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Introduction
  • Commonly referred to as a reverse Bankart lesion
  • Epidemiology
    • demographics
      • may occur in all athletes due to trauma
      • most commonly occur in 
        • football linemen (blocking)
        • weightlifters (bench press) 
  • Pathophysiology
    • mechanism
      • usually from a posteriorly directed force with arm flexed, adducted, and internally rotated
  • Associated injuries
    • Kim lesion
      • is an incomplete and sometimes concealed avulsion of posterior labrum
Anatomy
  • Posterior labrum
    • function
      • helps create cavity-compression and creates 50% of the glenoid socket depth
      • provides posterior stability
    • anatomy
      • composed of fibrocartilagenous tissue
      • anchors posterior inferior glenohumeral ligament (PIGHL)
  • See complete Glenohumeral joint anatomy 
Presentation
  • Symptoms 
    • shoulder pain
    • sense of instability
    • mechanical symptoms (clicking, popping) with range of motion
  • Physical exam
    • posterior joint line tenderness
    • provocative tests
      • Posterior Load and Shift
      • Jerk test
        • subluxation with posteriorly applied force while arm is in flexion and internal rotation
      • Kim test
        • subluxation with posteriorly applied force as arm is dynamically adducted by examiner
Imaging
  • Radiographs
    • recommended views
      • complete shoulder series
    • findings
      • are often normal
  • MRI 
    • diagnostic study of choice
    • intra-articular contrast (MRI arthrogram) increases sensitivity for labral pathology
Treatment
  • Nonoperative
    • NSAIDs, PT
      • indications
        • first line of treatment
      • technique
        • rotator cuff strengthening and periscapular stabilization
  • Operative
    • posterior labral repair with capsulorrhaphy 
      • indications
        • extensive nonoperative management fails
      • technique
        • both open and arthroscopic techniques can be used
        • probing of posterior labrum is required to rule out a subtle Kim lesion 
Complications
  • Axillary nerve palsy
    • posterior branch of the axillary nerve is at risk during arthroscopic stabilization 
      • travels within 1 mm of the inferior shoulder capsule and glenoid rim
        • is at risk during suture passage at the posterior inferior glenoid
  • Overtightening of posterior capsule
    • can lead to anterior subluxation or coracoid impingement
 

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