Antosh Ivan J, Tokish John M, Owens Brett D
Keller Army Hospital, West Point, New York.
Steadman-Hawkins Clinic of the Carolinas, Spartanburg, South Carolina.
Sports Health. 2016 Nov/Dec;8(6):520-526. doi: 10.1177/1941738116672446. Epub 2016 Oct 4.
Posterior shoulder instability has become more frequently recognized and treated as a unique subset of shoulder instability, especially in the military. Posterior shoulder pathology may be more difficult to accurately diagnose than its anterior counterpart, and commonly, patients present with complaints of pain rather than instability. "Posterior instability" may encompass both dislocation and subluxation, and the most common presentation is recurrent posterior subluxation. Arthroscopic and open treatment techniques have improved as understanding of posterior shoulder instability has evolved.
Electronic databases including PubMed and MEDLINE were queried for articles relating to posterior shoulder instability.
Clinical review.
Level 4.
In low-demand patients, nonoperative treatment of posterior shoulder instability should be considered a first line of treatment and is typically successful. Conservative treatment, however, is commonly unsuccessful in active patients, such as military members. Those patients with persistent shoulder pain, instability, or functional limitations after a trial of conservative treatment may be considered surgical candidates. Arthroscopic posterior shoulder stabilization has demonstrated excellent clinical outcomes, high patient satisfaction, and low complication rates. Advanced techniques may be required in select cases to address bone loss, glenoid dysplasia, or revision.
Posterior instability represents about 10% of shoulder instability and has become increasingly recognized and treated in military members. Nonoperative treatment is commonly unsuccessful in active patients, and surgical stabilization can be considered in patients who do not respond. Isolated posterior labral repairs constitute up to 24% of operatively treated labral repairs in a military population. Arthroscopic posterior stabilization is typically considered as first-line surgical treatment, while open techniques may be required in complex or revision settings.
后肩关节不稳已越来越多地被视为肩关节不稳的一个独特亚型并得到治疗，尤其是在军事领域。后肩关节病变可能比前肩关节病变更难准确诊断，并且患者通常表现为疼痛而非不稳。“后不稳”可能包括脱位和半脱位，最常见的表现是复发性后半脱位。随着对后肩关节不稳认识的发展，关节镜和开放治疗技术也有所改进。
检索包括PubMed和MEDLINE在内的电子数据库，查找与后肩关节不稳相关的文章。
临床综述。
4级。
对于需求较低的患者，后肩关节不稳的非手术治疗应被视为一线治疗方法，且通常是成功的。然而，保守治疗在现役患者（如军人）中通常不成功。那些在尝试保守治疗后仍持续存在肩部疼痛、不稳或功能受限的患者可被视为手术候选者。关节镜下后肩关节稳定术已显示出优异的临床效果、较高的患者满意度和较低的并发症发生率。在某些特定病例中可能需要采用先进技术来处理骨质丢失、关节盂发育不良或翻修问题。
后不稳约占肩关节不稳的10%，在军人中已越来越多地得到认识和治疗。保守治疗在现役患者中通常不成功，对无反应的患者可考虑手术稳定治疗。在军人人群中，孤立的后盂唇修复占手术治疗盂唇修复的比例高达24%。关节镜下后稳定术通常被视为一线手术治疗方法，而在复杂或翻修情况下可能需要采用开放技术。
