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 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 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 in chronic cases axillary view may show glenoid retroversion or posterior glenoid erosion MRI indications diagnostic study of choice technique 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 failure risk increases if adduction and internal rotation are not avoided in the acute postoperative period 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 7 1 2 3 4 5 6 7 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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? Tested Concept QID: 4628 FIGURES: A Type & Select Correct Answer 1 Pectoralis major rupture 23% (977/4299) 2 Supraspinatus partial thickness tear 1% (53/4299) 3 SLAP lesion 9% (366/4299) 4 Tendonitis of the long head of the biceps 2% (79/4299) 5 Posterior labral tear 65% (2806/4299) L 3 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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? Tested Concept QID: 3575 FIGURES: A B Type & Select Correct Answer 1 Radial 0% (16/3327) 2 Upper subscapular 0% (9/3327) 3 Lower subscapular 1% (39/3327) 4 Suprascapular 1% (21/3327) 5 Axillary 97% (3224/3327) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
All Videos (3) Podcasts (1) 2016 Baseball Sports Medicine: Game Changing Concepts The Batters Shoulder and Posterior Labral Tears - Christopher Ahmad, MD (BSM #6, 2016) Christopher S. Ahmad Shoulder & Elbow - Posterior Labral Tear B 10/30/2017 466 views 5.0 (2) Login to View Community Videos Login to View Community Videos Kim lesion David Abbasi Shoulder & Elbow - Posterior Labral Tear D 4/15/2013 2301 views 4.2 (8) Login to View Community Videos Login to View Community Videos Arthroscopic shoulder posterior labral repair David Abbasi Shoulder & Elbow - Posterior Labral Tear D 4/14/2013 1832 views 5.0 (8) Shoulder & Elbow⎪Posterior Labral Tear Orthobullets Team Shoulder & Elbow - Posterior Labral Tear Listen Now 12:55 min 1/31/2020 115 plays 4.0 (1)
Shoulder loose body with posterior labral tear with posterior subluxation in 32M (C1339) Shoulder & Elbow - Posterior Labral Tear E 11/29/2012 127 4 6