Recent advances in the evaluation and treatment of shoulder instability: Anterior, posterior, and multidirectional

Abstract

Summary Complications can be classified based on technical error, recurrent instability, stiffness, and pain. Technical error is most concerning because of the use of articular suture anchors. There are challenges in placing anchors into the posterior glenoid. This may be due to less familiarity with glenoid angulation, orientation of the posterior portals, and bone changes making it easy to slide and delaminate articular cartilage. Drill holes can be directed and controlled with a drill guide. Use a tap if bone is hard and screw-in anchors are chosen. Regardless of the choice of anchor, make sure the anchor is well below the articular surface. Recurrent instability and stiffness can occur for a number of reasons. A significant reduction in capsular volume is completed with repairs posteriorly and anteriorly. Many shoulders will gradually loosen with persistent stretching. If after 6 months the rotation gains have plateaued and loss of motion is problematic, an arthroscopic capsulotomy and lysis of adhesions is considered. This is uncommon and many shoulders continue to stretch after 6 months. Patients with continued pain with a stabilized shoulder need further evaluation. Look to the scapular mechanics for a possible clue. Abnormal scapular thoracic rhythm during elevation, and abduction may suggest additional problems external to the glenohu-meral joint. Posterior capsular reduction can theoretically contribute to subacromial and coracoid impingement symptoms. By repairing anterior capsule and labral tears, the risk of impingement is avoided.