Multidirectional Instability of the Shoulder

  • Anthony A. RomeoEmail author
  • Benjamin Bruce


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.


Rotator Cuff External Rotation Humeral Head Thoracic Outlet Syndrome Rotator Interval 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Video 18.1

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


  1. 1.
    Gaskill TR, Taylor DC, Millett PJ. Management of multidirectional instability of the shoulder. J Am Acad Orthop Surg. 2011;19:758–67.PubMedGoogle Scholar
  2. 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.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 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.PubMedCrossRefGoogle Scholar
  4. 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. 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.PubMedCrossRefGoogle Scholar
  6. 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.PubMedGoogle Scholar
  7. 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.PubMedCrossRefGoogle Scholar
  8. 8.
    Bahu MJ, Trentacosta N, Vorys GC, Covey AS, Ahmad CS. Multidirectional instability: evaluation and treatment options. Clin Sports Med. 2008;27:671–89.PubMedCrossRefGoogle Scholar
  9. 9.
    Schenk TJ, Brems JJ. Multidirectional instability of the shoulder: pathophysiology, diagnosis, and management. J Am Acad Orthop Surg. 1998;6:65–72.PubMedGoogle Scholar
  10. 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.PubMedCrossRefGoogle Scholar
  11. 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.PubMedGoogle Scholar
  12. 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.CrossRefGoogle Scholar
  13. 13.
    Lippitt S, Matsen F. Mechanisms of glenohumeral joint stability. Clin Orthop Relat Res. 1993;291:20–8.PubMedGoogle Scholar
  14. 14.
    Morris AD, Kemp GJ, Frostick SP. Shoulder electromyography in multidirectional instability. J Shoulder Elbow Surg. 2004;13:24–9.PubMedCrossRefGoogle Scholar
  15. 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.PubMedCrossRefGoogle Scholar
  16. 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.PubMedCrossRefGoogle Scholar
  17. 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.PubMedCrossRefGoogle Scholar
  18. 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.PubMedCrossRefGoogle Scholar
  19. 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.PubMedCrossRefGoogle Scholar
  20. 20.
    Hewitt M, Getelman MH, Snyder SJ. Arthroscopic management of multidirectional instability: pancapsular plication. Orthop Clin North Am. 2003;34:549–57.PubMedCrossRefGoogle Scholar
  21. 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.PubMedGoogle Scholar
  22. 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.PubMedCrossRefGoogle Scholar
  23. 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.PubMedCrossRefGoogle Scholar
  24. 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.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Voigt C, Schulz AP, Lill H. Arthroscopic treatment of multidirectional glenohumeral instability in young overhead athletes. Open Orthop J. 2009;3:107–14.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 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.PubMedCrossRefGoogle Scholar
  27. 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.PubMedCrossRefGoogle Scholar
  28. 28.
    Treacy SH, Savoie 3rd FH, Field LD. Arthroscopic treatment of multidirectional instability. J Shoulder Elbow Surg. 1999;8:345–50.PubMedCrossRefGoogle Scholar
  29. 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.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  1. 1.Department of OrthopaedicsRush University Medical CenterChicagoUSA

Personalised recommendations