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Patients with posterior instability more likely to undergo shoulder stabilization without dislocation

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DENVER — Patients who presented with posterior shoulder instability were more likely to undergo shoulder stabilization surgery after a shorter duration of symptoms and without a dislocation compared with patients with anterior instability, according to results presented here.

“Posterior instability tends to present after a shorter duration of symptoms, and [patients] were over three-times more likely to undergo stabilization without having had a frank dislocation,” Micah Naimark, MD, said in his presentation at the Arthroscopy Association of North America Annual Meeting. “Posterior instability is associated with high rates of posterior labral cartilage pathology.”

Micah Naimark

Using the Multicenter Orthopedic Outcome Network (MOON) database, Naimark and colleagues identified 541 patients who underwent shoulder stabilization procedures for either anterior (78%) or posterior (22%) shoulder instability.

“Looking at the posterior instability cohort, their physical examination findings, including the posterior apprehension and posterior jerk tests, were positive only approximately 60% of the time,” Naimark said.

He noted 14% of patients in the anterior instability group and 47% of patients in the posterior instability group reported no history of frank shoulder dislocation prior to shoulder stabilization surgery. Compared with anterior stabilization, Naimark said “posterior stabilizations were performed more acutely after shorter duration of symptoms and fewer dislocations.”

Preoperative MRI identified posterior labral tears in more than 80% of patients, according to Naimark, while other articular pathology, including other labral tears, bony defects, articular cartilage lesions and biceps pathology, was identified approximately 20% of the time.

“As you can see in the posterior instability cohort, 57% of the patients had either grade III or grade IV articular cartilage changes on the posterior glenoid,” Naimark said. – by Casey Tingle

Reference:

Naimark M, et al. Paper #SS-65. Presented at: Arthroscopy Association of North America Annual Meeting; May 18-20, 2017; Denver.

Disclosure: Naimark reports no relevant financial disclosures.