Multidirectional instability of the shoulder: biomechanics, clinical presentation, and treatment strategies

  • Giovanni MerollaEmail author
  • Simone Cerciello
  • Claudio Chillemi
  • Paolo Paladini
  • Elisa De Santis
  • Giuseppe Porcellini


Multidirectional instability (MDI) of the shoulder is a condition where the dislocation occurs in more than one direction with minimal or no causative trauma. Its pathoanatomy is complex and characterized by a redundant capsule, resulting in increased glenohumeral joint volume. The fact that several further factors may contribute to symptom onset complicates the diagnosis and hampers the identification of a therapeutic approach suitable for all cases. There is general agreement that the initial treatment should be conservative and that surgery should be reserved for patients who have not responded to an ad hoc rehabilitation program. We review the biomechanics, clinical presentation, and treatment strategies of shoulder MDI.


Shoulder Multidirectional instability Pathomechanics Arthroscopy Open surgery 



The authors are grateful to Word Designs ( for the language revision.

Conflict of interest

None of the authors have any conflicts of interest to disclose.


  1. 1.
    Neer CS II, Foster CR (1980) Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder. A preliminary report. J Bone Joint Surg Am 62:897–908PubMedGoogle Scholar
  2. 2.
    Altchek DW, Warren RF, Skyhar MJ, Ortiz G (1991) T-plasty modification of the Bankart procedure for multidirectional instability of the anterior and inferior types. J Bone Joint Surg Am 73:105–112PubMedGoogle Scholar
  3. 3.
    Flatow EL, Miniaci A, Evans PJ, Simonian PT, Warren RF (1998) Instability of the shoulder: complex problems and failed repairs: part II. Failed repairs. Instr Course Lect 47:113–125PubMedGoogle Scholar
  4. 4.
    Neer CS II (1985) Involuntary inferior and multidirectional instability of the shoulder: etiology, recognition, and treatment. Instr Course Lect 34:232–238PubMedGoogle Scholar
  5. 5.
    Pollock RG, Owens JM, Flatow EL, Bigliani LU (2000) Operative results of the inferior capsular shift procedure for multidirectional instability of the shoulder. J Bone Joint Surg Am 82:919–928PubMedGoogle Scholar
  6. 6.
    Matsen FA III, Thomas SC, Rockwood CA Jr, Wirth MA (2005) Glenohumeral instability. In: Rockwood CA Jr, Matsen FA III (eds) The shoulder, vol 1. Saunders, Philadelphia, pp 611–754Google Scholar
  7. 7.
    Gerber C, Nyffeler RW (2002) Classification of glenohumeral joint instability. Clin Orthop Relat Res 400:65–76PubMedCrossRefGoogle Scholar
  8. 8.
    Cofield RH, Irving JF (1987) Evaluation and classification of shoulder instability. With special reference to examination under anesthesia. Clin Orthop Relat Res 223:32–43PubMedGoogle Scholar
  9. 9.
    Johnson SM, Robinson CM (2010) Shoulder instability in patients with joint hyperlaxity. J Bone Joint Surg Am 92:1545–1557PubMedCrossRefGoogle Scholar
  10. 10.
    Rodeo SA, Suzuki K, Yamauchi M, Bhargava M, Warren RF (1998) Analysis of collagen and elastic fibers in shoulder capsule in patients with shoulder instability. Am J Sports Med 26:634–643PubMedGoogle Scholar
  11. 11.
    Merolla G, De Santis E, Cools AMJ, Porcellini G (2014) Functional outcomes and quality of life after rehabilitation for voluntary posterior shoulder instability: a prospective blinded cohort study. Eur J Orthop Surg Traumatol June 3 [Epub ahead of print]Google Scholar
  12. 12.
    Bankart A (1938) The pathology and treatment of recurrent dislocation of the shoulder joint. Br J Surg 26:23CrossRefGoogle Scholar
  13. 13.
    Burkhead WZ, Rockwood CA Jr (1992) Treatment of instability of the shoulder with an exercise program. J Bone Joint Surg Am 74:890–896PubMedGoogle Scholar
  14. 14.
    Tibone JE, Bradley JP (1993) The treatment of posterior subluxation in athletes. Clin Orthop 291:124–137PubMedGoogle Scholar
  15. 15.
    Rowe CR, Pierce DS, Clark JG (1973) Voluntary dislocation of the shoulder. A preliminary report on a clinical, electromyographic, and psychiatric study of twenty-six patients. J Bone Joint Surg Am 55:445–460PubMedGoogle Scholar
  16. 16.
    Cooper RA, Brems JJ (1992) The inferior capsular-shift procedure for multidirectional instability of the shoulder. J Bone Joint Surg Am 74:1516–1521PubMedGoogle Scholar
  17. 17.
    Dewing CB, McCormick F, Bell SJ, Solomon DJ, Stanley M, Rooney TB, Provencher MT (2008) An analysis of capsular area in patients with anterior, posterior, and multidirectional shoulder instability. Am J Sports Med 36:515–522PubMedCrossRefGoogle Scholar
  18. 18.
    Ahmad CS, Freehill MQ, Blaine TA, Levine WN, Bigliani LU (2003) Anteromedial capsular redundancy and labral deficiency in shoulder instability. Am J Sports Med 31:247–252PubMedGoogle Scholar
  19. 19.
    Uhthoff HK, Piscopo M (1985) Anterior capsular redundancy of the shoulder: congenital or traumatic? An embryological study. J Bone Joint Surg Br 67:363–366PubMedGoogle Scholar
  20. 20.
    Oyama S, Myers JB, Wassinger CA, Ricci RD, Lephart SM (2008) Asymmetric resting scapular posture in healthy overhead athletes. J Athl Train 43:565–570PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Ludewig PM, Phadke V, Braman JP, Hassett DR, Cieminski CJ, LaPrade RF (2009) Motion of the shoulder complex during multiplanar humeral elevation. J Bone Joint Surg 91:378–389PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Freedman L, Munro RR (1966) Abduction of the arm in the scapular plane: scapular and glenohumeral movements: a roentgenographic study. J Bone Joint Surg 48:1503–1510PubMedGoogle Scholar
  23. 23.
    Itoi E, Motzkin NE, Morrey BF, An KN (1992) Scapular inclination and inferior stability of the shoulder. J Shoulder Elbow Surg 1:131–139PubMedCrossRefGoogle Scholar
  24. 24.
    Warner JJ, Deng XH, Warren RF, Torzilli PA (1992) Static capsuloligamentous restraints to superior-inferior translation of the glenohumeral joint. Am J Sports Med 20:675–685PubMedCrossRefGoogle Scholar
  25. 25.
    Illyés A, Kiss RM (2006) Kinematic and muscle activity characteristics of multidirectional shoulder joint instability during elevation. Knee Surg Sports Traumatol Arthrosc 14:673–685PubMedCrossRefGoogle Scholar
  26. 26.
    Struyf F, Nijs J, Baeyens JP, Mottram S, Meeusen R (2011) Scapular positioning and movement in unimpaired shoulders, shoulder impingement syndrome, and glenohumeral instability. Scand J Med Sci Sports 21:352–358PubMedCrossRefGoogle Scholar
  27. 27.
    Morris AD, Kemp GJ, Frostick SP (2004) Shoulder electromyography in multidirectional instability. J Shoulder Elbow Surg 13:24–29PubMedCrossRefGoogle Scholar
  28. 28.
    Barden JM, Balyk R, Raso VJ, Moreau M, Bagnall K (2005) Atypical shoulder muscle activation in multidirectional instability. Clin Neurophysiol 116:1846–1857PubMedCrossRefGoogle Scholar
  29. 29.
    Augé WK 2nd, Morrison DS (2000) Assessment of the infraspinatus spinal stretch reflex in the normal, athletic, and multidirectionally unstable shoulder. Am J Sports Med 28:206–213PubMedGoogle Scholar
  30. 30.
    Abboud JA, Soslowsky LJ (2002) Interplay of the static and dynamic restraints in glenohumeral instability. Clin Orthop Relat Res 400:48–57PubMedCrossRefGoogle Scholar
  31. 31.
    Lee SB, Kim KJ, O’Driscoll SW, Morrey BF, An KN (2000) Dynamic glenohumeral stability provided by the rotator cuff muscles in the mid-range and end-range of motion. A study in cadavera. J Bone Joint Surg Am 82:849–857PubMedGoogle Scholar
  32. 32.
    Lippit SB, Vanderhooft JE, Harris SL, Sidles J, Harryman DT, Mattsen F (1993) Glenohumeral stability from concavity compression: a quantitative analysis. J Shoulder Elbow Surg 2:27–35CrossRefGoogle Scholar
  33. 33.
    Halder AM, Kuhl SG, Zobitz ME, Larson D, An KN (2001) Effects of the glenoid labrum and glenohumeral abduction on stability of the shoulder joint through concavity-compression: an in vitro study. J Bone Joint Surg Am 83:1062–1069PubMedGoogle Scholar
  34. 34.
    Schiffern SC, Rozencwaig R, Antoniou J, Richardson ML, Matsen FA 3rd (2002) Anteroposterior centering of the humeral head on the glenoid in vivo. Am J Sports Med 30:382–387PubMedGoogle Scholar
  35. 35.
    Barden JM, Balyk R, Raso VJ, Moreau M, Bagnall K (2004) Dynamic upper limb proprioception in multidirectional shoulder instability. Clin Orthop Relat Res 420:181–189PubMedCrossRefGoogle Scholar
  36. 36.
    Beard DJ, Dodd CAF, Simpson HARW (2000) Sensorimotor changes after anterior cruciate ligament reconstruction. Clin Orthop 372:205–216PubMedCrossRefGoogle Scholar
  37. 37.
    Jerosch J, Prymka M (1996) Proprioception and joint stability. Knee Surg Sports Traumatol Arthrosc 4:171–179PubMedCrossRefGoogle Scholar
  38. 38.
    Gaskill TR, Taylor DC, Millett PJ (2011) Management of multidirectional instability of the shoulder. J Am Acad Orthop Surg 19:758–767PubMedGoogle Scholar
  39. 39.
    Grahame R, Bird HA, Child A (2000) The revised (Brighton 1998) criteria for the diagnosis of benign joint hypermobility syndrome (BJHS). J Rheumatol 27:1777–1779PubMedGoogle Scholar
  40. 40.
    Rowe CR, Zarins B (1981) Recurrent transient subluxation of the shoulder. J Bone Joint Surg Am 63:863–872PubMedGoogle Scholar
  41. 41.
    Arendt EA (1988) Multidirectional shoulder instability. Orthopedics 11:113–120PubMedGoogle Scholar
  42. 42.
    Jerosch J, Castro WH (1990) Shoulder instability in Ehlers–Danlos syndrome: an indication for surgical treatment? Acta Orthop Belg 56:451–453PubMedGoogle Scholar
  43. 43.
    Jobe FW, Kvitne RS, Giangarra CE (1989) Shoulder pain in the overhand or throwing athlete: the relationship of anterior instability and rotator cuff impingement. Orthop Rev 18:963–975PubMedGoogle Scholar
  44. 44.
    Silliman JF, Hawkins RJ (1993) Classification and physical diagnosis of instability of the shoulder. Clin Orthop Relat Res 291:7–19PubMedGoogle Scholar
  45. 45.
    Gerber C, Ganz R (1984) Clinical assessment of instability of the shoulder: with special reference to anterior and posterior drawer tests. J Bone Joint Surg Br 66:551–556PubMedGoogle Scholar
  46. 46.
    Pollock RG, Bigliani LU (1993) Recurrent posterior shoulder instability: diagnosis and treatment. Clin Orthop Relat Res 291:85–96PubMedGoogle Scholar
  47. 47.
    Gagey OJ, Gagey N (2001) The hyperbaduction test. J Bone Joint Surg Br 83:69–74PubMedCrossRefGoogle Scholar
  48. 48.
    Schaeffeler C, Waldt S, Bauer JS, Kirchhoff C, Haller B, Schröder M, Rummeny EJ, Imhoff AB, Woertler K (2014) MR arthrography including abduction and external rotation images in the assessment of atraumatic multidirectional instability of the shoulder. Eur Radiol 24:1376–1385PubMedCrossRefGoogle Scholar
  49. 49.
    Provencher MT, Dewing CB, Bell SJ, McCormick F, Solomon DJ, Rooney TB (2008) Stanley M (2008) An analysis of the rotator interval in patients with anterior, posterior, and multidirectional shoulder instability. Arthroscopy 24:921–929PubMedCrossRefGoogle Scholar
  50. 50.
    von Eisenhart-Rothe R, Mayr HO, Hinterwimmer S, Graichen H (2010) 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 38:375–382CrossRefGoogle Scholar
  51. 51.
    Matsen FA, Thomas SC, Rockwood CA (1990) Glenohumeral instability. In: Rockwood CA, Matsen FA (eds) The shoulder, vol 1. Saunders, Philadelphia, pp 526–569Google Scholar
  52. 52.
    Guerrero P, Busconi B, Deangelis N, Powers G (2009) Congenital instability of the shoulder joint: assessment and treatment options. J Orthop Sports Phys Ther 39:124–134PubMedCrossRefGoogle Scholar
  53. 53.
    Mallon WJ, Speer KP (1995) Multidirectional instability: current concepts. J Shoulder Elbow Surg 4:54–64PubMedCrossRefGoogle Scholar
  54. 54.
    Magarey ME, Jones MA (2003) Dynamic evaluation and early management of altered motor control around the shoulder complex. Man Ther 8:195–206PubMedCrossRefGoogle Scholar
  55. 55.
    Rowe CR (1956) Prognosis in dislocations of the shoulder. J Bone Joint Surg Am 38:957–977PubMedGoogle Scholar
  56. 56.
    Misamore GW, Sallay PI, Didelot W (2005) A longitudinal study of patients with multidirectional instability of the shoulder with seven- to ten-year follow-up. J Shoulder Elbow Surg 14:466–470PubMedCrossRefGoogle Scholar
  57. 57.
    Darlow B (2006) Neuromuscular retraining for multidirectional instability of the shoulder—a case study. NZ J Physioth 34:60–65Google Scholar
  58. 58.
    Ide J, Maeda S, Yamaga M, Morisawa K, Takagi K (2003) Shoulder-strengthening exercise with an orthosis for multidirectional shoulder instability: quantitative evaluation of rotational shoulder strength before and after the exercise program. J Shoulder Elbow Surg 12:342–345PubMedCrossRefGoogle Scholar
  59. 59.
    Kiss J, Damrel D, Mackie A, Neumann L, Wallace WA (2001) Non-operative treatment of multidirectional shoulder instability. Int Orthop 24:354–357PubMedCentralPubMedCrossRefGoogle Scholar
  60. 60.
    Nyiri P, Illyés A, Kiss R, Kiss J (2010) Intermediate biomechanical analysis of the effect of physiotherapy only compared with capsular shift and physiotherapy in multidirectional shoulder instability. J Shoulder Elbow Surg 19:802–813PubMedCrossRefGoogle Scholar
  61. 61.
    Rowe CR, Patel D, Slouthmayd WW (1978) The Bankart procedure: a long-term end-result study. J Bone Joint Surg Am 60A:1–16Google Scholar
  62. 62.
    Scheibel M, Habermeyer P (2008) Subscapularis dysfunction following anterior surgical approach to the shoulder. J Shoulder Elbow Surg 17:671–683PubMedCrossRefGoogle Scholar
  63. 63.
    Jobe FW, Giangarra CE, Kvitne RS, Glousman RE (1991) Anterior capsulolabral reconstruction of the shoulder in overhead sports. Am J Sports Med 19:428–434PubMedCrossRefGoogle Scholar
  64. 64.
    Field LD, Warren RF, O’Brien SJ, Altchek DW, Wickiewicz TL (1995) Isolated closure of rotator interval defects for shoulder instability. Am J Sports Med 23:557–563PubMedCrossRefGoogle Scholar
  65. 65.
    Snyder SJ (2003) Shoulder arthroscopy. Lippincott Williams and Wilkins, New York, pp 22–28Google Scholar
  66. 66.
    Matthews LS, Zarins B, Michael RH, Helfet DL (1985) Anterior portal selection for shoulder arthroscopy. Arthroscopy 1:33–39PubMedCrossRefGoogle Scholar
  67. 67.
    Wolf EM (1989) Anterior portals in shoulder arthroscopy. Arthroscopy 5:201–208PubMedCrossRefGoogle Scholar
  68. 68.
    Cicak N, Klobucar H, Bicanic G, Trsek D (2005) Arthroscopic extracapsular plication to treat multidirectional instability of the shoulder. Arthroscopy 21:1278PubMedCrossRefGoogle Scholar
  69. 69.
    Wiley WB, Goradia VK, Pearson SE (2005) Arthroscopic capsular plication-shift. Arthroscopy 21:119–121PubMedCrossRefGoogle Scholar
  70. 70.
    McIntyre LF, Caspari RB, Savoie FH III (1997) The arthroscopic treatment of multidirectional shoulder instability: two-year results of a multiple suture technique. Arthroscopy 13:418–425PubMedCrossRefGoogle Scholar
  71. 71.
    Gartsman GM, Roddey TS, Hammerman SM (2001) Arthroscopic treatment of bidirectional glenohumeral instability: two- to five-year follow-up. J Shoulder Elbow Surg 10:28–36PubMedCrossRefGoogle Scholar
  72. 72.
    Sekiya JK (2005) Arthroscopic labral repair and capsular shift of the glenohumeral joint: technical pearls for a multiple pleated plication through a single working portal. Arthroscopy 21:766PubMedGoogle Scholar
  73. 73.
    Karas SG, Creighton RA, DeMorat GJ (2004) Glenohumeral volume reduction in arthroscopic shoulder reconstruction: a cadaveric analysis of suture plication and thermal capsulorrhaphy. Arthroscopy 20:179–184PubMedCrossRefGoogle Scholar
  74. 74.
    Cohen SB, Wiley W, Goradia VK, Pearson S, Miller MD (2005) Anterior capsulorrhaphy: an in vitro comparison of volume reduction—arthroscopic plication versus open capsular shift. Arthroscopy 21:659–664PubMedCrossRefGoogle Scholar
  75. 75.
    Flanigan DC, Forsythe T, Orwin J, Kaplan L (2006) Volume analysis of arthroscopic capsular shift. Arthroscopy 22:528–533PubMedCrossRefGoogle Scholar
  76. 76.
    Wilk KE, Macrina LC (2013) Nonoperative and postoperative rehabilitation for glenohumeral instability. Clin Sports Med 32:865–914PubMedCrossRefGoogle Scholar
  77. 77.
    Arciero RA, Wheeler JH, Ryan JB, McBride JT (1994) Arthroscopic Bankart repair versus nonoperative treatment for acute, initial anterior shoulder dislocations. Am J Sports Med 22:589–594PubMedCrossRefGoogle Scholar
  78. 78.
    Yin B, Levy D, Meadows M, Moen T, Gorroochurn P, Cadet ER, Levine WN, Ahmad CS (2014) How does external rotation bracing influence motion and functional scores after arthroscopic shoulder stabilization? Clin Orthop Relat Res 472:2389–2396PubMedCrossRefGoogle Scholar
  79. 79.
    Bigliani LU, Pollock RG, McIlveen SJ, Endrizzi DP, Flatow EL (1995) Shift of the posteroinferior aspect of the capsule for recurrent posterior glenohumeral instability. J Bone Joint Surg Am 77:1011–1020PubMedGoogle Scholar
  80. 80.
    van Tankeren E, de Waal Malefijt MC, van Loon CJ (2002) Open capsular shift for multi directional shoulder instability. Arch Orthop Trauma Surg 122:447–450PubMedGoogle Scholar
  81. 81.
    Fleega BA, El Shewy MT (2012) Arthroscopic inferior capsular shift: long-term follow-up. Am J Sports Med 40:1126–1132PubMedCrossRefGoogle Scholar
  82. 82.
    Voigt C, Schulz AP, Lill H (2009) Arthroscopic treatment of multidirectional glenohumeral instability in young overhead athletes. Open Orthop J 24(3):107–114Google Scholar
  83. 83.
    Baker CL 3rd, Mascarenhas R, Kline AJ, Chhabra A, Pombo MW, Bradley JP (2009) Arthroscopic treatment of multidirectional shoulder instability in athletes: a retrospective analysis of 2- to 5-year clinical outcomes. Am J Sports Med 37:1712–1720PubMedCrossRefGoogle Scholar
  84. 84.
    Lubiatowski P, Ogrodowicz P, Wojtaszek M, Breborowicz M, Długosz J, Romanowski L (2012) Arthroscopic capsular shift technique and volume reduction. Eur J Orthop Surg Traumatol 22:437–441PubMedCentralPubMedCrossRefGoogle Scholar
  85. 85.
    Ma HL, Huang HK, Chiang ER, Wang ST, Hung SC, Liu CL (2012) Arthroscopic pancapsular plication for multidirectional shoulder instability in overhead athletes. Orthopedics 35:e497–e502PubMedCrossRefGoogle Scholar
  86. 86.
    Moon YL, Singh H, Yang H, Chul LK (2011) Arthroscopic rotator interval closure by purse string suture for symptomatic inferior shoulder instability. Orthopedics 34(4):11Google Scholar
  87. 87.
    Bak K, Spring BJ, Henderson JP (2000) Inferior capsular shift procedure in athletes with multidirectional instability based on isolated capsular and ligamentous redundancy. Am J Sports Med 28:466–471PubMedGoogle Scholar
  88. 88.
    Choi CH, Ogilvie-Harris DJ (2002) Inferior capsular shift operation for multidirectional instability of the shoulder in players of contact sports. Br J Sports Med 36:290–294PubMedCentralPubMedCrossRefGoogle Scholar
  89. 89.
    Marquardt B, Pötzl W, Witt KA, Steinbeck J (2005) A modified capsular shift for atraumatic anterior-inferior shoulder instability. Am J Sports Med 33:1011–1015PubMedCrossRefGoogle Scholar
  90. 90.
    Steinbeck J, Jerosch J (1997) Surgery for atraumatic anterior-inferior shoulder instability. A modified capsular shift evaluated in 20 patients followed for 3 years. Acta Orthop Scand 68:447–450PubMedCrossRefGoogle Scholar
  91. 91.
    Jacobson ME, Riggenbach M, Wooldridge AN, Bishop JY (2012) Open capsular shift and arthroscopic capsular plication for treatment of multidirectional instability. Arthroscopy 28:1010–1017PubMedCrossRefGoogle Scholar
  92. 92.
    Oron A, Reshef N, Beer Y, Brosh T, Agar G (2012) The influence of radiofrequency ablation patterns on length, histological and mechanical properties of tendons. Muscles Ligaments Tendons J 10(2):85–90Google Scholar
  93. 93.
    D’Alessandro DF, Bradley JP, Fleischli JE, Connor PM (2004) Prospective evaluation of thermal capsulorrhaphy for shoulder instability: indications and results, two- to five-year follow-up. Am J Sports Med 32:21–33PubMedCrossRefGoogle Scholar
  94. 94.
    Favorito PJ, Langenderfer MA, Colosimo AJ, Heidt RS Jr, Carlonas RL (2002) Arthroscopic laser-assisted capsular shift in the treatment of patients with multidirectional shoulder instability. Am J Sports Med 30:322–328PubMedGoogle Scholar
  95. 95.
    Mohtadi NG, Kirkley A, Hollinshead RM, McCormack R, MacDonald PB, Chan DS, Sasyniuk TM, Fick GH, Paolucci EO (2014) Electrothermal arthroscopic capsulorrhaphy: old technology, new evidence. A multicenter randomized clinical trial. J Shoulder Elbow Surg 23:1171–1180PubMedCrossRefGoogle Scholar
  96. 96.
    Toth AP, Warren RF, Petrigliano FA, Doward DA, Cordasco FA, Altchek DW, O’Brien SJ (2011) Thermal shrinkage for shoulder instability. HSS J 7:108–114PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2015

Authors and Affiliations

  • Giovanni Merolla
    • 1
    • 2
    Email author
  • Simone Cerciello
    • 1
  • Claudio Chillemi
    • 3
  • Paolo Paladini
    • 1
  • Elisa De Santis
    • 2
    • 4
  • Giuseppe Porcellini
    • 1
  1. 1.Unit of Shoulder and Elbow Surgery“D. Cervesi” Hospital, CattolicaCattolicaItaly
  2. 2.“Marco Simoncelli” Biomechanics Laboratory“D. Cervesi” Hospital, CattolicaCattolicaItaly
  3. 3.Department of Orthopedics and TraumatologyIstituto Chirurgico Ortopedico Traumatologico (ICOT)LatinaItaly
  4. 4.Shoulder Team Rehabilitation OfficeForlìItaly

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