Posterior glenoid osteoplasty for unstable dislocating shoulders. Surgery to build up the back of the glenoid socket using an osteotomy and graft can restore shoulder anatomy and lessen pain and improve function.
Edited By: Frederick A. Matsen III, M.D., Winston J. Warme, MD
Last updated Friday, October 16, 2009
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Figure 6 - A six-centimeter incision is based on the major posterior axillary crease
Considering surgery
Types of surgery recommended
Posterior glenoid osteoplasty can help restore the function and comfort of shoulders that are unstable posteriorly.
The goal of posterior glenoid osteoplasty for recurrent posterior
instability is to restore the depth of the back of the shoulder socket
or glenoid. This is accomplished through a posterior approach that does
not require any muscles or tendons to be detached.
This procedure cannot be accomplished arthroscopically. The incision
is made in the normal skin creases around the shoulder, leaving a
minimal surgical scar (see figure 6).
If the stability is lost because of a deficiency in the posterior
glenoid lip, posterior glenoid osteoplasty can help restore stability
by building up this lip.
When performed by an experienced shoulder surgeon, posterior glenoid
osteoplasty has an excellent chance of restoring stability to the
shoulder. This procedure is particularly valuable in patients who have
stretchy or thin ligaments and those who have failed previous surgeries.
Who should consider posterior glenoid osteoplasty?
Posterior glenoid osteoplasty is considered for patients with recurrent
posterior instability or feelings of unsteadiness or apprehension that
have not responded to a well-conducted rehabilitation program.Surgical options
A number of different surgical procedures for recurrent posterior glenohumeral instability have been described.
These include arthroscopic suturing, burning the inside of the
capsule with laser treatment or with radio frequency heat probes as
well as open surgical tightening of the capsule. None of these
procedures restores the posterior lip of the socket. All of these
procedures are at risk for failure if the ligaments and capsule are
thin, stretchy or weak. None of these procedures provides a robust
augmentation of the posterior glenoid lip.
Posterior glenoid osteoplasty has the advantages of providing a
robust change in the stabilizing geometry of the shoulder. It does not
depend on healing of compromised ligamentous tissue or a predictable
response to thermal energy.
Effectiveness
In the hands of an experienced shoulder surgeon, posterior glenoid
osteoplasty can help restore to the unstable shoulder some of its lost
comfort and function. With a good rehabilitation effort and with the
avoidance of additional injuries, the result of the surgery should last
for a long time.Urgency
Surgery for instability is not an emergency. Posterior glenoid
osteoplasty is an elective procedure that can be scheduled when
circumstances are optimal. The patient has time to become informed and
to select an experienced surgeon.
Before surgery is undertaken, the patient needs to:
- be in optimal health,
- understand and accept the risks and alternatives of surgery, and
- understand the postoperative rehabilitation program.
Posterior glenoid osteoplasty should be performed when conditions
are optimal. Particularly in the case of atraumatic instability, an
extended effort at non-operative management is suggested. Usually a 6-
to 12-week try at strengthening exercises is sufficient to determine
whether exercises are likely to be effective.
Risks
The risks of posterior glenoid osteoplasty include but are not limited to the following:
- infection
- injury to nerves and blood vessels
- inability to carry out the planned repair
- stiffness of the joint
- tear of the rotator cuff
- pain
- persistent instability
- arthritis
- the need for additional surgeries
There are also risks associated with anesthesia, including death.
An experienced shoulder surgery team will use special techniques to minimize these risks, but cannot totally eliminate them.
Managing risk
Many of the risks of surgery for instability can be managed
effectively if they are promptly identified and treated. Infections may
require a wash out in the operating room and subsequent antibiotic
treatment. Blood vessel or nerve injury may require repair. Stiffness
may require exercises or additional surgery. Persistent instability or
arthritis may require the consideration of additional surgery.
If the patient has questions or concerns about the course after surgery, the surgeon should be informed as soon as possible.
Surgery for posterior shoulder instability at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington
If you are interested in making an appointment to discuss this procedure in Seattle, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-BONE (2663) to make an appointment. Our clinical center is located in Seattle Washington, USA
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