Dr. Grant Garcia specializes in posterior labral repair for patients experiencing shoulder pain, instability, or dysfunction caused by tears in the back portion of the shoulder labrum. These injuries are often associated with sports participation, trauma, or repetitive shoulder stress. Patients in Seattle, Bellevue, Everett, and Kirkland, WA, receive advanced arthroscopic treatment focused on restoring shoulder stability, relieving symptoms, and helping them return to an active lifestyle.

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
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

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