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Posterior Shoulder Stabilisation

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Updated Sep 20264 citations

Why this operation has been suggested

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. At your first visit we take a history, examine your shoulder, and arrange scans if they are needed. Posterior shoulder instability means the ball at the top of your arm slips out of place towards the back of the socket. It is an uncommon problem, and it is often missed at first, which can delay the right diagnosis.

We usually try non-operative care first. That may mean changing your activities and doing a physiotherapy program. Some people improve enough with this and do not need surgery. If your shoulder keeps slipping, aching, or limiting what you can do after a fair trial of physiotherapy, we may suggest keyhole surgery to stabilise it. Keyhole surgery means the surgeon works through small cuts using a camera. The aim is a shoulder that stays in place, with less pain and better function. Most people return to sport between 4.3 and 8.6 months after surgery. We will talk through the options with you and decide together.

Before the operation

In the days before surgery you will need some scans to plan the operation. These may include an X-ray, an MRI scan, or an ultrasound. You will get clear instructions from our team about what to do. You will need to stop eating seven hours before surgery. We ask for a little extra time so we can bring you forward if the theatre list runs early. If you take regular medicines, bring a list of them and we will tell you which ones to pause. Arrange for someone to drive you home afterwards. Wear loose, comfortable clothing. If you have other medical conditions, you may need blood tests or a review with the anaesthetist.

On the day

You will arrive at the hospital's surgical admissions unit. There you are checked in and prepared for theatre. You will meet the anaesthetist, the doctor who puts you to sleep and keeps you comfortable during the operation. This operation is done under general anaesthetic. A regional nerve block is sometimes added for post-operative pain relief; the anaesthetist will discuss this with you on the day.

You are then taken into the operating theatre, where the operation is performed. Afterwards you wake up in the recovery area. Nurses will watch over you while the anaesthetic wears off. Once you are stable, you either go to the ward or go home, depending on the procedure and your recovery.

What the operation involves

Keyhole surgery is the usual approach for this problem. Your surgeon makes two or three small cuts, each about 1 cm, around the back of the shoulder. A thin camera goes in through one of the cuts so the surgeon can see inside the joint on a screen. Working through the other small cuts, your surgeon tightens and repairs the tissue at the back of the shoulder that holds the ball in the socket. Small anchors in the bone hold the repaired tissue in place while it heals.

If your shoulder has been unstable for a long time, or keyhole repair is not right for your shoulder, there are other operations. One option adds a small piece of bone to the back of the socket to act as a bumper that stops the ball slipping backwards. Another option reshapes the bone of the socket itself with a carefully planned cut, which changes the shape of the joint so the ball sits where it should. Your surgeon will explain which approach suits your scans and your shoulder.

The small cuts are closed with stitches, then covered with a dressing. You will get instructions about caring for the wound and when the stitches come out or dissolve.

After the operation

When you wake up, you will be in the recovery area, and later on the ward if you are staying overnight. Nurses will check your shoulder and keep you comfortable with pain relief. Your arm will be in a sling to rest the repair. The small cuts will be covered with dressings, and we will show you how to keep them clean and dry. A physiotherapist may visit to help you start gentle movements, such as loosening your elbow, wrist and hand. Most people walk around within a few hours of surgery. Please arrange for someone to stay with you for the first 24 hours after you get home. Your team will tell you whether you go home the same day or stay one night in hospital.

Recovery

For the first few days your shoulder will be sore and swollen. This is normal and settles gradually. Pain relief keeps you comfortable, and ice packs help with the swelling. Resting your arm in the sling also eases the ache.

Your physiotherapist will guide your rehabilitation. You will start with gentle movements for your elbow, wrist and hand, then build up to shoulder movement as the repair heals. You can do most things at home with your other hand, such as eating, writing and dressing. Avoid lifting with the sore arm or pushing up from a chair with it until your surgeon says it is safe. Sleeping can be uncomfortable at first. Many people find it easier to sleep propped up in a chair or with pillows behind their back.

As the swelling settles and movement returns, everyday tasks get easier. Once your surgeon clears you to drive, you must be able to hold the wheel with both hands and react in an emergency stop, and you must be off strong pain medication. You cannot drive while you are in the sling. Our guide to driving after upper-limb surgery explains this in more detail. When your shoulder feels steady and your strength comes back, you can return to work and sport step by step, following your physiotherapist's plan.

Recovery varies from person to person. Your timeline may differ, and your surgeon and physiotherapist will guide you along the way.

What can go wrong

Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.

Sometimes the shoulder keeps slipping after surgery. You might notice the same catching or giving-way feeling you had before, or a sense that the ball is sliding towards the back of the socket again. If this happens, tell your surgeon at your next review so they can examine it and plan what to do next.

One option for stubborn instability adds a small piece of bone to the back of the socket. With this operation, problems are not unusual, and the shoulder may not feel as steady or as comfortable as hoped. If you have this operation and your shoulder still feels loose or painful afterwards, bring it up at your review appointment.

Another option reshapes the socket bone itself with a planned cut. Even with this operation, the shoulder can remain unstable. If you still feel slipping, clicking, or a lack of confidence in the shoulder after the healing period, do not put up with it. Tell your surgeon so they can check whether the joint is sitting where it should.

The complications table on this page lists typical rates if you want the specifics.

When to call us

Most problems settle with time and simple care. Some need urgent attention. Call us if you have a fever, or the wound becomes more red, swollen, or starts to leak fluid. Go to emergency if you have sudden severe pain, new swelling in your calf, or shortness of breath. Go to emergency if your arm goes numb, or you cannot move it. If your shoulder starts slipping again, call the clinic so we can review it early.

Advanced reading: the deeper science (optional)

This section goes further than you need for your own treatment decisions. Posterior shoulder instability is worth the extra reading because it behaves differently from the anterior version most people have heard of, and the difference runs in the direction you would not guess.

Posterior is the more stable repair, and the harder return

A meta-analysis comparing anterior with posterior instability after arthroscopic repair found that patients with anterior instability had higher return-to-sport rates but were more likely to have postoperative instability. Posterior patients were the reverse: the repair held better, but fewer got back to their sport [1].

That is worth sitting with, because it separates two things patients tend to fuse together. "Will my shoulder stay in?" and "will I get back to what I did?" have different answers here, and the second is the harder one.

The underlying results for the operation itself are good. A systematic review of 2,307 arthroscopic posterior stabilisations reported good outcomes with high patient satisfaction and low rates of recurrent instability, revision and residual pain [2]. A separate review of 1,047 athletes found high rates of return to sport, and relatively high rates of return to the pre-injury level [3]. Both findings can be true at once, posterior stabilisation is a reliable operation, and it is still a harder road back than its anterior counterpart.

What predicts failure

The most useful recent work is about who does badly. A systematic review of 960 patients identified three risk factors for failure or revision after arthroscopic posterior capsulolabral repair: female sex, reduced glenoid bone width, and preoperative glenoid bone loss greater than 11% to 15% [4].

Equally informative is what did not predict failure: glenoid version, type of sport, labral width and labral version showed no significant effect [4]. Version in particular is often discussed as though it were decisive, and on this evidence it is not.

The practical consequence is that the glenoid bone stock deserves proper assessment before surgery. Beyond roughly the 11–15% mark, a soft-tissue repair alone is working against mechanics it cannot fix, and that is the conversation to have before the operation rather than after a failure.

Why it gets missed

Posterior instability rarely presents as a dislocation. It is more often pain with a loaded, flexed arm, a bench press, a push-up, a hand pushing off a chair, with no history of the shoulder visibly coming out. That presentation invites the label of impingement or tendinopathy, and the diagnosis is frequently made late.

If you have pain pushing through a flexed arm and it has not responded to treatment aimed at the rotator cuff, posterior instability is worth specifically excluding.

Reviewed by Dr Kieran Hirpara · 13 August 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

References for the advanced reading
  1. Vopat ML, Coda RG, Giusti NE, Baker J, Tarakemeh A, Schroeppel JP, et al. Differences in outcomes between anterior and posterior shoulder instability after arthroscopic Bankart repair: a systematic review and meta-analysis. Orthop J Sports Med. 2021;9(5).
  2. Ralph JE, Hurley ET, Lunn K, Levin JM, Klifto CS, Owens BD, et al. Outcomes of arthroscopic stabilization for posterior shoulder instability: a systematic review. J Shoulder Elbow Surg. 2024;33(11):2530-8.
  3. Matar RN, Shah NS, Gardner TJ, Grawe BM. Return to sport after surgical treatment for posterior shoulder instability: a systematic review. JSES Int. 2020;4(4):797-802.
  4. Afetse EK, Noonan J, Munro A, Waterman BR, Ruzbarsky JJ, Kanakamedala AC, et al. Female sex, reduced glenoid bone width, and glenoid bone loss greater than 11% to 15% may increase the risk of failure after arthroscopic posterior capsulolabral repair: a systematic review. Arthroscopy. 2025;41(12):5332-42.e1.
Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Arthroscopic stabilization of posterior shoulder instability yields promising early and midterm results [4].
  • Arthroscopic stabilization for posterior shoulder instability results in good outcomes, high patient satisfaction, low rates of recurrent instability, low rates of revisions, and low rates of residual pain [14].
  • Arthroscopic management of posterior-inferior shoulder instability has a successful track record and a minimal complication profile [8].
  • Arthroscopic surgical techniques have facilitated successful management of both recurrent posterior subluxations and frank posterior instability [9].
  • Successful correction of scapular anatomy (glenoid and acromion) at a minimum of 2 years can improve static subluxation and restore subjective and objective shoulder stability [2].
  • Posterior bone block augmentation for recurrent posterior shoulder instability does not reliably yield substantial improvements in patient-reported outcomes and is associated with frequently observed complications [12].
  • There is a high rate of return to sport after arthroscopic posterior shoulder stabilization, ranging from 4.3 to 8.6 months after surgery [15].
  • The thresholds defined in recent studies can provide a guideline for interpreting patient outcomes following arthroscopic stabilization for posterior shoulder instability, allowing for earlier detection of recurrent posterior instability [3].
  • Coracoid morphology differs significantly in patients undergoing posterior shoulder stabilization when compared to patients undergoing surgery for anterior instability or a comparison cohort [7].
  • Over the past several centuries, a number of procedures have been developed to address posterior shoulder instability as this pathology has become better understood [6].
  • Additional long-term randomized trials are needed to compare surgical positioning (beach-chair versus lateral decubitus) for posterior shoulder stabilization to better understand potential advantages and disadvantages [1].

Anatomy & Pathophysiology

  • Posterior shoulder instability pathology has become better understood over the past several centuries, leading to the development of various surgical procedures [6].
  • Advances in understanding posterior glenohumeral anatomy and biomechanics have improved comprehension of this disorder and guided clinical decision-making regarding surgical indications, contraindications, nonsurgical treatments, and stabilization techniques [16].
  • Posterior shoulder instability (PSI) is classified using the ABC classification, which distinguishes three groups based on the nature of pathology and two subtypes based on pathomechanical causes [17].
  • Female patients are significantly more likely to have posterior shoulder instability compared to anterior shoulder instability, whereas male patients are significantly more likely to have anterior shoulder instability [11].
  • Delayed diagnosis of posterior glenohumeral dislocations is common [18].
  • Coracoid morphology differs significantly in patients undergoing posterior shoulder stabilization compared to patients undergoing surgery for anterior instability or a comparison cohort [7].
  • Patients with constitutional static posterior shoulder instability (Type C1) differ from healthy controls regarding osseous scapular and humeral morphology, scapulothoracic orientation, and shoulder girdle muscle distribution [31].
  • Glenoid as well as acromial malalignment alone is associated with pathological posterior translation of the humeral head across the glenoid upon simulated active elevation [24].
  • The acromion acts as a mechanical buttress to posterior humeral head displacement [27].
  • Successful correction of scapular anatomy (glenoid and acromion) can improve static subluxation and restore subjective and objective shoulder stability at a minimum of 2 years [2].
  • Glenohumeral contact patterns highly depend on the amount of glenoid retroversion and posterior labral and/or bony glenoid integrity [25].
  • Posterior and posterior superior labral (PPS) injuries produce alterations in glenohumeral kinematics with implications for joint instability, increased joint loading, and potential joint damage [26].
  • The long head of the biceps has a pertinent biomechanical role in glenohumeral stability regardless of the condition of the superior labrum [28].
  • Surgical treatment of posterior shoulder instability must balance the necessity to repair torn capsulolabral tissues with the tendency to over constrain the shoulder [34].

Classification

  • Posterior shoulder instability is an uncommon condition that is often unrecognized, leading to incorrect diagnoses and delays [5].
  • The ABC classification distinguishes three groups of posterior shoulder instability based on the nature of pathology and two subtypes based on pathomechanical causes [17].
  • The ABC classification provides diagnostic criteria and treatment strategies for posterior shoulder instability [17].
  • Female patients are significantly more likely to have posterior shoulder instability compared to male patients, who are significantly more likely to have anterior shoulder instability [11].

Clinical Presentation

  • Recurrent posterior shoulder instability is an uncommon condition that is often unrecognized, leading to incorrect diagnoses and delays [5].
  • Bilateral posterior shoulder dislocations with reverse Hill-Sachs lesions are uncommon and prone to misdiagnosis [30].
  • In patients with suspected posterior glenohumeral instability, imaging can show abnormalities of the bone, labrum, and joint capsule [20].
  • Posterior shoulder instability is distinguished into three groups based on the nature of pathology and two subtypes based on pathomechanical causes in the ABC classification [17].
  • Female patients are significantly more likely to have posterior shoulder instability compared to anterior shoulder instability [11].
  • Successful correction of scapular anatomy can improve static subluxation and restore subjective and objective shoulder stability at a minimum of 2 years follow-up [2].
  • Arthroscopic management of posterior-inferior shoulder instability has a successful track record and minimal complication profile [8].
  • Arthroscopic stabilization of posterior shoulder instability resulted in good outcomes with high patient satisfaction and low rates of recurrent instability, revisions, and residual pain [14].
  • The early and midterm results of arthroscopic stabilization of the shoulder for posterior instability are promising [4].
  • Participants with microtraumatic posterior shoulder instability demonstrated significant improvements in patient-reported outcome measures and high rates of return to sport following a 24-week conservative rehabilitation program [21].
  • The thresholds defined in the study can provide a guideline for interpreting patient outcomes following arthroscopic stabilization for posterior shoulder instability, allowing for earlier detection of recurrent posterior instability [3].

Investigations

  • Delayed diagnosis of posterior glenohumeral dislocation is common [18].
  • Regardless of the radiologist interpretation of magnetic resonance arthrogram (MRA), patients with symptomatic posterior shoulder instability benefit from arthroscopic stabilization surgery [19].
  • In cases of traumatic posterior shoulder dislocation with associated acromion fracture, anatomical reduction and retention of the acromion fracture may be needed to prevent recurrent posterior instability [37].
  • Anterior greater tuberosity malunion after posterior shoulder fracture dislocation is a rare and debilitating condition [38].

Treatment

Non-Operative Management

  • NHL team physicians strongly favor nonoperative management in-season for initial posterior instability events of the shoulder [32].

Arthroscopic Stabilization

  • Regardless of the radiologist interpretation of MRA, patients with symptomatic posterior shoulder instability do benefit from arthroscopic stabilization surgery [19].
  • Additional long-term randomized trials comparing beach-chair and lateral decubitus positions are needed to better understand the potential advantages and disadvantages of surgical positioning for posterior shoulder stabilization [1].

Bone Block Augmentation

  • Posterior bone block augmentation for recurrent posterior shoulder instability does not reliably yield substantial improvements in patient-reported outcomes, and complications are frequently observed [12].
  • There is a moderate rate of recurrence following posterior bone block for posterior shoulder instability [13].
  • The iliac posterior shoulder bone-block is effective in managing instances of involuntary posterior shoulder instability, showing satisfactory results in terms of non-recurrence, pain relief, and function recovery [10].
  • Both glenoid osteotomy and bone block procedures can successfully address symptomatic posterior shoulder instability [22].

Scapular Osteotomy

  • At a minimum of 2 years successful correction of scapular anatomy can improve static subluxation and restore subjective and objective shoulder stability [2].

Outcome Interpretation

  • The thresholds defined in this study can provide a guideline for interpreting patient outcomes following arthroscopic stabilization for posterior shoulder instability, allowing for earlier detection of recurrent posterior instability [3].

Complications

  • Posterior bone block augmentation for recurrent posterior shoulder instability does not reliably yield substantial improvements in patient-reported outcomes [12].
  • Complications are frequently observed following posterior bone block augmentation for recurrent posterior shoulder instability [12].
  • There is a moderate rate of recurrence following posterior bone block procedures for posterior shoulder instability [13].
  • Glenoid osteotomy for posterior shoulder instability is associated with a high rate of persistent instability [40].

Recovery

  • Arthroscopic stabilization of posterior shoulder instability results in good outcomes with high patient satisfaction [14].
  • Arthroscopic stabilization of posterior shoulder instability is associated with low rates of recurrent instability [14].
  • Arthroscopic stabilization of posterior shoulder instability is associated with low rates of revisions [14].
  • Arthroscopic stabilization of posterior shoulder instability is associated with low rates of residual pain [14].
  • There is a high rate of return to sport after arthroscopic posterior shoulder stabilization [15].
  • Return to sport after arthroscopic posterior shoulder stabilization ranges from 4.3 to 8.6 months after surgery [15].
  • There are high rates of return to sport among athletes who underwent surgical treatment for posterior shoulder instability [23].
  • There are relatively high rates of return to preinjury level of sport among athletes who underwent surgical treatment for posterior shoulder instability [23].
  • Arthroscopic posterior Bankart repair for traumatic posterior shoulder instability in collision sports athletes results in a low recurrence rate [35].
  • Arthroscopic posterior Bankart repair for traumatic posterior shoulder instability in collision sports athletes results in a high return-to-play rate [35].
  • Arthroscopic posterior Bankast repair for traumatic posterior shoulder instability in collision sports athletes results in clinically meaningful improvement [35].
  • Participants with microtraumatic posterior shoulder instability demonstrated significant improvements in patient-reported outcome measures following a 24-week conservative rehabilitation program [21].
  • Participants with microtraumatic posterior shoulder instability demonstrated high rates of return to sport following a 24-week conservative rehabilitation program [21].
  • Successful correction of scapular anatomy can improve static subluxation [2].
  • Successful correction of scapular anatomy can restore subjective shoulder stability [2].
  • Successful correction of scapular anatomy can restore objective shoulder stability [2].
  • The iliac posterior shoulder bone-block is effective in managing instances of involuntary posterior shoulder instability [10].
  • The iliac posterior shoulder bone-block shows satisfactory results in terms of non-recurrence [10].
  • The iliac posterior shoulder bone-block shows satisfactory results in terms of pain relief [10].
  • The iliac posterior shoulder bone-block shows satisfactory results in terms of function recovery [10].

Key Evidence

  • [L4] Additional long-term randomized trials comparing these positions are needed to better understand the potential advantages and disadvantages of surgical positioning for posterior shoulder stabilization. [1] (10.1177/2325967118822452)
  • [L4] At a minimum of 2 years successful correction of scapular anatomy can improve static subluxation and restore subjective and objective shoulder stability. [2] (10.1016/j.jseint.2025.06.018)
  • [L4] The thresholds defined in this study can provide a guideline for interpreting patient outcomes following arthroscopic stabilization for posterior shoulder instability, allowing for earlier detection of recurrent posterior instability. [3] (10.1016/j.jseint.2025.08.006)
  • [L1] The early and midterm results of arthroscopic stabilization of the shoulder for posterior instability are promising. [4] (10.1016/j.arthro.2014.11.009)
  • [L5] Recurrent posterior shoulder instability is an uncommon condition often unrecognized, leading to incorrect diagnoses and delays. [5] (10.5435/00124635-200608000-00004)
  • [L5] Over the past several centuries, a number of procedures have been developed to address posterior shoulder instability, particularly as this pathology has become better understood. [6] (10.1016/j.jses.2019.08.008)
  • [L3] Coracoid morphology differs significantly in patients undergoing posterior shoulder stabilization when compared to patients undergoing surgery for anterior instability or a comparison cohort. [7] (10.1177/03635465261421534)
  • [L4] Arthroscopic management of posterior-inferior shoulder instability has a successful track record and minimal complication profile. [8] (10.1016/j.arthro.2018.06.057)
  • [L5] The article outlines the evolution of diagnostic acumen and treatment algorithms for posterior shoulder instability, emphasizing that arthroscopic surgical techniques have facilitated successful management of both recurrent posterior subluxations and frank posterior instability. [9] (10.1016/j.csm.2008.06.001)
  • [L4] The iliac posterior shoulder bone-block is effective in managing instances of involuntary posterior shoulder instability, showing satisfactory results in terms of non-recurrence, pain relief, and function recovery. [10] (10.1016/j.otsr.2008.09.008)
  • [L4] Overall, male patients were significantly more likely to have anterior shoulder instability, while female patients were significantly more likely to have posterior shoulder instability. [11] (10.1177/23259671211006437)
  • [L1] Posterior bone block augmentation for recurrent posterior shoulder instability does not reliably yield substantial improvements in patient-reported outcomes, and complications are frequently observed. [12] (10.1016/j.arthro.2021.07.018)
  • [L4] There is a moderate rate of recurrence following posterior bone block for posterior shoulder instability. [13] (10.1016/j.jse.2021.06.013)
  • [L4] Arthroscopic stabilization of posterior shoulder instability resulted in good outcomes with high patient satisfaction and low rates of recurrent instability, revisions, and residual pain. [14] (10.1016/j.jse.2024.04.006)
  • [L4] There is a high rate of return to sport after arthroscopic posterior shoulder stabilization, ranging from 4.3 to 8.6 months after surgery. [15] (10.1016/j.asmr.2020.08.007)
  • [L5] Advances in understanding posterior glenohumeral anatomy and biomechanics have improved comprehension of this challenging disorder and helped guide clinical decision making, including delineation of surgical indications and contraindications, nonsurgical treatment solutions, and appropriate stabilization and bone augmentation techniques. [16] (10.5435/jaaos-d-15-00631)
  • [L5] This review guides the reader to correctly identify posterior shoulder instability (PSI) by providing diagnostic criteria and treatment strategies based on the ABC classification, which distinguishes three groups of PSI based on the nature of pathology and two subtypes based on pathomechanical causes. [17] (10.1530/eor-24-0025)
  • [L4] Overall, reduction was achieved via open means in the majority of shoulders, and delayed diagnosis is common. [18] (10.1302/0301-620x.101b1.bjj-2018-0984.r1)
  • [L3] Regardless of the radiologist interpretation of MRA, patients with symptomatic posterior shoulder instability do benefit from arthroscopic stabilization surgery. [19] (10.1016/j.xrrt.2026.100675)
  • [L5] In patients with suspected posterior glenohumeral instability, imaging of the affected shoulder can show abnormalities of the bone, labrum, and joint capsule. [20] (10.2214/ajr.07.3849)
  • [L4] Participants with microtraumatic posterior shoulder instability demonstrated significant improvements in patient-reported outcome measures and high rates of return to sport following a 24-week conservative rehabilitation program. [21] (10.1016/j.jseint.2024.09.016)
  • [L1] Both glenoid osteotomy and bone block procedures can successfully address symptomatic posterior shoulder instability. [22] (10.1016/j.xrrt.2025.03.004)
  • [L4] The systematic review demonstrated high rates of return to sport and relatively high rates of return to preinjury level of sport among all athletes who underwent surgical treatment for posterior shoulder instability. [23] (10.1016/j.jseint.2020.08.002)
  • [L5] Glenoid as well as acromial malalignment alone is associated with pathological posterior translation of the humeral head across the glenoid upon simulated active elevation. [24] (10.1177/03635465251411312)
  • [L5] Glenohumeral contact patterns highly depend on the amount of glenoid retroversion and posterior labral and/or bony glenoid integrity. [25] (10.1177/03635465251365497)
  • [L5] The PPS injury produces alterations in GH kinematics with implications for GH joint instability, increased GH joint loading, and potential joint damage. [26] (10.1016/j.jse.2024.12.023)
  • [L5] The acromion acts as a mechanical buttress to posterior humeral head displacement. [27] (10.1016/j.jse.2024.09.047)
  • [L5] The long head of the biceps has a pertinent biomechanical role in glenohumeral stability regardless of the condition of the superior labrum. [28] (10.1016/j.arthro.2025.05.022)
  • [L4] Bilateral posterior shoulder dislocations with reverse Hill-Sachs lesions are uncommon and prone to misdiagnosis; early recognition and tailored treatment strategies are essential for satisfactory functional outcomes. [30] (10.1186/s12891-026-09537-y)
  • [L3] Patients with C1 shoulders differ from healthy controls regarding osseous scapular and humeral morphology, scapulothoracic orientation, and shoulder girdle muscle distribution. [31] (10.1177/03635465241233706)
  • [L4] NHL team physicians strongly favor nonoperative management in-season for initial posterior instability events of the shoulder. [32] (10.1177/23259671261440208)
  • [L5] Surgical treatment must balance the necessity to repair torn capsulolabral tissues with the tendency to over constrain the shoulder. [34] (10.5435/jaaos-d-19-00535)
  • [L4] Arthroscopic posterior Bankart repair for traumatic posterior shoulder instability in collision sports athletes resulted in a low recurrence rate, high return-to-play rate, and clinically meaningful improvement. [35] (10.1016/j.asmr.2025.101264)
  • [L4] In such cases, anatomical reduction and retention of the acromion fracture may be needed to prevent recurrent posterior instability. [37] (10.1016/j.xrrt.2025.09.006)
  • [L4] Anterior greater tuberosity malunion after posterior shoulder fracture dislocation is a rare and debilitating condition. [38] (10.1016/j.xrrt.2024.12.002)
  • [L4] However, the high rate of persistent instability should be considered when making treatment decisions. [40] (10.1177/17585732211056053)

References

[1] Outcomes of Arthroscopic Posterior Shoulder Stabilization in the Beach-Chair Versus Lateral Decubitus Position: A Systematic Review. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967118822452

[2] Scapular (glenoid and acromion) osteotomies for the treatment of posterior shoulder instability: technique and preliminary results. JSES International. 2025. DOI: 10.1016/j.jseint.2025.06.018

[3] Defining clinical significance following primary stabilization of posterior shoulder instability. JSES International. 2025. DOI: 10.1016/j.jseint.2025.08.006

[4] Arthroscopic Treatment of Posterior Shoulder Instability: A Systematic Review. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.11.009

[5] Recurrent Posterior Shoulder Instability. Journal of the American Academy of Orthopaedic Surgeons. 2006. DOI: 10.5435/00124635-200608000-00004

[6] History of surgical stabilization for posterior shoulder instability. JSES Open Access. 2019. DOI: 10.1016/j.jses.2019.08.008

[7] Coracoid Morphology and the Risk of Posterior Shoulder Instability: A Magnetic Resonance Imaging Study. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465261421534

[8] Patient Positioning in Arthroscopic Management of Posterior‐Inferior Shoulder Instability: A Systematic Review Comparing Beach Chair and Lateral Decubitus Approaches. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2018.06.057

[9] Arthroscopic Management of Posterior Shoulder Instability: Diagnosis, Indications, and Technique. Clinics in Sports Medicine. 2008. DOI: 10.1016/j.csm.2008.06.001

[10] Iliac bone-block autograft for posterior shoulder instability. Orthopaedics & Traumatology: Surgery & Research. 2009. DOI: 10.1016/j.otsr.2008.09.008

[11] Differences in Outcomes Between Anterior and Posterior Shoulder Instability After Arthroscopic Bankart Repair: A Systematic Review and Meta-analysis. Orthopaedic Journal of Sports Medicine. 2021. DOI: 10.1177/23259671211006437

[12] Bone Block Augmentation of the Posterior Glenoid for Recurrent Posterior Shoulder Instability Is Associated With High Rates of Clinical Failure: A Systematic Review. Arthroscopy. 2021. DOI: 10.1016/j.arthro.2021.07.018

[13] Posterior glenoid bone block transfer for posterior shoulder instability: a systematic review. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2021.06.013

[14] Outcomes of arthroscopic stabilization for posterior shoulder instability: a systematic review. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2024.04.006

[15] Return to Play After Arthroscopic Stabilization for Posterior Shoulder Instability—A Systematic Review. Arthroscopy, Sports Medicine, and Rehabilitation. 2020. DOI: 10.1016/j.asmr.2020.08.007

[16] Posterior Glenohumeral Instability: Evidence-based Treatment. Journal of the American Academy of Orthopaedic Surgeons. 2017. DOI: 10.5435/jaaos-d-15-00631

[17] Diagnosis and treatment of posterior shoulder instability based on the ABC classification. EFORT Open Reviews. 2024. DOI: 10.1530/eor-24-0025

[18] The aetiology of posterior glenohumeral dislocations and occurrence of associated injuries. The Bone & Joint Journal. 2019. DOI: 10.1302/0301-620x.101b1.bjj-2018-0984.r1

[19] No difference in outcomes for posterior shoulder instability surgery in patients with a normal vs. pathological radiologist reported magnetic resonance arthrogram study. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2026.100675

[20] Imaging Signs of Posterior Glenohumeral Instability. American Journal of Roentgenology. 2009. DOI: 10.2214/ajr.07.3849

[21] The efficacy of conservative management of micro-traumatic posterior shoulder instability. JSES International. 2025. DOI: 10.1016/j.jseint.2024.09.016

[22] Posterior shoulder instability – A systematic review and meta-analysis of glenoid osteotomy and bone block procedures. JSES Reviews, Reports, and Techniques. 2025. DOI: 10.1016/j.xrrt.2025.03.004

[23] Return to sport after surgical treatment for posterior shoulder instability: a systematic review. JSES International. 2020. DOI: 10.1016/j.jseint.2020.08.002

[24] Scapular Morphology and Posterior Shoulder Stability: Biomechanical Evidence From an Advanced Cadaveric Shoulder Simulator. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465251411312

[25] Correcting Excessive Glenoid Retroversion in Combination With Posterior Glenoid Bone Grafting Leads to Improved Glenohumeral Contact Pressures in a Cadaveric Posterior Instability Model. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465251365497

[26] 2025 Basic Science Neer Award Winner: The impact of posterior and posterior superior labral injuries and the effect of their treatment on glenohumeral kinematics in the deceleration and follow-through phase of throwing: a biomechanical study. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.12.023

[27] Posterior shoulder stability depends on acromial anatomy: a cadaveric, biomechanical study. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.09.047

[28] Biceps Tenodesis/Tenotomy Disrupts Biomechanical Glenohumeral Stability in the Setting of Superior Labrum Anteroposterior Tear and Repair. Arthroscopy. 2025. DOI: 10.1016/j.arthro.2025.05.022

[30] Bilateral posterior shoulder dislocations with reverse Hill-Sachs lesions: a report of two cases and a literature review. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09537-y

[31] Differences in Osseous Shoulder Morphology, Scapulothoracic Orientation, and Muscle Volume in Patients With Constitutional Static Posterior Shoulder Instability (Type C1) Compared With Healthy Controls. The American Journal of Sports Medicine. 2024. DOI: 10.1177/03635465241233706

[32] Treatment of Posterior Shoulder Instability in National Hockey League Players: A Survey of NHL Team Physicians. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671261440208

[34] Posterior Labral Injury and Glenohumeral Instability in Overhead Athletes: Current Concepts for Diagnosis and Management. Journal of the American Academy of Orthopaedic Surgeons. 2020. DOI: 10.5435/jaaos-d-19-00535

[35] Favorable Outcomes After Arthroscopic Posterior Bankart Repair for Traumatic Posterior Shoulder Instability in Collision Athletes. Arthroscopy, Sports Medicine, and Rehabilitation. 2025. DOI: 10.1016/j.asmr.2025.101264

[37] Traumatic posterior shoulder dislocation with associated acromion fracture: a report of 2 cases. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2025.09.006

[38] Arthroscopic repair of an anteriorly malunited greater tuberosity after a posterior shoulder fracture-dislocation in a 16-year-old male. JSES Reviews, Reports, and Techniques. 2025. DOI: 10.1016/j.xrrt.2024.12.002

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