Editorial Commentary: A Delphi Expert Consensus Provides Clarity on Diagnosis, Treatment, Rehabilitation, and Return-to-Sports for Posterior Shoulder Instability

Abstract

Posterior shoulder instability (PSI) is an uncommon condition, accounting for 2% to 12% of shoulder instability cases. However, PSI might be more common and possibly accounts for up to 24% of all young, active patients treated for shoulder instability. The etiology of PSI is complex and multifactorial, making accurate diagnosis, classification, and treatment challenging. The accurate diagnosis of PSI is problematic and varies with symptoms ranging from pain, decreased strength, or endurance to mechanical symptoms such as clicking or popping, and only a minority of patients present after a posterior shoulder dislocation. Appropriate imaging is necessary and should include radiographs and advanced imaging with magnetic resonance imaging, preferably magnetic resonance arthrography. The goal of treatment is to reduce pain, improve function, and prevent or reduce recurrence. Both surgical and conservative treatments are demanding, and both osseous and soft-tissue pathologies need to be addressed adequately. Typically, a conservative approach should be considered first for the first 6 months, with a focus on proprioceptive exercises, strengthening of the dynamic stabilizers, and improving scapulothoracic mechanics. The primary indication for surgery is recurrent symptoms. Controversies exist regarding the choice between open and arthroscopic stabilization of soft-tissue defects, the treatment of the McLaughlin lesion, and the management of osseous defects.