Twenty-four patients who had posterior subluxation of the glenohumeral
joint were assigned to one of two groups on the basis of the severity of
the symptoms. The sixteen patients in Group I, who had less severe
symptoms, were treated with a physical therapy program that was based on
exercises to strengthen muscles. The eleven patients in Group II (three of
whom had no success with physical therapy when they were originally in
Group I) had a posterior capsulorrhaphy, with or without a bone block.
According to an over-all rating, Group I had a rate of success of 63 per
cent, and Group II had a rate of success of 91 per cent. The patients who
had more severe ligamentous laxity were not more likely to fail either of
the treatment programs. Although voluntary subluxation may be a subtle but
important indicator of underlying emotional difficulties, it appears that,
in the patient who is emotionally stable, the ability to voluntarily
subluxate the shoulder posteriorly is not associated with a negative
prognosis for either non-surgical or surgical treatment. Patients who have
moderately disabling posterior subluxation of the shoulder should be
treated with an intensive program that is designed to strengthen muscles.
Patients who have symptoms that are severely disabling or who have had no
success with non-operative treatment should be treated with posterior
capsulorrhaphy. When the posterior aspect of the glenoid is severely
deficient and when the posterior portion of the capsule or the
infraspinatus tendon is attenuated, a bone block should augment the
reconstruction.