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: Winston J. Warme, MD, Frederick A. Matsen III, M.D.
Last updated Monday, October 09, 2006

Figure 6 - A six-centimeter incision is based on the major posterior axillary crease

Considering surgery

What kinds of surgery are recommended for posterior shoulder instability?

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 for posterior shoulder instability and in what cases?

What options exist for surgery for posterior shoulder instability?

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.

When performed by an experienced surgeon, how effective is posterior glenoid osteoplasty for posterior shoulder instability likely to be and how long will the benefit last?

How urgent is posterior glenoid osteoplasty for posterior shoulder instability?

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:

1. be in optimal health,
2. understand and accept the risks and alternatives of surgery, and
3. 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.

What are the most frequent and most serious risks of posterior glenoid osteoplasty for posterior shoulder instability? How common are they?

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

An experienced shoulder surgery team will use special techniques to minimize these risks, but cannot totally eliminate them.

If risks occur during or after posterior glenoid osteoplasty for posterior shoulder instability how are they managed?

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

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