Chronic posterior shoulder dislocation: Current evidence, treatment options, and a decision-making algorithm

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Radiology

Background:

• Chronic posterior shoulder dislocation (CPSD) is an infrequent but often overlooked injury, comprising 2-5% of all shoulder dislocations.
• Commonly resulting from trauma, seizures, or electrical shock, CPSD can lead to reverse Hill-Sachs lesions (rHSL), posterior glenoid erosion, and soft-tissue contractures.
• Delayed diagnosis, occurring in 50-79% of cases, transforms acute injuries into chronic conditions, increasing risks of instability, osteoarthritis, and functional impairment.

Purpose of the Study:

• To synthesize current evidence on the etiology, diagnosis, imaging, treatment, and outcomes of CPSD.
• To propose a surgical decision-making algorithm for managing CPSD.

Main Methods:

• A comprehensive literature search was conducted for peer-reviewed articles published between 2006 and 2026.
• Inclusion criteria focused on adult patients with chronic PSD, examining interventions, clinical outcomes, and rehabilitation.
• Narrative synthesis was employed to analyze the collected data.

Main Results:

• The primary etiology of CPSD is traumatic, with pathoanatomy frequently involving reverse Hill-Sachs lesions (rHSL) and posterior capsulolabral damage.
• Diagnosis utilizes axillary radiographs, CT scans for bony defects, and MRI for soft-tissue assessment.
• Treatment strategies are individualized based on dislocation duration, rHSL size, glenoid integrity, and patient-specific factors, integrated into a stepwise algorithm.

Conclusions:

• High clinical suspicion and advanced imaging are crucial for the timely diagnosis of CPSD.
• Joint-preserving reconstructions offer superior outcomes for moderate defects with early intervention; arthroplasty is indicated for extensive damage.
• The proposed algorithm offers structured guidance, although further multicenter RCTs and standardized classifications are needed due to study heterogeneity and the condition's rarity.