of athletes with glenohumeral instability. Knee Surg Sports Traumatol Arthrosc. 2016;24(2):382–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Myers JB, Lephart SM. The role of the sensorimotor system in the athletic shoulder. J Athl Train. 2000;35(3):351–63.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Riemann B, Lephart SM. The sensorimotor system, part I: the physiologic basis of functional joint stability. J Athl Train. 2002;37(1):71–9.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Herrington L, Horsley I, Rofl C. Evaluation of shoulder joint position sense in both asymptomatic and rehabilitated professional rugby players and matched controls. Phys Ther Sport. 2010;11(1):18–22.CrossRefPubMedGoogle Scholar
  27. 27.
    Warner JJ, Micheli LJ, Arslanian LE, Kennedy J, Kennedy R. Scapulothoracic motion in normal shoulders and shoulders with glenohumeral instability and impingement syndrome. A study using Moire topographic analysis. Clin Orthop. 1992;285:191–9.Google Scholar
  28. 28.
    Morris AD, Kemp GJ, Frostick SP. Shoulder electromyography in multidirectional instability. J Shoulder Elb Surg. 2004;13:24–9.CrossRefGoogle Scholar
  29. 29.
    Young MS. Electromyographic biofeedback use in the treatment of voluntary posterior dislocation of the shoulder: a case study. J Orthop Sports Phys Ther. 1994;20(3):171–5.CrossRefPubMedGoogle Scholar
  30. 30.
    Rowe CR, Pierce DS, Clarks JG. Voluntary dislocation of the shoulder: a preliminary report on a clinical, electromyographic and psychiatric study of twenty-six patients. J Bone Joint Surg Am. 1973;55-A:445–59.CrossRefGoogle Scholar
  31. 31.
    Kessel L. Posterior shoulder dislocation. In: Kessel L, Bayley I, editors. Clinical disorders of the shoulder. 2nd ed. New York: Churchill Livingstone; 1986. p. 125–37.Google Scholar
  32. 32.
    Harryman DT, Sidles JA, Harris SL, Matsen FA. The role of the rotator interval capsule in passive motion and stability of the shoulder. J Bone Joint Surg Am. 1992;74(1):53–66.CrossRefPubMedGoogle Scholar
  33. 33.
    Tonino PM, Gerber C, Itoi E. Complex shoulder disorders: evaluation and treatment. J Am Acad Orthop Surg. 2009;17:125–36.CrossRefPubMedGoogle Scholar
  34. 34.
    Carofino BC, Brogan DM, Kircher MF, Elhassan BT, Spinner RJ, Bishop AT, Shin AY. Iatrogenic nerve injuries during shoulder surgery. J Bone Joint Surg Am. 2013;95(18):1667–74.CrossRefGoogle Scholar
  35. 35.
    Meyer M, Graveleau N, Hardy P, Landreau P. Anatomic risks of shoulder arthroscopy portals: anatomic cadaveric study of 12 portals. Arthroscopy. 2007;23(5):529–36.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Castagna A, Snyder SJ, Conti M, Borroni M, Massazza G, Garofalo R. Posterior humeral avulsion of the glenohumeral ligament: a clinical review of 9 cases. Arthroscopy. 2007;23(8):809–15.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Hurley JA, Anderson TE, Dear W, Andrish JT, Bergfeld JA, Weiker GG. Posterior shoulder instability. Surgical versus conservative results with evaluation of glenoid version. Am J Sports Med. 1992;20:396–400.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Martetschläger F, Padalecki JR, Millett PJ. Modified arthroscopic McLaughlin procedure for treatment of posterior instability of the shoulder with an associated reverse Hill-Sachs lesion. Knee Surg Sports Traumatol Arthrosc. 2013;21(7):1642–6.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Schwartz E, Warren RF, O’Brien SJ, Fronek J. Posterior shoulder instability. Orthop Clin North Am. 1987;18(3):409–19.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Burkhead WZ Jr, Rockwood CA Jr. Treatment of instability of the shoulder with an exercise program. J Bone Joint Surg Am. 1992;74:890–6.CrossRefPubMedGoogle Scholar
  41. 41.
    Takwale VJ, Calvert P, Rattue H. Involuntary positional instability of the shoulder in adolescents and young adults. Is there any benefit from treatment? J Bone Joint Surg Br. 2000;82(5):719–23.CrossRefPubMedGoogle Scholar
  42. 42.
    Kiss J, Damrel D, Mackie A, Neumann L, Wallace WA. Non-operative treatment of multidirectional shoulder instability. Int Orthop. 2001;24(6):354–7.CrossRefPubMedGoogle Scholar
  43. 43.
    McIntyre K, Bélanger A, Dhir J, Somerville L, Watson L, Willis M, Sadi J. Evidence-based conservative rehabilitation for posterior glenohumeral instability: a systematic review. Phys Ther Sport. 2016;22:94–100.CrossRefPubMedGoogle Scholar
  44. 44.
    Illyes A, Kiss J, Kiss RM. Electromyographic analysis during pull, forward punch, elevation and overhead throw after conservative treatment or capsular shift at patient with multidirectional shoulder joint instability. J Electromyogr Kinesiol. 2009;19:e438–47.CrossRefPubMedGoogle Scholar
  45. 45.
    Saccomanno MF, Fodale M, Capasso L, Cazzato G, Milano G. Generalized joint laxity and multidirectional instability of the shoulder. Joints. 2014;1(4):171–9.PubMedPubMedCentralGoogle Scholar
  46. 46.
    Warby SA, Pizzari T, Ford JJ, Hahne AJ, Watson L. The effect of exercise-based management for multidirectional instability of the glenohumeral joint: a systematic review. J Shoulder Elb Surg. 2014;23:128–42.CrossRefGoogle Scholar
  47. 47.
    Kiss RM, Illyes A, Kiss J. Physiotherapy vs. capsular shift and physiotherapy in multidirectional shoulder joint instability. J Electromyogr Kinesiol. 2010;20:489–501.CrossRefPubMedGoogle Scholar
  48. 48.
    Ide J, Maeda S, Yamaga M, Morisawa K, Takagi K. Shoulder strengthening exercise with an orthosis for multidirectional shoulder instability: quantitative evaluation of rotational shoulder strength before and after the exercise program. J Shoulder Elb Surg. 2003;12:342–5.CrossRefGoogle Scholar
  49. 49.
    Barden JM, Balyk R, Raso VJ, Moreau M, Bagnall K. Atypical shoulder muscle activation in multidirectional instability. Clin Neurophysiol. 2005;116:1846–57.CrossRefPubMedGoogle Scholar
  50. 50.
    Illyes A, Kiss RM. Kinematic and muscle activity characteristics of multidirectional shoulder joint instability during elevation. Knee Surg Sports Traumatol Arthrosc. 2006;14:673–85.CrossRefPubMedGoogle Scholar
  51. 51.
    Chen D, Goldberg J, Herald J, Critchley I, Barmare A. Effects of surgical management on multidirectional instability of the shoulder: a meta-analysis. Knee Surg Sport Traumatol Arthrosc. 2016;24(2):630–9.CrossRefGoogle Scholar
  52. 52.
    Brzoska R, Blasiak A, Hldaki W, Streit JJ, Toussaint B, Solecki W. Arthroscopic Bankart repair using Extracapsular suture between the glenohumeral ligaments and subscapularis tendon (BLS technique): a technical note. Tech Shoulder Surg. 2012;13:86–9.CrossRefGoogle Scholar
  53. 53.
    Lafosse L, Boyle S. Arthroscopic Latarjet procedure. J Shoulder Elb Surg. 2010;19:2–12.CrossRefGoogle Scholar
  54. 54.
    Boileau P, Hardy MB, McClelland WB Jr, Thélu CE, Schwartz DG. Arthroscopic posterior bone block procedure: a new technique using suture anchor fixation. Arthrosc Tech. 2013;2(4):e473–7.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Ortmaier R, Moroder P, Hirzinger C, Resch H. Posterior open wedge osteotomy of the scapula neck for the treatment of advanced shoulder osteoarthritis with posterior head migration in young patients. J Shoulder Elb Surg. 2017;26(7):1278–86. pii: S1058-2746.CrossRefGoogle Scholar
  56. 56.
    Hawkins RH. Glenoid osteotomy for recurrent posterior subluxation of the shoulder: assessment by computed axial tomography. J Shoulder Elb Surg. 1996;5:393–400.CrossRefGoogle Scholar

Copyright information

© ESSKA 2018

Authors and Affiliations

  • Roman Brzóska
    • 1
    Email author
  • Hubert Laprus
    • 2
  • Paweł Ranosz
    • 3
  • Patryk Kłaprocz
    • 2
  • Tomasz Rynkiewicz
    • 4
  1. 1.Orthopaedic/Upper LimbSt. Luke’s HospitalBielsko-BiałaPoland
  2. 2.Department of OrthopedicsSt Luke’s HospitalBielsko-BiałaPoland
  3. 3.Boni Fratres CatoviensisKatowicePoland
  4. 4.Ludwik Rydygier Memorial Specialized HospitalKrakowPoland

Personalised recommendations