Multidirectional Shoulder Instability (MDI)
Abnormal amount of excursion of the humeral head on the glenoid in all directions. MDI peaks in second and third decades of life
Causes
• Microtrauma from overuse, it is seen with overhead throwing, volleyball players, swimmers, gymnasts.
• Generalized ligamentous laxity: associated with connective tissue disorders: Ehlers-Danlos and Marfan’s
Symptoms
- pain
- instability
- weakness
- paresthesias
- crepitus
- shoulder instability
- during sleep
Physical exam
The patient must have instability in 2 or more planes (anterior, posterior, or inferior) to be defined as MDI.
The signs of generalized hypermobility – generalized ligamentous laxity = Beighton’s criteria >4/9
- able to touch palms to floor while bending at waist (1 point)
- genu recurvatum (2 points)
- elbow hyperextension (2 points)
- MCP hyperextension (2 points)
- thumb abduction to the ipsilateral forearm (2 points)
Non Operative Therapy
Concentrates on:
1. Core stability
2. Scapula Stability
3. Muscle patterning
4. Proprioception
5. Functional Rehab.
Surgery
Treat ALL Pathology present:
• Labral (Anterior, Posterior, Superior)
• Capsule Laxity
• Bone Defects (Humeral Head, Glenoid)
• Cuff tears
Summary
Treat ALL Pathology present:
• Labral (Anterior, Posterior, Superior)
• Capsule Laxity
• Bone Defects (Humeral Head, Glenoid)
• Cuff tears