Multidirectional Shoulder Instability

Lennard Funk & Kathleen Roney, 2008

Definition (Neer) = Abnormal amount of excursion of the humeral head on the glenoid in all directions

Classification - Neer

  • Group I Antero-inferior dislocation / Posterior subluxation
  • Group II Postero-inferior dislocation /Anterior subluxation
  • Group III Global dislocation

Definitions

  • Instability = a symptom, usually one direction
  • Laxity = a sign, usually multidirectional
  • Multidirectional Instability - VERY Rare

Stanmore Classification (Bayley Triangle)

Examination

  • Laxity - using Cofield's technique
  • Gagey Test for Inferior capsule
  • Muscle Patterning
  • Kinetic Chain
  • Generalised Hypermobility (Beighton Score)

Investigations

In all cases: X-Ray (AP and axillary views), MR Arthrogram

If indicated: CT scan, EMG's, EUA & Arthroscopy

Decision Making

  • Polar Type I = Surgery (+ rehab)Management
  • Polar Type III = Specialist Shoulder Physiotherapy
  • Polar Type II = combination of above (needs skillful and careful management)

Shoulder Therapy

Concentrates on:

  1. Core stability
  2. Scapula Stability
  3. Muscle patterning
  4. Proprioception
  5. Functional Rehab

Combined Rehab exercises incorporate Core stabilty, Proprioception, Scapula, ROM, Strength

See more here

Surgery

Treat ALL Pathology present:

  • Labral (Anterior, Posterior, Superior)
  • Capsule Laxity
  • HAGL
  • Bone Defects (Humeral Head, Glenoid)
  • Cuff tears