According to one study on posterior shoulder joint renew Review dislocation, "more than 60% of posterior dislocations are misdiagnosed initially by the treating orthopedic surgeon, and the correct diagnosis is often delayed for months or years." The other major point to observe is that because the shoulder is a "circle" labels such as anterior and posterior instability are not as valid or helpful today because with the ability to evaluate and treat the entire joint using advanced arthroscopic techniques,
we are learning that many different types of injuries (labrum, cartilage, capsule, ligament, nerve, and rotator cuff) can be part of the injury spectrum regardless of the primary direction of the shoulder dislocation. So it is vital to have a surgical technique that allows us to evaluate and treat the entire "circle" and not just a limited area of focus. This shift in thinking about shoulder dislocation has also resulted in a significant improvement in outcomes with modern arthroscopic techniques in experienced hands.
Maya, a 17 year old gymnast from Chicago, initially dislocated her shoulder doing a back flip on the balance beam 3 years ago. Since then she has had multiple episodes of subluxation and dislocation, the most recent one before evaluation at our shoulder clinic while throwing a ball. She has had multiple evaluations and extensive physical therapy over the past 3 years, but her symptoms are worsening and she has had to stop gymnastics because of the shoulder. Our examination reveals
that Maya is extremely flexible both generally (double-jointed) and with examination of her other unaffected shoulder and does not have any evidence of nerve injury (sometimes seen with shoulder dislocation). MRI arthrogram confirms evidence of generalized shoulder laxity and anterior inferior labrum tear. We again reviewed our protocol for unstable shoulder and global arthroscopic repair and she and her parents wanted to proceed with an arthroscopic repair. Maya was noted to have a "global" labrum tear at surgery, meaning that over time she had torn the labrum completely around the entire glenoid (socket). She also had created a chondral defect (gouge or trough) in the humeral head (ball) during one of her previous episodes of