Posterior Capsule

Modern Study Review (AI-Generated)

High-Yield Summary

The posterior capsule of the shoulder plays a critical role in glenohumeral stability, particularly in preventing posterior instability and maintaining normal shoulder kinematics. Surgical repair of the posterior capsule is indicated in cases of symptomatic posterior instability or capsular laxity refractory to conservative management. Modern techniques emphasize precise anatomic dissection and capsular plication to restore stability while preserving surrounding musculature and minimizing morbidity.

Key Diagnostic Findings

Anatomy

• Posterior Capsule: Thin fibrous structure reinforcing the posterior glenohumeral joint.
• Surrounding Structures: Infraspinatus tendon lies superficial to the capsule; teres minor is adjacent but typically not separated during surgery.
• Landmarks: Posterior glenoid rim, labrum, and posterior deltoid fascia.

Clinical Presentation

• Posterior shoulder pain, often with a history of trauma or repetitive microtrauma.
• Sensation of instability or subluxation, especially with forward flexion and internal rotation.
• Positive posterior drawer or jerk tests on physical exam.

Imaging

• MRI: Best for assessing capsular integrity, labral tears (posterior Bankart lesions), and muscle/tendon pathology.
• CT Arthrogram: Useful for detailed evaluation of posterior labral and capsular lesions.
• X-rays: May show subtle posterior subluxation or glenoid bone loss.

Classification Systems

• No widely adopted formal classification system specific to posterior capsule tears; posterior instability is often classified clinically as:
• Traumatic vs. atraumatic
• Voluntary vs. involuntary instability
• Structural vs. functional instability

Current Gold Standard Treatment

Non-operative

• Indications: First-line for atraumatic or mild posterior instability without significant structural damage.
• Treatment: Physical therapy focusing on scapular stabilization, posterior rotator cuff strengthening, and proprioceptive training.
• Outcomes: Good in compliant patients; failure leads to surgical consideration.

Operative

• Indications:
• Persistent symptomatic posterior instability despite conservative care.
• Structural lesions such as posterior labral tears or capsular laxity.
• Traumatic posterior dislocations with capsular insufficiency.
• Surgical Technique:
• Patient positioned lateral decubitus or beach chair.
• Posterior approach with vertical incision over posterior shoulder.
• Careful dissection through deltoid fascia and infraspinatus tendon interval to expose the thin posterior capsule.
• Capsular incision and inspection for labral pathology (posterior Bankart lesion).
• Capsular plication (reefing) to tighten the capsule, typically on the inferior limb to restore tension.
• Preservation of infraspinatus and teres minor integrity emphasized.
• Modern Advances: Arthroscopic posterior capsular repair and labral repair are increasingly preferred for less morbidity and faster recovery.

Modern Complications & Outcomes

Complications

Outcomes

• Surgical repair generally yields good to excellent outcomes in restoring stability and function.
• Arthroscopic techniques show comparable results to open repair with less morbidity.
• Rehabilitation focusing on gradual range of motion and strengthening is critical for success.
• Long-term outcomes depend on patient selection, surgical technique, and adherence to rehab protocols.

Classic Clinical Notes

Posterior Capsule

Surgical Technique
Posterior Capsular Repair – Dr. Hawkins

Positioning:

• Lateral decubitus on the beanbag.

Prepping and Draping:

• Shave the area.
• 10×10 steri-drape across the neck.
• Mark off the tip of the acromion.
• Incision is vertically down from the posterior tip to the axillary fold.

Approach:

• Vertical skin incision.
• Cautery through the dermis.
• Mets through the subcutaneous tissue to reach the deltoid fascia.
• Undermine the subcutaneous tissue to expose the fascia (do not go through it).
• Incise the deltoid fascia and split the fibers.
• Palpate the posterior glenoid to guide dissection.
• Use mets to split fibers until reaching fascia overlying the infraspinatus tendon.
• Insert Galpis.
• Undermine deltoid to visualize infraspinatus tendon.
• Do not separate infraspinatus from teres minor.
• Use cautery to go through the tendon; use Howarth to develop interval between tendon and capsule.
• Start superiorly; dissect horizontally along superior border of tendon and vertically through tendon to expose capsule.
• Capsule is thin and easy to perforate.
• Incise capsule horizontally, then vertically along labral edge.
• Look for Bankart equivalent (rare).
• Plicate capsule by reefing up on the inferior limb.

Last Updated on January 25, 2026 by orthonet