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Shoulder Instability, Multidirectional, Sports Medicine

David E.J. Bazzo, MD, FAAFP, CAQSM and Tara Robbins, MD Reviewed 04/2019
 


BASICS

DESCRIPTION

  • Multidirectional instability (MDI) is an increase in glenohumeral translation in more than one direction causing either subluxation (any partial loss of normal articulation) or dislo...

DIAGNOSIS

HISTORY

  • MDI is associated with recurrent or “low-energy” trauma.

  • Unilateral versus bilateral shoulder problems: 30–70% of patients with MDI have symptoms in the opposite shoulder as well.

  • MDI o...

TREATMENT

GENERAL MEASURES

  • Analgesia: Nonsteroidal anti-inflammatory drugs (NSAIDs) can decrease pain acutely, but long-term analgesic usage typically is not necessary.

  • Reduction: typically, reduce spon...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Most patients with MDI should be referred for physical therapy. Patients who fail physical therapy can be referred to an orthopedist for consideration of surgical...

REFERENCES

1
Bahu MJ, Trentacosta N, Vorys GC, et al. Multidirectional instability: evaluation and treatment options. Clin Sports Med.  2008;27(4):671–689.
2
Bateman M, Smith BE, Osborne SE, et al. ...

ADDITIONAL READING

  • Caprise PAJr, Sekiya JK. Open and arthroscopic treatment of multidirectional instability of the shoulder. Arthroscopy.  2006;22(10):1126–1131.

  • Foster CR. Multidirectional instab...

CLINICAL PEARLS

  • First-line treatment is prolonged course of physical therapy/independent exercise program with emphasis on strengthening anterior deltoid and rotator cuff muscles for at least 6 mo and...

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