Treatment of multidirectionalshoulder instability in the athlete

Multidirectional instability in the athlete refers to symptomatic laxity of the shoulder in more than one direction.This is in contrast to unidirectional instability, which involves subluxation or dislocation in only one direction. The diagnosis and treatment of this disorder can be challenging owing to the unusual demands athletes place on their shoulders to be effective in their sport. The laxity required for overhand throwing, gymnastics, swimming, volleyball and tennis — while increased compared with that required for activities of daily living or with that of the opposite shoulder — must be symptomatic to be pathologic. Formerly, it was thought that generalized ligamentous laxity was a requirement for multidirectional instability, but now it is realized many athletes have multidirectional instability in the setting of otherwise normal ligamentous laxity. Nonoperative treatment is frequently successful in these athletes. When conservative management is unsuccessful, the capsular shift procedure has demonstrated good results in allowing these athletes to return to their sport. Arthroscopic and thermal capsulorrhaphy also offer other options for surgical treatment of this problem and will be briefly discussed.