Introduction 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 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 Anatomy 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) Glenohumeral joint anatomy Presentation 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 Imaging Radiographs recommended views true AP, scapular Y and axillary views axillary view required to ensure glenohumeral joint reduction posterior shoulder dislocations may be missed on AP radiographs alone findings often normal axillary view may show glenoid retroversion or posterior glenoid erosion in chronic cases MRI diagnostic study of choice intra-articular contrast increases sensitivity for labral pathology Treatment 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 probing of posterior labrum is required to rule out a subtle Kim lesion outcomes generally good return to previous level of function in overhead throwing athletes not as reproducible as other athletes 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 at risk during suture passage at the posterior inferior glenoid Overtightening of posterior capsule can lead to anterior subluxation or coracoid impingement
QUESTIONS 1 of 6 1 2 3 4 5 6 Previous Next Sorry, this question is for Virtual Curriculum Members Only Click here to purchase (OBQ12.268) A 27-year-old male bodybuilder presents to the office with vague, deep shoulder pain and weakness with his bench press. His examination is somewhat difficult due to his large size, but no significant abnormal findings are noted. Radiographs are normal, and an MRI arthrogram is shown in Figure A. Which of the following is the most likely etiology of his complaints? Review Topic QID: 4628 FIGURES: A 1 Pectoralis major rupture 25% (618/2453) 2 Supraspinatus partial thickness tear 1% (32/2453) 3 SLAP lesion 9% (219/2453) 4 Tendonitis of the long head of the biceps 2% (50/2453) 5 Posterior labral tear 62% (1525/2453) Select Answer to see Preferred Response PREFERRED RESPONSE 5 (OBQ11.152) A 20-year-old college football offensive lineman undergoes arthroscopic right shoulder surgery for the injury shown in Figure A. Post-operatively he complains of burning pain in the region marked in yellow on Figure B. Which of the following nerves was most likely injured during the procedure? Review Topic QID: 3575 FIGURES: A B 1 Radial 0% (10/2284) 2 Upper subscapular 0% (4/2284) 3 Lower subscapular 1% (27/2284) 4 Suprascapular 0% (11/2284) 5 Axillary 97% (2224/2284) Select Answer to see Preferred Response PREFERRED RESPONSE 5 Sorry, this question is for Virtual Curriculum Members Only Click here to purchase Sorry, this question is for Virtual Curriculum Members Only Click here to purchase Sorry, this question is for Virtual Curriculum Members Only Click here to purchase
The Batters Shoulder and Posterior Labral Tears - Christopher Ahmad, MD (BSM #6, 2016) Shoulder & Elbow - Posterior Labral Tear - Events & Meetings Title: The Batters Shoulder and Posterior Labral Tears Speaker: Christopher S. A... 10/30/2017 47 views Kim lesion Shoulder & Elbow - Posterior Labral Tear - Surgical Techniques Arthroscopic video demonstrating probing a Kim lesion. Kim lesions are an incom... 4/15/2013 1704 views Arthroscopic shoulder posterior labral repair Shoulder & Elbow - Posterior Labral Tear - Surgical Techniques Arthroscopic shoulder posterior labral repair for instability 4/14/2013 1358 views
Shoulder loose body with posterior labral tear with posterior subluxation (C1339) Shoulder & Elbow - Posterior Labral Tear HPI - 32 yr old male with hx of "shoulder dislocation" when in high school during football. Not aware if posterior or anterior. Was scheduled to have surgery back then but choose not to. Did well for many years but recently started to develop locking and catching and occational shoulder pains, otherwise very functional. Options for this patient? 11/29/2012 121 4 6