Abstract
In 1980 Neer and Foster suggested the concept of multidirectional shoulder instability (MDI). The hallmark of this clinical condition is the presence of symptomatic inferior instability in addition to anterior and posterior instability. Although a redundant capsule was believed to be the main pathological lesion and the inferior capsular shift procedure had become the standard operation in the management of MDI that does not respond to nonoperative treatment, the entire spectrum of MDI was not clearly identified. In 2002 Gerber and Nyffeler classified MDI into MDI with hyperlaxity and without hyperlaxity. The most commonly recommended treatment for MDI is exercise-based management; however, there is a need for high-quality intervention studies to be undertaken to validate the effects of exercise on MDI. In the studies of arthroscopic capsular plication procedures, failure rates (recurrent instability) were 18–21 % and return to preoperative level of sports was 86 %, which are comparable to the results of open capsular shift.
Zusammenfassung
Im Jahr 1980 entwickelten Neer und Foster das Konzept der multidirektionalen Schulterinstabilität (MDI). Kennzeichnend ist dabei das Vorliegen einer symptomatischen inferioren Instabilität neben einer anterioren und posterioren Instabilität. Obwohl davon ausgegangen wurde, dass eine hyperlaxe Gelenkkapsel die wesentliche pathologische Läsion sei und obwohl der inferiore Kapsel-Shift zum Standardeingriff beim Management einer nicht auf konservative Therapie ansprechenden MDI geworden war, war das gesamte Spektrum der MDI nicht klar identifiziert. In 2002 modifizierten Gerber und Nyffeler die Klassfikation: MDI mit und MDI ohne Hyperlaxizität. Zwar werden am häufigsten übungsbasierte Behandlungen empfohlen, dennoch sind qualitativ hochwertige Interventionsstudien erforderlich, um ihr Effekte auf eine MDI zu validieren. In den Studien zu arthroskopischen Kapselraffungen betrugen die Versagensraten (rezidivierende Instabilität) zwischen 18 und 21 %, und 86 % der Operierten nahmen ihre sportlichen Aktivitäten auf präoperativem Niveau wieder auf. Diese Resultate sind mit denen nach offenem Kapsel-Shift vergleichbar.
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J. Ide states that there are no conflicts of interest.
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Ide, J. Multidirectional shoulder instability in young athletes. Obere Extremität 9, 96–101 (2014). https://doi.org/10.1007/s11678-014-0263-3
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DOI: https://doi.org/10.1007/s11678-014-0263-3
Keywords
- Multidirectional shoulder instability
- Sulcus sign
- Redundant capsule
- Exercise-based management
- Arthroscopic capsular plication