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Posterior Stabilization (Open)

synonyms:

Open Posterior Capsular Shift Indications

Open Posterior Capsular Shift Contraindications

  • Voluntary, habitual instability due to psychological problems.

Open Posterior Capsular Shift Alternatives

Open Posterior Capsular Shift Pre-op Planning / Special Considerations

  • Ensure there is not a glenoid or humeral head lesion requiring bone graft or OATS

Open Posterior Capsular Shift Technique

  • Sign operative site
  • Pre-operative antibiotics, +/- regional block
  • General endotracheal anesthesia
  • Lateral position. All bony prominences well padded.
  • Skin incision from scapular spine inferiorly.
  • Define posterior/middle deltoid interval and develop plane.
  • May need to detach 1-2cm of deltoid from scapular spine for exposure.
  • Split infraspinatus (Dresse J, Tech Shoulder Elbow Surg 2005;6:199), (Shaffer BS, AJSM 1994;22:113). May develop plane between infraspinatus/teres minor; but this presents high risk to axillary nerve & posterior circumflex humeral vessels.
  • Any medial dissection must be limited to 1.0cm medial to the glenoid to avoid injury to the suprascapular nerve.
  • Identify capsule. Incise capsule 1cm medial to its humeral insertion from superior to inferior. Split capsule in T fashion.
  • Ensure there is not a glenoid or humeral head lesion requiring bone graft or OATS
  • Identify and repair posterior labral avulsion usually with suture anchor.
  • Shift inferior capsular flap superiorly and superior flap inferiorly and repair with non-absobable suture.
  • Superior advancement and placation of posterior capsule with non-absorbable suture anchors.
  • Examination under anesthesia.
  • Prep and drape in standard sterile fashion.
  • Irrigate.
  • Close in layers.

Open Posterior Capsular Shift Complications

Open Posterior Capsular Shift Follow-up care

  • Post-op: Place in shoulder immobilizer in slight abduction, slight extension and slight external rotation. Avoid flexion and internal rotation to protect repair. Perform elbow, wrist, hand ROM/strengthening,
  • 7-10 Days: Wound check, continue immobilization,
  • 6 Weeks: Discontinue immobilizer; begin cross-body adduction and light progressive resistive exercises / PT.
  • 3 Months: Begin sport specific training.
  • 4 Months: May return to non-contact sports.
  • 6 Months: May return to contact/collision sports.

Open Posterior Capsular Shift Outcomes

  • 19% recurrence, 84% patient satisfaction. Significantly poorer satisfaction/outcomes in shoulders with chondral defects at the time of stabilization and in patients aged <37 years at the time of surgery. No progressive radiographic signs of glenohumeral arthritis were seen up to 22 years after surgery. (Wolf BR, JSES 2005;14:157).
  • 50% excellent; 32% good; 2% fair; 18% poor. 12% recurrent instability (Bibliani LU, JBJS 1995;77A:1011).
  • Shoulder Outcome measures

Open Posterior Capsular Shift Review References