Our Summary

This research paper is about a less common type of shoulder instability, called Posterior Shoulder Instability (PSI), which often affects young athletes who use their arms a lot or play contact sports. The cause of PSI can either be due to a trauma, like an accident or injury, or can occur without any obvious cause, which makes it harder to diagnose. The surgical treatment for PSI has changed over time, moving from open surgery to less invasive arthroscopic techniques. Usually, this procedure is performed with two working portals (small openings for surgical instruments) while the patient is lying on their side. The paper presents a new technique for repairing the labrum (a type of cartilage in the shoulder joint) using all-suture anchors (a type of surgical tool), with the patient sitting up in a ‘beach-chair’ position, and only using one working portal. The procedure also includes closing the capsule, which is the connective tissue that surrounds the shoulder joint.

FAQs

  1. What is posterior shoulder instability and who does it frequently affect?
  2. What is the evolution of surgical management for posterior shoulder instability?
  3. What is the described technique for posterior labral repair?

Doctor’s Tip

A helpful tip a doctor might tell a patient about labral repair is to follow post-operative instructions carefully, including proper shoulder immobilization and physical therapy exercises to ensure proper healing and rehabilitation of the shoulder joint. It is important to communicate any concerns or changes in symptoms to your healthcare provider for proper management and monitoring of the healing process.

Suitable For

Patients who are typically recommended for labral repair are those with posterior shoulder instability, especially young overhead or contact athletes. The etiology of the instability may be traumatic or atraumatic, and diagnosis can be more difficult in cases of atraumatic instability. Surgical management of posterior shoulder instability has evolved to include arthroscopic techniques, with posterior stabilization commonly performed using all-suture anchors. This technique can be performed with the patient in the beach-chair position via 1 working portal with capsular closure.

Timeline

Before labral repair:

  1. Patient experiences shoulder pain, instability, and limited range of motion.
  2. Patient undergoes a physical examination and imaging tests to diagnose the labral tear.
  3. Surgeon recommends surgery for labral repair.

After labral repair:

  1. Patient undergoes arthroscopic posterior labral repair using all-suture anchors with the patient in the beach-chair position via 1 working portal.
  2. Capsular closure is performed to stabilize the shoulder joint.
  3. Patient undergoes post-operative rehabilitation to regain strength and range of motion in the shoulder.
  4. Patient gradually resumes normal activities and sports participation with guidance from the surgeon and physical therapist.
  5. Patient experiences improved shoulder stability and reduced pain after successful labral repair.

What to Ask Your Doctor

  1. What is the likelihood of success for a labral repair in my specific case?
  2. What are the potential risks and complications associated with the surgery?
  3. How long is the recovery process expected to be after a labral repair?
  4. Will physical therapy be necessary after the surgery, and if so, for how long?
  5. What type of anesthesia will be used during the procedure?
  6. How many of these surgeries have you performed, and what is your success rate?
  7. Will I need to make any lifestyle or activity modifications after the surgery?
  8. How long do the results of the surgery typically last?
  9. Are there any alternative treatments or procedures that could be considered instead of a labral repair?
  10. How soon after the surgery can I expect to return to normal activities or sports?

Reference

Authors: Dey Hazra ME, Dey Hazra RO, Hanson JA, Millett PJ. Journal: Arthrosc Tech. 2022 Aug 6;11(9):e1557-e1561. doi: 10.1016/j.eats.2022.04.007. eCollection 2022 Sep. PMID: 36185126