Inestabilidad posterior de hombro secundario a avulsión humeral del haz posterior del ligamento glenohumeral inferior – Revisión sistemática de alcance
Thesis
Introduction: Reverse humeral avulsion of glenohumeral ligament injuries represent a rare cause of posterior instability in the literature. Objective: To offer a clinical context on the mechanism of trauma, frequent clinical and imaging findings and treatments described for the management of this type of pathology. Methods: A systematic scope riview was carried out in the main databases (Cochrane, Science Direct, Lilacs Bireme, Ovid, Pubmed). Identifying 161 studies, 13 met criteria. 74 cases were included in the study. Results: 6.8% of shoulder instabilities are posterior, 0.9% due to RHAGL. Young patients, athletes between 20-30 years old are associated with these injuries. Axial trauma, in 90° flexion, adduction and internal rotation was the most frequent mechanism of injury. 71% are complete. 93% are associated with other intra-articular injuries. Symptoms are nonspecific. Posterior shoulder pain was the most frequent symptom. Instability tests are not very sensitive (77%). Resonance has a 50% sensitivity. Most are diagnosed by arthroscopy. Conservative treatment is indicated in patients with low demand, partial or isolated lesions (<33%). Open or arthroscopic surgical management in athlete patients, high demand, persistent pain or instability. Most report significant improvement in functional scales, achieving to return to their previous work or sports activities in 2-year follow-ups without pain. Conclusion: RHAGL is currently underdiagnosed, its identification is complex and several factors are attributed; clinical inexperience, high relationship with other intra-articular pathologies with non-specific symptoms, being cause of disability due to chronic posterior instability.
