title: Multidirectional instability of the shoulder: biomechanics, clinical presentation, and treatment strategies.
abstract: 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.
authors: Unit of Shoulder and Elbow Surgery, "D. Cervesi" Hospital, Cattolica, AUSL della Romagna Ambito Territoriale di Rimini, Cattolica, Italy, giovannimerolla@hotmail.com.
authors: Giovanni
authors: G
authors: Merolla
authors: Simone
authors: S
authors: Cerciello
authors: Claudio
authors: C
authors: Chillemi
authors: Paolo
authors: P
authors: Paladini
authors: Elisa
authors: E
authors: De Santis
authors: Giuseppe
authors: G
authors: Porcellini
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena / Q000502:physiology; D003952:Diagnostic Imaging / Q000379:methods; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D010808:Physical Examination / Q000379:methods; D012008:Recurrence; D012783:Shoulder Dislocation / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D012785:Shoulder Joint / Q000502:physiology; D016896:Treatment Outcome; D055815:Young Adult
references: Am J Sports Med. 2010 Feb;38(2):375-82
references: 19940294
references: Am J Sports Med. 1995 Sep-Oct;23(5):557-63
references: 8526270
references: Clin Orthop Relat Res. 1993 Jun;(291):124-37
references: 8504591
references: Am J Sports Med. 2009 Sep;37(9):1712-20
references: 19605592
references: J Bone Joint Surg Am. 1978 Jan;60(1):1-16
references: 624747
references: J Shoulder Elbow Surg. 2008 Jul-Aug;17(4):671-83
references: 18329294
references: Am J Sports Med. 2003 Mar-Apr;31(2):247-52
references: 12642260
references: Arthroscopy. 1989;5(3):201-8
references: 2775394
references: J Bone Joint Surg Am. 2001 Jul;83-A(7):1062-9
references: 11451977
references: Eur J Orthop Surg Traumatol. 2015 Feb;25(2):263-72
references: 24890673
references: Arthroscopy. 2005 Oct;21(10):1278
references: 16226669
references: Knee Surg Sports Traumatol Arthrosc. 1996;4(3):171-9
references: 8961235
references: Clin Orthop Relat Res. 1993 Jun;(291):7-19
references: 8504616
references: J Bone Joint Surg Am. 1980 Sep;62(6):897-908
references: 7430177
references: Am J Sports Med. 2005 Jul;33(7):1011-5
references: 15983123
references: J Bone Joint Surg Am. 1992 Dec;74(10):1516-21
references: 1469011
references: Arthroscopy. 2008 Aug;24(8):921-9
references: 18657741
references: Scand J Med Sci Sports. 2011 Jun;21(3):352-8
references: 21385219
references: Am J Sports Med. 2002 May-Jun;30(3):322-8
references: 12016070
references: J Bone Joint Surg Am. 2009 Feb;91(2):378-89
references: 19181982
references: J Bone Joint Surg Am. 1956 Oct;38-A(5):957-77
references: 13367074
references: Arthroscopy. 2004 Feb;20(2):179-84
references: 14760352
references: J Bone Joint Surg Am. 2000 Jun;82(6):849-57
references: 10859105
references: J Bone Joint Surg Br. 1985 May;67(3):363-6
references: 3997941
references: Clin Neurophysiol. 2005 Aug;116(8):1846-57
references: 15982928
references: Acta Orthop Scand. 1997 Oct;68(5):447-50
references: 9385244
references: Clin Orthop Relat Res. 2004 Mar;(420):181-9
references: 15057095
references: Arthroscopy. 2012 Jul;28(7):1010-7
references: 22365265
references: J Bone Joint Surg Am. 2010 Jun;92(6):1545-57
references: 20516333
references: Am J Sports Med. 2000 Jul-Aug;28(4):466-71
references: 10921636
references: Eur J Orthop Surg Traumatol. 2012 Aug;22(6):437-441
references: 22837736
references: Orthop Rev. 1989 Sep;18(9):963-75
references: 2797861
references: Am J Sports Med. 2008 Mar;36(3):515-22
references: 18216272
references: Open Orthop J. 2009 Dec 24;3:107-14
references: 20119510
references: J Shoulder Elbow Surg. 2010 Sep;19(6):802-13
references: 20713276
references: Instr Course Lect. 1998;47:113-25
references: 9571408
references: Orthopedics. 1988 Jan;11(1):113-20
references: 3281150
references: J Bone Joint Surg Am. 1973 Apr;55(3):445-60
references: 4703200
references: Eur Radiol. 2014 Jun;24(6):1376-85
references: 24623367
references: Arthroscopy. 1997 Aug;13(4):418-25
references: 9276046
references: Arthroscopy. 2006 May;22(5):528-33
references: 16651163
references: J Shoulder Elbow Surg. 2004 Jan-Feb;13(1):24-9
references: 14735069
references: Int Orthop. 2001;24(6):354-7
references: 11294430
references: Acta Orthop Belg. 1990;56(2):451-3
references: 2239192
references: Clin Orthop Relat Res. 2002 Jul;(400):65-76
references: 12072747
references: Arthroscopy. 2005 Jun;21(6):766
references: 15944644
references: J Shoulder Elbow Surg. 2003 Jul-Aug;12(4):342-5
references: 12934027
references: Clin Orthop Relat Res. 2014 Aug;472(8):2389-96
references: 24158541
references: HSS J. 2011 Jul;7(2):108-14
references: 22754408
references: J Shoulder Elbow Surg. 2001 Jan-Feb;10(1):28-36
references: 11182733
references: Am J Sports Med. 1992 Nov-Dec;20(6):675-85
references: 1456361
references: Muscles Ligaments Tendons J. 2012 Sep 10;2(2):85-90
references: 23738279
references: J Bone Joint Surg Am. 1995 Jul;77(7):1011-20
references: 7608222
references: Arch Orthop Trauma Surg. 2002 Nov;122(8):447-50
references: 12442181
references: J Bone Joint Surg Am. 1991 Jan;73(1):105-12
references: 1985978
references: Knee Surg Sports Traumatol Arthrosc. 2006 Jul;14(7):673-85
references: 16362361
references: Orthopedics. 2011 Apr 11;34(4):null
references: 21469638
references: Am J Sports Med. 2004 Jan-Feb;32(1):21-33
references: 14754720
references: J Shoulder Elbow Surg. 2005 Sep-Oct;14(5):466-70
references: 16194736
references: J Bone Joint Surg Am. 1992 Jul;74(6):890-6
references: 1634579
references: Clin Orthop Relat Res. 1993 Jun;(291):85-96
references: 8504618
references: J Orthop Sports Phys Ther. 2009 Feb;39(2):124-34
references: 19194021
references: Clin Orthop Relat Res. 2002 Jul;(400):48-57
references: 12072745
references: Clin Orthop Relat Res. 2000 Mar;(372):205-16
references: 10738429
references: Instr Course Lect. 1985;34:232-8
references: 3833944
references: Br J Sports Med. 2002 Aug;36(4):290-4
references: 12145120
references: J Am Acad Orthop Surg. 2011 Dec;19(12):758-67
references: 22134208
references: Am J Sports Med. 2002 May-Jun;30(3):382-7
references: 12016079
references: J Athl Train. 2008 Oct-Dec;43(6):565-70
references: 19030133
references: Am J Sports Med. 1998 Sep-Oct;26(5):634-43
references: 9784809
references: Arthroscopy. 1985;1(1):33-9
references: 4091907
references: Man Ther. 2003 Nov;8(4):195-206
references: 14559042
references: J Shoulder Elbow Surg. 1992 May;1(3):131-9
references: 22971605
references: Clin Sports Med. 2013 Oct;32(4):865-914
references: 24079440
references: Orthopedics. 2012 Apr;35(4):e497-502
references: 22495849
references: J Shoulder Elbow Surg. 2014 Aug;23(8):1171-80
references: 24939380
references: J Bone Joint Surg Br. 2001 Jan;83(1):69-74
references: 11245541
references: Arthroscopy. 2005 Jun;21(6):659-64
references: 15944619
references: J Shoulder Elbow Surg. 1993 Jan;2(1):27-35
references: 22959294
references: J Bone Joint Surg Am. 2000 Jul;82-A(7):919-28
references: 10901306
references: Am J Sports Med. 2000 Mar-Apr;28(2):206-13
references: 10750997
references: J Shoulder Elbow Surg. 1995 Jan-Feb;4(1 Pt 1):54-64
references: 7874566
references: J Bone Joint Surg Br. 1984 Aug;66(4):551-6
references: 6746691
references: Clin Orthop Relat Res. 1987 Oct;(223):32-43
references: 3308270
references: J Bone Joint Surg Am. 1981 Jul;63(6):863-72
references: 7240326
references: J Bone Joint Surg Am. 1966 Dec;48(8):1503-10
references: 5955639
references: Arthroscopy. 2005 Jan;21(1):119-21
references: 15650678
references: J Rheumatol. 2000 Jul;27(7):1777-9
references: 10914867
references: Am J Sports Med. 2012 May;40(5):1126-32
references: 22437281
references: Am J Sports Med. 1994 Sep-Oct;22(5):589-94
references: 7810780
references: Am J Sports Med. 1991 Sep-Oct;19(5):428-34
references: 1962705