2015 posterior shoulder instability in overhead athletes

9
Posterior Shoulder Instabilit y in Overhead Athletes Edward S. Chang,  MD a, *,  Nicholas J. Greco,  MD b , Michael P. McClincy,  MD b , James P. Bradley,  MD c INTRODUCTION Overhead, or thr owing, athlet es are a distinct group of patients with unique injuries to the shoul- der. Much attention has been placed on superior labral anterior to posterior tears and undersurface rotator cuff tears in the overhead athlete. Posterior shoul der instabili ty in thr owers, alt hough less com- mon than the previ ously ment ioned conditions, can lead to si mi lar symptoms as well as decr eased performance. 1,2 Thr ee general eti ologies of poster ior instabili ty of the shoulder exist: acute traumatic, repetitive mi- crotrauma, and atraumatic or ligamentous laxity. In athletes, the most common cause of posterior instabili ty is from repeti tive microt rauma to the posterior capsulolabral complex. 3,4 This is espe- cially well documented in football lineman, weight lif ter s, and rowers. Recent studies have shown these athlet es return to preinj ury level of com- pet iti on following art hroscopic capsul olabral reconstruction. 5 Posterior shoul der instabili ty in overhead ath- let es presents a uni que and dif ficult chall enge. Often, this group has an inherent capsular laxity and/or humeral retroversion to accommodate the range of motion (ROM) necessary to throw. 6 This adaptation makes the diagnosis of posterior cap- sulolabral pathology challenging, as the examiner must dif fer ent iat e bet ween adapti ve capsul ar laxi ty and pathologi c instabilit y. Further compli- cati ng matters, the intraoperative surgeon must a Department of Orthopaedic Surgery, Sports Medicine Institute at Inova Medical Group, Inova Health System, 8501 Arlington Boulevard, Suite 200, Fairfax, VA 22031, USA;  b Department of Orthopaedic Surgery , University of Pittsburgh Medical Center, 3200 South Water Street, Pittsburgh, PA 15203, USA;  c Department of Orthopae- dic Surgery, University of Pittsburgh Medical Center, 200 Delafield Road, 200 Medical Arts Building, Suite 4010, Pittsburgh, PA 15125, USA * Corresponding author . E-mail address: [email protected] KEYWORDS  Posterior shoulder instability   Throwers   Overhead athletes   Zone-specific repair  Surgical technique   Arthroscopic posterior capsulolabral reconstruction KEY POINTS  Overhead-throwing athletes are at a risk for injury to the posterior glenolabral complex from repet- itive microtrauma.  The examiner must differentiate between adaptive capsular laxity and pathologic instability.  Repair constructs using suture anchors improves the athlete’s prospect in returning to throwing activities.  Knotless fixation should be used above the glenoid equator to minimize iatrogenic humeral head abrasion from suture knots.  The overhead athlete’s kinetic chain and throwing mechanics must be analyzed and corrected to decrease the risk of reinjury. Orthop Clin N Am 47 (2016) 179–187 http://dx.doi.org/10.1016/j.ocl.2015.08.026 0030-5898/16/$ – see front matter 2016 Elsevier Inc. All rights reserved.  o      r       t       h      o      p      e       d       i      c  .       t       h      e      c       l       i      n       i      c      s  .      c      o      m

Upload: diego-subiabre

Post on 05-Jul-2018

215 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: 2015 Posterior Shoulder Instability in Overhead Athletes

8/16/2019 2015 Posterior Shoulder Instability in Overhead Athletes

http://slidepdf.com/reader/full/2015-posterior-shoulder-instability-in-overhead-athletes 1/9

Page 2: 2015 Posterior Shoulder Instability in Overhead Athletes

8/16/2019 2015 Posterior Shoulder Instability in Overhead Athletes

http://slidepdf.com/reader/full/2015-posterior-shoulder-instability-in-overhead-athletes 2/9

Page 3: 2015 Posterior Shoulder Instability in Overhead Athletes

8/16/2019 2015 Posterior Shoulder Instability in Overhead Athletes

http://slidepdf.com/reader/full/2015-posterior-shoulder-instability-in-overhead-athletes 3/9

Page 4: 2015 Posterior Shoulder Instability in Overhead Athletes

8/16/2019 2015 Posterior Shoulder Instability in Overhead Athletes

http://slidepdf.com/reader/full/2015-posterior-shoulder-instability-in-overhead-athletes 4/9

Page 5: 2015 Posterior Shoulder Instability in Overhead Athletes

8/16/2019 2015 Posterior Shoulder Instability in Overhead Athletes

http://slidepdf.com/reader/full/2015-posterior-shoulder-instability-in-overhead-athletes 5/9

Page 6: 2015 Posterior Shoulder Instability in Overhead Athletes

8/16/2019 2015 Posterior Shoulder Instability in Overhead Athletes

http://slidepdf.com/reader/full/2015-posterior-shoulder-instability-in-overhead-athletes 6/9

Page 7: 2015 Posterior Shoulder Instability in Overhead Athletes

8/16/2019 2015 Posterior Shoulder Instability in Overhead Athletes

http://slidepdf.com/reader/full/2015-posterior-shoulder-instability-in-overhead-athletes 7/9

Page 8: 2015 Posterior Shoulder Instability in Overhead Athletes

8/16/2019 2015 Posterior Shoulder Instability in Overhead Athletes

http://slidepdf.com/reader/full/2015-posterior-shoulder-instability-in-overhead-athletes 8/9

Page 9: 2015 Posterior Shoulder Instability in Overhead Athletes

8/16/2019 2015 Posterior Shoulder Instability in Overhead Athletes

http://slidepdf.com/reader/full/2015-posterior-shoulder-instability-in-overhead-athletes 9/9