Multidirectional Instablility – Atraumatic Frequently Asked Questions

The shoulder is the most mobile joint in the human body with a complex arrangement of bone and soft tissue (ligaments, tendons, and muscles) that work together to produce shoulder movement. Click here for more information.
Atraumatic shoulder instability develops in patients who have increased looseness of the supporting ligaments that surround the shoulder’s glenohumeral joint. The laxity can be a natural condition (present from birth) or a condition that has developed over time. Many patients with Multidirectional Instability (MDI) are active in overhead sports (such as gymnastics, swimming, or throwing) that repetitively stretch the shoulder capsule to extreme ranges of motion. Click here for more information.

MDI problems are generally related to recurrent episodes of dislocation. Click here for more information.

A diagnosis of atraumatic shoulder instability is made after a physician will take the patient’s history and perform a physical examination including a joint mobility examination. X-rays of the shoulder, an MRI, or arthroscopy may also be used in the evaluation. Click here for more information.
Most patients with MDI can be treated non-operatively with a physical therapy program that emphasizes muscular rehabilitation. The majority of patients who follow a rehabilitation program diligently for at least six months will achieve pain relief. Click here for more information.
The traditional surgery for MDI is designed to make the joint capsule smaller and reduce glenohumeral movement. This open surgical procedure is called an extensive inferior capsular release and imbrication. Recently, new arthroscopic techniques have been developed to correct multidirectional instability. These arthroscopic techniques are very exciting, but remain experimental, especially for athletes who require stability and the preservation of motion. Click here for more information.

The most common complication is recurrent instability, which can happen in 20% or more cases, even with carefully chosen patients. Post-operative stiffness and loss of motion are also
complications; however, loss of motion is often an acceptable result of achieving stability. An average loss of motion in external rotation is about 10 degrees. A loss of motion greater than that occurs in about 5% of the cases. Other small risks (less than 1%) common to most surgery procedures include infection, nerve damage, or blood vessel injury. 

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Recovery from MDI (Multidirectional Instability) is a long process that usually requires a six-month physical therapy rehabilitation program. If this succeeds, an ongoing maintenance program to prevent the return of instability symptoms is often necessary. If six months of physical therapy has not controlled the instability, surgery may be indicated. 

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Following surgery the patient will wear a sling for the first four to six weeks with gentle range of motion exercises, followed by a physical therapy program. Full participation in sports is generally restricted for nine to twelve months following the repair. Click here for more information.
MDI refers to a multidirectional laxity of the shoulder joint with associated instability. The instability generally results from stretching of the shoulder’s supporting ligaments, which leads to increased movement of the glenohumeral joint. Click here for more information.
Research suggests that many patients (80%) will improve with physical therapy alone. The patient’s diligence and commitment to a daily maintenance program is required for the best chance of success. Click here for more information.
Motion loss varies. The normal range of shoulder motion at 90 degrees of abduction (elbow pointing away from the body) is from 80-120 degrees of external (outward) rotation (the higher number is seen in patients who have developed increased motion for throwing sports). After a surgical stabilization, a stable shoulder will have on average about 90 degrees of external rotation at 90 degrees of abduction. Preliminary results show that arthroscopic procedures may reduce motion loss, but these are still being evaluated. Click here for more information.
Arthroscopic techniques continue to evolve and improve. The short-term follow up data suggests that the success rates of arthroscopic repairs may equal those of open procedures. Although the initial results are very encouraging, further long-term studies are required to validate them. Click here for more information.

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