summary A posterior labral tear is referred to as a reverse Bankart lesion, or attenuation of the posterior capsulolabral complex, and commonly occurs due to repetitive microtrauma in athletes. Diagnosis can be made clinically with positive posterior labral provocative tests and confirmed with MRI studies of the shoulder. Treatment may be nonoperative or operative depending on chronicity of symptoms, degree of instability, and patient activity demands. Epidemiology Demographics athletes weightlifters (bench press) football linemen (blocking) swimmers gymnasts wrestlers Etiology 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 login to view 1 more bullet 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 login to view 4 more bullets posterior load and shift test login to view 7 more bullets jerk test login to view 4 more bullets kim test login to view 4 more bullets Imaging Radiographs recommended views true AP, scapular Y and axillary views login to view 2 more bullets findings often normal in chronic cases axillary view may show login to view 2 more bullets MRI indications diagnostic study of choice technique intra-articular contrast increases sensitivity for labral pathology Treatment Nonoperative activity modification, NSAIDs, PT indications login to view 1 more bullet technique login to view 2 more bullets Operative posterior labral repair, capsulorrhaphy indications login to view 1 more bullet technique login to view 5 more bullets outcomes login to view 5 more bullets 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 login to view 1 more bullet Overtightening of posterior capsule can lead to anterior subluxation or coracoid impingement