Proliance Surgeons
Grant H. Garcia, MD

Grant H. Garcia, MD Orthopedic Surgeon & Sports Medicine Specialist View Profile

Grant H. Garcia, MD

Grant H. Garcia, MD Orthopedic Surgeon & Sports Medicine Specialist View Doctor Profile

posterior labral repair

Content below from orthobullets.com

Posterior Labral Tears and Repair

  • Definition
    • commonly referred to as a reverse Bankart lesion, or attenuation of the posterior capsulolabral complex
  • Epidemiology
    • athletes
      • weightlifters (bench press)
      • football linemen (blocking)
      • swimmers
      • gymnasts
      • wrestlers
  • Pathophysiology
    • repetitive microtrauma to the posterior capsulolabral complex
      • most common mechanism
      • posteriorly directed force with the arm in a flexed, internally rotated and adducted position
    • glenoid retroversion
      • patients with increased glenoid retroversion (~17°) were 6x more likely to experience posterior instability compared to those with less glenoid retroversion (~7°)
  • Associated injuries
    • Kim lesion
      • an incomplete and sometimes concealed avulsion of posteroinferior labrum
  • Posterior labrum
    • function
      • helps generate cavity-compression effect of glenohumeral joint
      • creates 50% of the glenoid socket depth
      • provides posterior stability
      • anatomy
        • composed of fibrocartilagenous tissue
        • anchors posterior inferior glenohumeral ligament (PIGHL)
  • Symptoms
    • vague, nonspecific posterior shoulder pain is the most common symptoms
      • worsens with provocative activities that apply a posteriorly directed force to the shoulder
        • ex: pushing heavy doors, bench press, push-ups
    • clicking or popping in the shoulder with range of motion
    • sense of instability
      • less common
    • pain during throwing
      • late cocking phase
  • Physical exam
    • posterior joint line tenderness
  • provocative tests
  • posterior apprehension test
    • arm positioned with shoulder forward flexed 90° and adducted
    • apply anterior support to scapula
    • apply posteriorly directed force to shoulder through humerus
    • positive if patient experiences sense of instability or pain
  • posterior load and shift test
    • patient rests arm at their side
    • grasp the proximal humerus and apply a posteriorly directed force
    • assess distance of translation and patient response
      • grade 0 = no translation
      • grade 1 = to edge of glenoid
      • grade 2 = over edge of glenoid but spontaneously relocates
      • grade 3 = over edge of glenoid, does not spontaneously relocate
  • jerk test
    • arm positioned with shoulder abducted 90° and fully internally rotated
    • axially load humerus while adducting the arm across the body
    • clunk indicates subluxation of the humeral head off the posterior glenoid
      • highly sensitive and specific for a posterior labral tear
  • kim test
    • arm positioned with shoulder abducted 90° and forward flexed 45°
    • apply posteriorly and inferiorly directed force to shoulder through humerus
    • positive if patient experiences pain
      • highly sensitive and specific for posteroinferior labral tear
  • Nonoperative
    • activity modification, NSAIDs, PT
      • indications
        • first line of treatment
      • technique
        • rotator cuff and deltoid strengthening
        • periscapular stabilization
  • Operative
    • posterior labral repair, capsulorrhaphy
      • indications
        • extensive nonoperative management fails
      • technique
        • arthroscopic and open techniques may be used
        • arthroscopic preferred to open given the extensive posterior surgical dissection required
          • more reliable return to play
        • suture anchor repair and capsulorrhaphy results in fewer recurrences and revisions than non-anchored repairs
  • outcomes
    • generally good
    • return to previous level of function in overhead throwing athletes not as reproducible as other athletes
    • failure risk increases if adduction and internal rotation are not avoided in the acute postoperative period

for more information visit orthobullets.com

  • Brown University
  • University of Pennsylvania
  • Cornell University
  • Hospital for Special Surgery
  • Rush University Medical Center
  • American Orthopaedic Society for Sports Medicine
  • American Academy of Orthopaedic Surgeons
  • American Association of Nurse Anesthetists