Skip to main content
SpringerLink
Log in

Multidirectional Instability of the Shoulder

  • Chapter
  • First Online:
Book cover Shoulder Arthroscopy

  • 2960 Accesses

Abstract

Multidirectional instability (MDI) represents a wide spectrum of disease, but is defined as symptomatic, involuntary, and uncontrollable subluxation or dislocation of the glenohumeral joint in two or more directions. Instability should be differentiated from laxity, in which no symptoms are present. Due to its inconsistent definition in the literature, it is difficult to reliably determine its actual incidence. MDI likely represents a less common clinical entity than anterior traumatic instability, representing 7–10 % of all instability cases.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 239.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Gaskill TR, Taylor DC, Millett PJ. Management of multidirectional instability of the shoulder. J Am Acad Orthop Surg. 2011;19:758–67.

    PubMed  Google Scholar 

  2. Blomquist J, Solheim E, Liavaag S, Schroder CP, Espehaug B, Havelin LI. Shoulder instability surgery in Norway: the first report from a multicenter register, with 1-year follow-up. Acta Orthop. 2012;83:165–70.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Owens BD, Duffey ML, Nelson BJ, De Berardino TM, Taylor DC, Mountcastle SB. The incidence and characteristics of shoulder instability at the United States Military Academy. Am J Sports Med. 2007;35:1168–73.

    Article  PubMed  Google Scholar 

  4. Neer 2nd CS, Foster CR. Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder. A preliminary report. J Bone Joint Surg. 1980;62A:897–908.

    Google Scholar 

  5. Gartsman GM, Roddey TS, Hammerman SM. Arthroscopic treatment of bidirectional glenohumeral instability: two- to five-year follow-up. J Shoulder Elbow Surg. 2001;10:28–36.

    Article  CAS  PubMed  Google Scholar 

  6. Kim SH, Ha KI, Yoo JC, Noh KC. Kim’s lesion: an incomplete and concealed avulsion of the posteroinferior labrum in posterior or multidirectional posteroinferior instability of the shoulder. Arthroscopy. 2004;20:712–20.

    PubMed  Google Scholar 

  7. Provencher MT, Dewing CB, Bell SJ, McCOrmick F, Solomon DJ, Rooney TB, et al. An analysis of the rotator interval in patients with anterior, posterior, and multidirectional shoulder instability. Arthroscopy. 2008;24:921–9.

    Article  PubMed  Google Scholar 

  8. Bahu MJ, Trentacosta N, Vorys GC, Covey AS, Ahmad CS. Multidirectional instability: evaluation and treatment options. Clin Sports Med. 2008;27:671–89.

    Article  PubMed  Google Scholar 

  9. Schenk TJ, Brems JJ. Multidirectional instability of the shoulder: pathophysiology, diagnosis, and management. J Am Acad Orthop Surg. 1998;6:65–72.

    CAS  PubMed  Google Scholar 

  10. Alpert JM, Verma N, Wysocki R, Yanke AB, Romeo AA. Arthroscopic treatment of multidirectional shoulder instability with minimum 270 degrees labral repair: minimum 2-year follow-up. Arthroscopy. 2008;24:704–11.

    Article  PubMed  Google Scholar 

  11. Rodeo SA, Suzuki K, Yamauchi M, Bhargava M, Warren RF. Analysis of collagen and elastic fibers in shoulder capsule in patients with shoulder instability. Am J Sports Med. 1998;26:634–43.

    CAS  PubMed  Google Scholar 

  12. von Eisenhart-Rothe R, Mayr HO, Hinterwimmer S, Graichen H. Simultaneous 3D assessment of glenohumeral shape, humeral head centering, and scapular positioning in atraumatic shoulder instability: a magnetic resonance–based in vivo analysis. Am J Sports Med. 2010;38:375–82.

    Article  Google Scholar 

  13. Lippitt S, Matsen F. Mechanisms of glenohumeral joint stability. Clin Orthop Relat Res. 1993;291:20–8.

    PubMed  Google Scholar 

  14. Morris AD, Kemp GJ, Frostick SP. Shoulder electromyography in multidirectional instability. J Shoulder Elbow Surg. 2004;13:24–9.

    Article  PubMed  Google Scholar 

  15. Illyés Á, Kiss R. Electromyographic analysis in patients with multidirectional shoulder instability during pull, forward punch, elevation and overhead throw. Knee Surg Sports Traumatol Arthrosc. 2007;15:624–31.

    Article  PubMed  Google Scholar 

  16. Barden JM, Balyk R, Raso VJM, Moreau M, Bagnall K. Dynamic upper limb proprioception in multidirectional shoulder instability. Clin Orthop Relat Res. 2004;420:181–9.

    Article  PubMed  Google Scholar 

  17. Kim SH, Park JC, Park JS, Oh I. Painful Jerk test. A predictor of success in nonoperative treatment of postero-inferior instability of the shoulder. Am J Sports Med. 2004;32:1849–55.

    Article  PubMed  Google Scholar 

  18. Warner JJ, Micheli LJ, Arslanian LE, Kennedy J, Kennedy R. Patterns of flexibility, laxity, and strength in normal shoulders and shoulders with instability and impingement. Am J Sports Med. 1990;18:366–75.

    Article  CAS  PubMed  Google Scholar 

  19. Ogston JB, Ludewig PM. Differences in 3-dimensional shoulder kinematics between persons with multidirectional instability and asymptomatic controls. Am J Sports Med. 2007;35:1361–70.

    Article  PubMed  Google Scholar 

  20. Hewitt M, Getelman MH, Snyder SJ. Arthroscopic management of multidirectional instability: pancapsular plication. Orthop Clin North Am. 2003;34:549–57.

    Article  PubMed  Google Scholar 

  21. Burkhead Jr WZ, Rockwood Jr CA. Treatment of instability of the shoulder with an exercise program. J Bone Joint Surg. 1992;74:890–6.

    PubMed  Google Scholar 

  22. Misamore GW, Sallay PI, Didelot W. A longitudinal study of patients with multidirectional instability of the shoulder with seven- to ten-year follow-up. J Shoulder Elbow Surg. 2005;14:466–70.

    Article  PubMed  Google Scholar 

  23. Baker 3rd CL, Mascarenhas R, Kline AJ, Cnhabra A, Pombo MW, Bradley JP. Arthroscopic treatment of multidirectional shoulder instability in athletes: a retrospective analysis of 2- to 5-year clinical outcomes. Am J Sports Med. 2009;37:1712–20.

    Article  PubMed  Google Scholar 

  24. Choi C, Ogilvie-Harris D. Inferior capsular shift operation for multidirectional instability of the shoulder in players of contact sports. Br J Sports Med. 2002;36:290–4.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Voigt C, Schulz AP, Lill H. Arthroscopic treatment of multidirectional glenohumeral instability in young overhead athletes. Open Orthop J. 2009;3:107–14.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. McIntyre LF, Caspari RB, Savoie 3rd FH. The arthroscopic treatment of multidirectional shoulder instability: two-year results of a multiple suture technique. Arthroscopy. 1997;13:418–25.

    Article  CAS  PubMed  Google Scholar 

  27. Kim SH, Kim HK, Sun JI, Park JS, Oh I. Arthroscopic capsulolabroplasty for posteroinferior multidirectional instability of the shoulder. Am J Sports Med. 2004;32:594–607.

    Article  PubMed  Google Scholar 

  28. Treacy SH, Savoie 3rd FH, Field LD. Arthroscopic treatment of multidirectional instability. J Shoulder Elbow Surg. 1999;8:345–50.

    Article  CAS  PubMed  Google Scholar 

  29. Provencher MT, Mologne TS, Hongo M, Zhao K, Tasto JP, An KN. Arthroscopic versus open rotator interval closure: biomechanical evaluation of stability and motion. Arthroscopy. 2007;23:583–92.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Rush University Medical Center, 1611 W. Harrison Ave, Suite 300, Chicago, 60612, IL, USA

    Anthony A. Romeo MD & Benjamin Bruce MD

Authors
  1. Anthony A. Romeo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Benjamin Bruce MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anthony A. Romeo MD .

Editor information

Editors and Affiliations

  1. Department of Orthopaedics, Catholic University of Rome, Rome, Roma, Italy

    Giuseppe Milano

  2. Department of Orthopaedics and Traumatology, Casa di Cura Villa Valeria, Rome, Roma, Italy

    Andrea Grasso

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

The video illustrates the arthroscopic procedure to address multidirectional instability of the shoulder (MPG 189542 kb)

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag London

About this chapter

Cite this chapter

Romeo, A.A., Bruce, B. (2014). Multidirectional Instability of the Shoulder. In: Milano, G., Grasso, A. (eds) Shoulder Arthroscopy. Springer, London. https://doi.org/10.1007/978-1-4471-5427-3_18

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-5427-3_18

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-5426-6

  • Online ISBN: 978-1-4471-5427-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation