Multidirectional instability (MDI) of the shoulder is a complex condition which remains a great challenge for orthopaedic surgeons to fully understand and successfully treat. We explore the origins of MDI of the shoulder and review the basic science of its proposed aetiology and the results of non-operative and operative treatment modalities. We then propose a new theory as to the aetiology and treatment of this complex condition.
NeerCS, FosterCR. Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder. J Bone Joint Surg1980; 62A: 897–908.
EmeryRJH, MullajiAB. Glenohumeral joint instability in normal adolescents. J Bone Joint Surg (Br)1991; 73B: 406–8.
4.
GerberC, GanzR. Clinical assessment of instability of the shoulder: with special reference to anterior and posterior drawer tests. J Bone Joint Surg (Br)1984; 66B: 551–6.
5.
EmeryRJH, DavidH. Changes in glenohumeral joint laxity during adolescence. J Shoulder Elbow Surg1994; 3: S67.
6.
BrewerBJ, WubbenRC, CarreraGF. Excessive retroversion of the glenoid cavity. A cause of non-traumatic posterior instability of the shoulder. J Bone Joint Surg Am1986; 68: 724–31.
7.
LippittSB, HarrisSL, HarrymanDT, SidlesJ, MatsenFAIII. In vivo quantification of the laxity of normal and unstable glenohumeral joints. J Shoulder Elbow Surg1994; 3: 215–23.
8.
HawkinsRJ, SchutteJP, JandaDH, HuckellGH. Translation of the glenohumeral joint with the patient under anaesthesia. J Shoulder Elbow Surg1996; 5: 286–92.
9.
HamadaK, FukudaH, NakajimaT, YamadaN. The inferior capsular shift operation for instability of the shoulder. Long-term results in 34 shoulders. J Bone Joint Surg Br1999; 81: 218–25.
10.
McFarlandEG, KimTK, ParkHB, NeiraCA, GutierrezMI. The effect of variation in definition on the diagnosis of multidirectional instability of the shoulder. J Bone Joint Surg Am2003; 85A: 2145–6.
DubsL, GschwendN. General joint laxity. Quantification and clinical relevance. Arch Orthop Trauma Surg1988; 107: 65–72.
13.
PollockRG, OwensJM, FlatowEL, BiglianiLU. Operative results of the inferior capsular shift procedure for multidirectional instability of the shoulder. J Bone Joint Surg Am2000; 82A: 919–28.
14.
YamamotoN, ItoiE, TuohetiY,. The effect of the inferior capsular shift on intra-articular pressure: a cadaveric study. Am J Sports Med2006; 34: 939–44.
15.
KarasSG, CreightonRA, DeMoratGJ. Glenohumeral volume reduction in arthroscopic shoulder reconstruction: a cadaveric analysis of suture placation and thermal capsulorrhaphy. Arthroscopy2004; 20: 179–84.
16.
CohenSB, WileyW, GoradiaVK, PearsonS, MillerMD. Anterior capsulorrhaphy: an in vitro comparison of volume reduction – arthroscopic plication versus open capsular shift. Arthroscopy2005; 21: 659–64.
17.
MiniaciA, McBirnieJ. Thermal capsular shrinkage for treatment of multidirectional instability of the shoulder. J Bone Joint Surg Am2003; 85A: 2283–7.
D'AlessandroDF, BradleyJP, FleischliJE, ConnorPM. Prospective evualtion of thermal capsulorrhaphy for shoulder instability: indications and results, two- to five-year follow-up. Am J Sports Med2004; 32: 21–33.
20.
LewisA, KitmuraT, BayleyJ. The classification of shoulder instability: new light through old windows!. Curr Orthop2004; 18: 97–108.
21.
BarrettC, EmeryR, WallaceA, DaveyN. Altered corticospinal control of shoulder musculature in shoulder instability – a case study. In: ChadwickEKJ, VeegerHEJ, Ven der HelmFCT, NagelsJ eds. Proceedings of the third conference of the International Shoulder Group, Delft University Press2001Netherlands.
InuiH, SugamotoK, MiyamotoT,. Three-dimensional relationship pf the glenohumeral joint in the elevated position in shoulders with multidirectional instability. J Shoulder Elbow Surg2002; 5: 510–5.
26.
LephartSM, MyersJB, BradleyJP, FuFH. Shoulder proprioception and function following thermal capsulorraphy. Arthroscopy2002; 18: 770–8.
27.
KissJ, DamrelD, MackieA, NeumannL, WallaceWA. Nonoperative treatment of multidirectional shoulder instability. Int Orthop2001; 24: 354–7.
28.
CooperDE, ArnoczkySP, O'BrienSJ,. Anatomy, histology, and vascularity of the glenoid labrum. An anatomical study. J Bone Joint Surg Am1992; 74: 46–52.
29.
HowellSM, GalinatBJ. The glenoid-labral socket: a constrained articular surface. Clin Orthop Relat Res1989; 243: 122–5.
30.
LazarusMD, SidlesJA, HarrymanDTII, MatsenFAIII. Effect of chondral-labral defect on glenoid concavity and glenohumeral stability. A cadaveric model. J Bone Joint Surg Am1996; 78: 94–102.
31.
KimSH, NohKC, ParkJS, RyuBD, OhI. Loss of chondrolabral containment of the glenohumeral joint in atraumatic posteroinferior multidirectional instability. J Bone Joint Surg Am2005; 87: 92–8.
32.
HurleyJA, AndersonTE, DearW,. Posterior shoulder instability. Surgical versus conservative results with evaluation of glenoid version. Am J Sports Med1992; 20: 396–400.
33.
WeishauptD, ZanettiM, NyffelerRW, GerberC, HodlerJ. Posterior glenoid rim deficiency in recurrent (atraumatic) posterior shoulder instability. Skeletal Radiol2000; 29: 204–10.
34.
KimSH, ParkJC, ParkJS, OhI. Painful jerk test: a predictor of success in nonoperative treatment of posteroinferior instability of the shoulder. Am J Sports Med2004; 32: 1849–55.
35.
KimSH, ParkJS, JeongWK, ShinSK. The Kim test: a novel test for posteroinferior labral lesion of the shoulder – a comparison to the jerk test. Am J Sports Med2005; 33: 1188–92.
36.
KimSH, KimHK, SunJI, ParkJS, OhI. Arthroscopic capsulolabroplasty for posteroinferior multidirectional instability of the shoulder. Am J Sports Med2004; 32: 594–607.
37.
KimSH, HaKI, YooJC, NohKC. Kim's lesion: an incomplete and concealed avulsion of the posteroinferior labrum in posterior or multidirectional posteroinferior instability of the shoulder. Arthroscopy2004; 20: 712–20.
38.
KimSH. Multidirectional instability – clinical evaluation and treatment. Abstract, Ninth International Conference Orthopaedics, Biomechanics, Sports Rehabilitation, Abstracts Book, University of Perugia and Perugia Hospital, Perugia, November 11–13, 2005: 82–7.
39.
KimSH, HaKI, ParkJH,. Arthroscopic posterior labral repair and capsular shift for traumatic unidirectional recurrent posterior subluxation of the shoulder. J Bone Joint Surg Am2003; 85A: 1479–87.
40.
BradleyJP, BakerCLIII, KlineAJ, ArmfieldDR, ChhabraA. Arthroscopic capsulolabral reconstruction for posterior instability of the shoulder: a prospective study of 100 shoulders. Am J Sports Med2006; 34: 1061–71.
