Multidimensional shoulder instability

Multidimensional shoulder instability
Classification and external resources
Specialty	{{#statements:P1995}}
Patient UK	[1]

Multidirectional shoulder instability (MDI)

Signs and symptoms

Those with MDI may have a variety of symptoms depending on the severity, ranging from vague shoulder pain to daily subluxations and dislocations. The most common symptoms of MDI are pain with activity, a loose feeling in the shoulder, and decreased strength. MDI can sometimes cause neurological symptoms like tingling and numbness. People with MDI commonly have a direction which is more unstable than the others, which is reflected in their symptoms. Inferior instability is sometimes associated with paresthesia, numbness, and pain, particularly when carrying heavy objects. Anterior instability is more associated with overhead movement, while posterior instability is associated with flexion and internal rotation.

Causes

Multiple factors play a role in the development of MDI. These factors are congenital, acquired, post-traumatic, and neuromuscular.

MDI is thought by many to be caused by repeated microtraumas to a congenitally lax and redundant joint capsule. MDI can also be caused by repetitive microtraumas to a normal joint. Since this condition is complex, MDI is frequently viewed as a continuum. Individuals on one end of the spectrum may have bilateral shoulder involvement, a high anomaly of congenital abnormalities, or connective tissue disorders; on the other end, patients may present with acquired instability limited to the shoulder due to repetitive use on the background of muscle imbalance.

Congenitally, glenoids with a reduced anterior-posterior diameter, greater retroversion, and hyperplasic characteristics can occur in those with MDI. This can lead to instability in all directions and lessen the humeral head's bony constraint. Patients usually have an excessive number of damaged or absent components in their joint capsule, a condition known as excessive capsular redundancy. A broad, patulous inferior capsule and a poor rotator interval are common causes of capsular redundancy in MDI. Joint laxity overall is caused by an increase in capsular volume brought on by these passive deficits.

When compared to normal controls, those with MDI often have scapulae that sit in downward rotation and exhibit diminished scapular upward rotation over range. These changes are due to impaired neuromuscular regulation of the glenohumeral joint and scapula. When the arm is raised and at rest, this occurrence leads to a relative lack of effective depth of the humeral head on the glenoid, which exacerbates inferior joint instability. Those with MDI also have decreased joint position sensation, or sensorimotor control, often known as proprioception.

Risk factors

Some people with MDI may have connective tissue disorders, such as Ehlers-Danlos syndrome, Marfan's syndrome, or less severe generalized joint laxity.

References

Sources

• Warby, Sarah Ann; Watson, Lyn; Ford, Jon J.; Hahne, Andrew J.; Pizzari, Tania (2017). "Multidirectional instability of the glenohumeral joint: Etiology, classification, assessment, and management". Journal of Hand Therapy. Elsevier BV. 30 (2): 175–181. doi:10.1016/j.jht.2017.03.005. ISSN 0894-1130. PMID 28576345.
• Bishop, Meghan E.; Patel, Heli; Erickson, Brandon J.; Dodson, Christopher C. (2022). "Multidirectional instability in female athletes". Annals of Joint. AME Publishing Company. 7: 1–10. doi:10.21037/aoj-20-33. ISSN 2415-6809. PMC 10929405 . PMID 38529164 .
• Kuhn, John E (2010). "A new classification system for shoulder instability". British Journal of Sports Medicine. BMJ. 44 (5): 341–346. doi:10.1136/bjsm.2009.071183. ISSN 0306-3674. PMID 20371559.
• Guerrero, Patrick; Busconi, Brian; Deangelis, Nicola; Powers, Gina (2009). "Congenital Instability of the Shoulder Joint: Assessment and Treatment Options". Journal of Orthopaedic & Sports Physical Therapy. Journal of Orthopaedic & Sports Physical Therapy (JOSPT). 39 (2): 124–134. doi:10.2519/jospt.2009.2860. ISSN 0190-6011. PMID 19194021.
• Merolla, Giovanni; Cerciello, Simone; Chillemi, Claudio; Paladini, Paolo; De Santis, Elisa; Porcellini, Giuseppe; Denaro, Vincenzo (2015-02-01). "Multidirectional instability of the shoulder: biomechanics, clinical presentation, and treatment strategies". European Journal of Orthopaedic Surgery & Traumatology. Springer Science and Business Media LLC. 25 (6): 975–985. doi:10.1007/s00590-015-1606-5. ISSN 1633-8065.
• Ruiz Ibán, Miguel Angel; Díaz Heredia, Jorge; García Navlet, Miguel; Serrano, Francisco; Santos Oliete, María (2017-08-31). "Multidirectional Shoulder Instability: Treatment". The Open Orthopaedics Journal. Bentham Science Publishers Ltd. 11 (1): 812–825. doi:10.2174/1874325001711010812. ISSN 1874-3250. PMC 5611704. PMID 28979595.
• Longo, Umile Giuseppe; Rizzello, Giacomo; Loppini, Mattia; Locher, Joel; Buchmann, Stefan; Maffulli, Nicola; Denaro, Vincenzo (2015). "Multidirectional Instability of the Shoulder: A Systematic Review". Arthroscopy: The Journal of Arthroscopic & Related Surgery. Elsevier BV. 31 (12): 2431–2443. doi:10.1016/j.arthro.2015.06.006. ISSN 0749-8063. PMID 26208802.
• Housset, Victor; Ho, Sean Wei Loong; Lädermann, Alexandre; Phua, Sean Kean Ann; Hui, Si Jian; Nourissat, Geoffroy (2024-04-01). "Multidirectional instability of the shoulder: a systematic review with a novel classification". EFORT Open Reviews. Bioscientifica. 9 (4): 285–296. doi:10.1530/eor-23-0029. ISSN 2058-5241. PMC 11044084 . PMID 38579775 .
• Şahin, Koray; Kendirci, Alper Şükrü; Albayrak, Muhammed Oğuzhan; Sayer, Gökhan; Erşen, Ali (2022-11-01). "Multidirectional instability of the shoulder: surgical techniques and clinical outcome". EFORT Open Reviews. Bioscientifica. 7 (11): 772–781. doi:10.1530/eor-22-0010. ISSN 2058-5241. PMC 9780612 . PMID 36475553 .
• Bak, Klaus; Wiesler, Ethan R.; Poehling, Gary G. (2010). "Consensus Statement on Shoulder Instability". Arthroscopy: The Journal of Arthroscopic & Related Surgery. Elsevier BV. 26 (2): 249–255. doi:10.1016/j.arthro.2009.06.022. ISSN 0749-8063. PMID 20141988.

External links

Classification	[[d: |D]]
External resources	Patient UK: Multidimensional shoulder instability NCI: Multidimensional shoulder instability

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