30-Second Snapshot
- Definition: Reverse-Bankart injury of the posterior glenoid labrum → pain ± posterior/combined shoulder instability.
- Epidemiology: 2-12 % of all shoulder-instability cases; rising in young overhead & contact athletes.
- Classic mechanism: Repetitive posterior load with arm flexed + adducted + IR (bench press, football blocking).
- Primary stabilisers under fire: Posterior labrum, capsule & PIGHL; dynamic help = subscapularis + rotator cuff.
- 1st-line care: Activity change + NSAIDs + PT (rotator cuff/scapular).
- Failing PT / large bone loss: Arthroscopic anchor repair ± capsular plication; address bone when > ≈ 25 %.
- Return-to-play: 4-6 mo (contact ≥ 5 mo); throwers need graduated toss program.
Anatomy Cliff-Notes
Structure | Key role in posterior stability |
Labrum | Deepens socket 50 %; anchor for PIGHL |
PIGHL | Checks posterior / inferior translation in flexed-IR positions |
Posterior capsule | Envelops humeral head; laxity → micro-subluxation |
Subscapularis | Power dynamic restraint (concavity–compression) |
Aetiology & Risk
Category | Typical scenario |
Micro-trauma (most) | Bench press, swimming, volleyball, football line play |
Acute trauma | Posterior dislocation after seizure, MVC, electric shock |
Atraumatic laxity | Ehlers-Danlos, Marfan, generalized hypermobility |
Anatomic | Glenoid retroversion > 10-15°, glenoid hypoplasia, reverse Hill-Sachs |
Red-Flag Symptoms & Tests
Feature | Details |
Pain | Deep posterior ache, ↑ with push-ups / heavy doors |
Mechanical | Click / pop / grind with motion |
Instability | Sense of “slip” when shoulder loaded behind body |
Jerk test | 90° ABD + IR, axial load → adduct; clunk = sublux/relocate |
Kim test | 90° ABD, 45° FF, post-infer load → pain = posteroinferior tear |
Skin dimple sign | Concavity over posteromedial deltoid (62 % sens / 92 % spec) |
Imaging Pearls
Modality | What it shows |
X-ray (Axillary!) | Confirms reduction, retroversion, reverse Hill-Sachs |
MRI-A (gold) | Labrum, capsular pouch, Kim lesions, HAGL |
CT ± 3-D | Quantify glenoid bone loss / version; HH defect size |
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Management Algorithm
Step 1 – Non-operative (≥ 4-6 mo)
- Relative rest & technique correction
- NSAIDs / ice
- PT blocks
- Rotator-cuff / scapular endurance
- Posterior capsule stretches avoided early
- Closed-chain & proprioception drills
Good–excellent outcome: ≈ 80 % atraumatic vs < 20 % traumatic.
Step 2 – Operative Indications
- Persistent pain / instability after structured rehab
- High-demand athlete needing full stability
- Bony deficit: glenoid > 20-25 % or HH > 25 % engagement
- Locked or recurrent posterior dislocation
Preferred technique:
- Arthroscopic labral repair + capsular plication (anchors 5-7 mm from rim; tie knots capsular-to-labrum).
- Address bone: iliac-crest / distal-tibia bone block for glenoid; modified McLaughlin or allograft for HH.
Recurrence: 8 % arthro vs 19 % open; risk ↑ with age < 40, seizures, large defects.
Post-op Milestones
Phase | Key goals / limits |
0-2 wk | Sling 24/7 (30° ABD, neutral rot) • pendulums, wrist/elbow ROM |
2-6 wk | PROM → 90° FF / 45° ER; NO IR past neutral; scapular sets |
6-8 wk | Discard sling; AROM, light Theraband ER; IR capped 45° |
8-12 wk | Full ROM (IR freed @ 12 wk) • isotonic RC, UBE, wall push-ups |
12-16 wk | Plyo & eccentric drills • Thrower’s-10; light toss @ 14 wk |
≥ 20 wk | Interval throwing / contact drills once isokinetics pass |
Prognosis
Metric | Data |
Arthro success | ≈ 90 % good/excellent |
Return-to-sport | 70-90 % non-throwers • 55-70 % throwers |
Main failure | Recurrent instability, stiffness if over-tightened |
Call to Action
If you have pain, book an appointment to be reviewed by Prof Imam or another member of our specialist team at The Arm Clinic. Early specialist care helps prevent long-term issues. Visit www.TheArmDoc.co.uk or book your consultation today. Phone: 020 3384 5588 | Email: Info@TheArmDoc.co.uk
Disclaimer
This information is for general educational purposes and should not be used as a substitute for professional medical advice. Consult a healthcare professional for individual guidance on your condition and treatment options.
This page was last clinically updated in May 2025