Posterior Shoulder Instability Repair

Overview

Posterior shoulder instability occurs when the shoulder slides backward out of the socket, usually from repeated loading in a flexed, adducted, internally rotated position rather than a dramatic dislocation. It is far less common than anterior instability and is frequently missed because it presents as deep pain, not an instability event. Arthroscopic posterior labral repair restores stability in most patients.

How Dr. Raffo Performs This Procedure

Arthroscopic posterior stabilization mirrors anterior Bankart repair in technique but is directed at the back of the shoulder:

1. The posterior labrum is identified and mobilized off the glenoid rim.
2. Suture anchors are placed along the posterior glenoid, and the labrum and capsule are repaired back to bone.
3. The posterior capsule is often tensioned as part of the same repair to address the redundancy that develops with repetitive posterior loading.
4. Portals are closed and the arm is placed in a sling or brace positioned to protect the posterior repair.

Who Is This For?

Posterior instability has a recognizable, if underappreciated, profile:

• Offensive linemen, blockers, and other football players who load the shoulder in a forward-pressing position repeatedly.
• Bench-press-heavy weightlifters and military recruits performing repetitive push-type loading.
• Patients describing deep posterior shoulder pain with pushing, blocking, or pressing activities, without a clear dislocation history.
• Patients whose standard shoulder X-rays look normal despite persistent symptoms — posterior instability frequently requires axillary views or CT to see clearly.

It is not the right diagnosis to assume in a patient with a classic anterior dislocation history, and it should be distinguished from multidirectional instability, where laxity runs in more than one direction and the atraumatic, often bilateral pattern points toward a rehab-first approach discussed on the multidirectional instability page.

Recovery & Rehabilitation

• 0–4 to 6 weeks: Bracing or sling immobilization in a position that protects the posterior repair; passive motion only, as directed.
• 6–12 weeks: Progressive active motion and early scapular and rotator cuff strengthening.
• 3–5 months: Sport-specific strengthening, including position-specific work for linemen and lifters.
• 7.5 months average: Return to sport, though the reported range spans 3–18 months depending on the individual and the sport (Gouveia, AJSM 2022).