Atraumatic recurrent posterior shoulder subluxation: review of the literature and recommendations for treatment.

Isolated atraumatic recurrent posterior subluxation of the shoulder (ARPS) constitutes 1% of all shoulder subluxations; it is therefore difficult for any single clinic to gain a large experience in treating this condition. Based on a review of the literature 83 cases of ARPS out of 237 reported cases with all types of posterior subluxation of the shoulder (185 patients) were analyzed. Most cases of ARPS occur between 11 and 20 years of age; they are frequently associated with changes such as dysplasia of the glenoid labrum or an alteration in the spinoglenoid angle. More than half of all ARPS occur bilaterally. The diagnosis is based on history, physical examination including tests of instability, or on techniques of dynamic examination (ultrasonography, arthroscopy). A plan of management related to the underlying etiology has been developed. At the first occurrence, cases of subluxation should be treated conservatively by kinesitherapy and physical therapy. Operative treatment is indicated when conservative management for at least 6 months has been unsuccessful and subluxation continues to occur during everyday activities, but it should never be instituted in patients with emotional disorders. The underlying pathologic lesion should determine the technique for shoulder reconstruction in atraumatic posterior shoulder subluxation. In cases in the atraumatic voluntary subgroup, surgery is indicated if conservative treatment fails and the voluntary component has been eliminated. In this subgroup, isolated soft tissue procedures have not been shown to produce good long-term results, and supplementary bony procedures are considered necessary. Conservative treatment exclusively is recommended in voluntary cases.