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Management of Multidirectional Instability of the Shoulder

Gaskill, Trevor R. MD; Taylor, COL (Ret) Dean C. MD; Millett, Peter J. MD, MSc

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: December 2011 - Volume 19 - Issue 12 - p 758–767
Review Article

Multidirectional shoulder instability is defined as symptomatic instability in two or more directions. Instability occurs when static and dynamic shoulder stabilizers become incompetent due to congenital or acquired means. Nonspecific activity-related pain and decreased athletic performance are common presenting complaints. Clinical suspicion for instability is essential for timely diagnosis. Several examination techniques can be used to identify increased glenohumeral translation. It is critical to distinguish increased laxity from instability. Initial management begins with therapeutic rehabilitation. If surgical management is required, capsular plication has been used successfully. Advanced arthroscopic techniques offer several advantages over traditional open approaches and may have similar outcomes. The role of rotator interval capsular plication is controversial, but it may be used to augment capsular plication in patients with specific patterns of instability. Despite encouraging results, outcomes remain inferior to those associated with traumatic unidirectional instability.

From The Steadman Clinic (Dr. Gaskill), the Steadman Philippon Research Institute (Dr. Millett), Vail, CO, and Duke Orthopaedics, Duke University Medical Center, Durham, NC (Dr. Taylor).

Dr. Taylor or an immediate family member serves as a board member, owner, officer, or committee member of the American Orthopaedic Society for Sports Medicine and the Magellan Society and has received research or institutional support from Histogenics. Dr. Millett or an immediate family member has received royalties from and serves as a paid consultant to or is an employee of Arthrex; has stock or stock options held in Game Ready and VuMedi; and has received research or institutional support from Arthrex, OrthoRehab, Össur Americas, Siemens Medical Solutions, Smith & Nephew, and ConMed Linvatec. Neither Dr. Gaskill nor any immediate family member has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article.

© 2011 by American Academy of Orthopaedic Surgeons
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