Generalized joint laxity and multidirectional instability of. Criteria for progression to phase 4 full rom no pain or palpable tenderness satisfactory isokinetic test satisfactory clinical examination phase 4. Repetitive overhead activities can also produce instability. The key elements in assessing shoulder instability should include posture and core stability, scapula control including function of the periscapular muscles and rotator cuff rc muscles, laxity of the joint, neurological and pain status, psychosocial factors including fear and anxiety to move the shoulder. The epidemiology and natural history of anterior shoulder instability. Shoulder instability is a common injury among people participating in contact and noncontact athletic activities. Multidirectional instability protocol post op multi.
Generalized joint laxity and shoulder instability are common conditions that exhibit a wide spectrum of different clinical forms and may coexist in the same patient. The treatment of multidirectional instability of the shoulder is complex. A guest editorial on the multidirectional instability of the shoulder. Shoulder instability is a symptomatic abnormal motion of the glenohumeral joint ghj, which can present as pain or a sense of displacement. The effects of a conservative rehabilitation program for multidirectional instability of the shoulder article pdf available in journal of shoulder and elbow surgery 271 september 2017 with. Anterior shoulder instability statpearls ncbi bookshelf. Oct 14, 2019 keys to shoulder instability rehabilitation. Active populations that find themselves in an externally rotated hand away from the body and abducted arm away from body position are the most vulnerable figure 1.
It allows you to raise your arm, rotate it, reach overhead, and turn your arm in many directions. Instability occurs when static and dynamic shoulder stabilizers become incompetent due to congenital or acquired means. Multidirectional shoulder instability definition of. The shoulder depends on ligaments, muscles and the labrum for stability. The shoulder does not actually dislocate, but can slide around in the glenoid fossa. Multidirectional instability mdi of the shoulder is a condition where the dislocation occurs in more than one direction with minimal or no causative trauma. Mdi was first described in 1980 by neer and foster. Two sensitive and specific physical tests are the jerk and kim tests. Nissen, mda,b introduction shoulder instability in young patients is a wellrecognized spectrum of disease, from common traumatic anterior dislocations to recurrent multidirectional instability mdi. Before i begin, lets talk about the terminology and classifications used when describing shoulder instability. Nonsurgical rehabilitation for multidirectional shoulder.
Pdf the effects of a conservative rehabilitation program. Nonoperative treatment of multidirectional shoulder instability. It is fundamental to distinguish laxity from instability. Mdi is caused by generalized capsular laxitythat is, insufficiency of the static ligament constraints of the glenohumeral joint. There is not a traumatic event that causes the instability, but rather the shoulder has a tendency to shift excessively, causing pain in the joint. Shoulder instability, sports medicine conditions and. Multidirectional shoulder instability pan capsular plication postsurgical rehabilitation protocol the following is a protocol for postoperative patients following multidirectional shoulder instability. To summarize, nonoperative rehabilitation of shoulder instability has many subtle variations. Generalized joint laxity and multidirectional instability. Multidirectional instability of the glenohumeral joint. Therefore, if a person has loose ligaments or weak muscles the shoulder can become unstable. Understanding multidirectional shoulder instability saint. When the humeral head comes completely out of the glenoid, the term shoulder dislocation is used.
Sixtytwo shoulders had received no previous surgical treatment group a while 22 had failed to respond to surgical treatment before the rehabilitation programme group b. Dec 14, 2005 alterations of shoulder motion have been suggested to be associated with shoulder disorders. Shoulder instability includes the spectrum of shoulder subluxation and dislocation. Atraumatic shoulder instability pathophysiology what are. Pdf multidirectional instability of the shoulder in elite. Traumatic shoulder instability occurs when there is an acute injury to the shoulder, such as a fall or sports injury. Mar 21, 2014 generalized joint laxity and shoulder instability are common conditions that exhibit a wide spectrum of different clinical forms and may coexist in the same patient.
Like the mcmurray test for evaluation of the meniscal injury in the knee joint, the basic principle of the jerk and kim tests is. Glenohumeral instability encompasses both dislocation and subluxation events, and instability events commonly affect the general population. Degree of instability and the effect of their functions. Nonsurgical rehabilitation for multidirectional shoulder instability ramin r. Anterior instability is the most common type of shoulder instability. Three key findings when diagnosing shoulder multidirectional. Goals maintain optimal level of strength, power and endurance. The surgeon should have a clear understanding of the role of hiperlaxity, anatomical variations, muscle misbalance and possible traumatic incidents in each patient. Traumatic anterior instability of the shoulder scielo. Shoulder instability in young patients is a wellrecognized spectrum of disease, from common traumatic anterior dislocations to recurrent multidirectional.
Multidirectional instability of the shoulder current. Because your shoulder allows for such a wide variety of movement, it is susceptible to reduced stability. To simplify my thought process, i always think of these 6 key factors before i decide what i want to focus on for each person. Shoulder instability occurs when the head of humerus the upper arm bone is forced out of the shoulder socket.
The shoulder is forcefully pulled out of its socket, and often must be placed back into position with special maneuvers, sometimes requiring anesthesia. Multidirectional instability sometimes abbreviated as mdi occurs when the shoulder joint is loose within the socket. The ball and socket are held together by the matching shape of the bones and cartilage, the strong, thickened tissue ligaments connecting the two major bones and the muscles around the shoulder. Shoulder instability is characterized by the disruption of the native dynamic and static stabilizers of the glenohumeral joint, leading to dislocation. Unidirectional instability twin boro physical therapy. May 12, 20 before i begin, lets talk about the terminology and classifications used when describing shoulder instability. Rehabilitation for shoulder instability current approaches. Multidirectional instability of the shoulder uptodate. Finally the shoulder may become uncomfortable even with the arm at rest and by then the acute symptoms are brought about with less forceful activities such. Review article management of multidirectional instability of. Fifteen patients with multidirectional instability and 15 normal controls were investigated.
Shoulder instability normally presents in one shoulder. The primary goal of this protocol is to protect the repair while steadily progressing towards and ultimately achieving preinjury. Alterations of shoulder motion have been suggested to be associated with shoulder disorders. Physiotherapy treatment for atraumatic recurrent shoulder. Multidirectional shoulder instability dr henry knipe and dr amir rezaee et al. The classification of shoulder instability identifying muscle patterning disorders by articles, september 1, 2009 shoulder instability or more specifically glenohumeral instability is a common and well described problem encountered in sports injuries.
The objective is associating a posteroinferior plication a to c with restoration of labral height and centering of the humeral head after an associated anteroinferior plication d. If the joint is pushed past these limits, the shoulder joint may move too much. Atraumatic shoulder instability pathophysiology what are we really treating. Multidirectional instability mdi of the shoulder is defined as symptomatic laxity of the glenohumeral joint. The main joint of the shoulder is a ball humerus and socket glenoid joint. Pediatric and adolescent shoulder instability matthew d. Background the treatment of multidirectional instability of the shoulder is complex. Multidirectional instability mdi is a relatively common, generally bilateral, typically atraumatic condition affecting shoulder function.
Pediatric and adolescent shoulder instability connecticut childrens. Multidirectional instability mdi of the shoulder is usually an atraumatic condition in which the shoulder demonstrates symptomatic laxity in more than one direction. Generalized joint laxity can be congenital or acquired. Impingement instability differentiation physiopedia.
While many people associate shoulder instability with a traumatic event such as a dislocation, multidirectional instability mdi can occur without trauma. Multidirectional instability brisbane knee and shoulder clinic. In 120 patients with anterior dislocations, there was a serious injury. Multidirectional shoulder instability pan capsular. Multidirectional instability mdi of the shoulder was initially described by neer and foster in 1980 as instability in 2 or more directions. So your patient comes to you complaining of an unstable shoulder, ask yourself is this more actively or passively unstable. The majority of shoulder dislocations occur as a result of trauma and may result in recurrent instability if the injury caused structural damage. This condition is known as shoulder instability and may result in the upper arm bone humerus moving partially or completely out of the socket during certain arm movements subluxation or dislocation. There currently is a wide variation in the definition of multidirectional instability of the shoulder in the literature.
Background multidirectional instability mdi is a relatively common, generally bilateral, typically atraumatic condition affecting shoulder function. Shoulder instability can also occur in people who regularly perform shoulder motions that stretch out the joint capsule. Does this patient have an instability of the shoulder or a labrum lesion. The cleveland shoulder institute specializes in advanced arthroscopic and open surgical techniques to treat multidirectional atraumatic onset instability. The objective of this study was to perform a 3d motion analysis kinematic and electromyographical of skeletal elements and muscles of shoulder joint in patients with multidirectional instability. Jul 05, 2018 multidirectional instability mdi is a relatively common, generally bilateral, typically atraumatic condition affecting shoulder function. Multidirectional shoulder instability shoulderdoc by prof.
Mdi is caused by generalized capsular laxitythat is, insufficiency of the static ligament constraints of the glenohumeral joint ghj. The inferior glenohumeral ligament in particular can serve as a restraint to both anterior and posterior translation of the humeral head. Multidirectional instability in the shoulder youtube. Methods the criteria for inclusion in this study were twofold. Understanding multidirectional shoulder instability. Approximately 90% of all shoulder dislocations occur in this direction. Orthopedics symptomatic glenohumeral instability in 1 direction clinical vague sx evaluation history, pe, radiographs, laxity tests, provocative tests treatment nonoperative. Multidirectional instability mdi is a complex shoulder condition first described by neer and foster 1 in 1980. A thorough history and physical examination are the keys to the diagnosis and treatment of mdi multidirectional instability. Shoulder instability shoulder subluxation physioadvisor. The surgeon should have a clear understanding of the role of hiperlaxity, anatomical variations, muscle.
Multidirectional instability misamore 64 patients ave 16 year 930 at 8 years. The shoulder joint is the most moveable joint in the body. Multidirectional instability mdi of the shoulder is symptomatic laxity in 2 or more directions, 1 of which is inferior. Fifteen patients with multidirectional instability and 15 normal controls were investigated during. When a shoulder is unstable it can dislocate, this is the complete separation of the ball of the shoulder, called the head of the humerus hoh from the socket, called the glenoid. The effects of a conservative rehabilitation program for multidirectional instability of the shoulder. Multidirectional instability is characterized by recurrent atraumatic instability of the glenohumeral joint due to a lax joint capsule.
Southern california orthopedic institute tm e 0 i c a l g r 0 u p multidirectional instability protocol post op multidirectional reconstruction phase iii 810 weeks to 1624 weeks. Shoulder instability has varying mechanisms of injury, direction, and severity. Multidirectional instability of the shoulder mdi indian. Is it a unidirectional and so possibly unilateral instability or is it multidirectional suggesting a previous history of dislocationtrauma which could produce joint laxity. There are different degrees of instability including instability and laxity in one direction, multidirectional instability, shoulder subluxation and shoulder dislocation. Classification systems based on clustering signs and symptoms have been.
Only prescribe one exercise from each section at any one time. This is a ball and socket type of joint that permits a wide range of movement. The effects of a conservative rehabilitation program for. When designing a rehabilitation program for patients with an unstable shoulder glenohumeral joint instability, its important that the follow key factors should be considered. The etiologic factors responsible for atraumatic instability of the shoulder joint are not known. Shoulder instability occurs when the head of the arm bone. Active populations that find themselves in an externally rotated hand away from the body and abducted arm away. Nov 29, 2009 this video shows two patients with multidirectional instability in the shoulder. Instability occurs when static and dynamic shoulder stabilizers become incompetent due to congenital or. Current concepts for evaluation and this information is current as of december 2, 2010 reprints and permissions permissions link. Kavanagh, pac this protocol provides general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement.
Shoulder instability update when should we operate. Derby shoulder instability rehabilitation programme. With positive results of any 2 tests or more, you can be fairly confident ruling. The classification of shoulder instability identifying. Shoulder instability is tendency of the glenohumeral joint to sublux or dislocate due to loss of its normal functional or anatomical stabilizers. This site complies with the honcode standard for trustworthy health information. Multidirectional instability twin boro physical therapy. Instability is a common problem to affect the shoulder, particularly in young active individuals. Rehabilitation program of the shoulder physiopedia.
Posted on february, 2018 by scott buxton conservative management is commonly recommended as the firstline treatment for multidirectional instability mdi of the shoulder. Kavanagh, pac this protocol provides general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of. Finally the shoulder may become uncomfortable even with the arm at rest and by then the acute symptoms are brought about with less forceful activities such as turning the steering wheel. Mdi encompasses symptomatic involuntary subluxation or dislocation of the glenohumeral joint in more than 1 direction, including the inferior, anterior, or posterior directions. With positive results of any 2 tests or more, you can be fairly confident ruling in favor of anterior shoulder instability. Acute traumatic anterior shoulder instability in the young active patient is controversial recurrence rates as high as 9295% reported with nonoperative treatment pts with large bony defects at the time of injury have a higher risk for recurrence. This video shows two patients with multidirectional instability in the shoulder. Arthroscopic view of the posterior part of a left shoulder with multidirectional instability obtained from the anterosuperior viewing portal. Some individuals have naturally loose ligaments which can predispose them to instability. The shoulder is the most unstable joint in the human body. Mdi is well described in overhead athletes eg, baseball players, tennis.
1436 1543 893 395 438 973 520 1641 1568 1107 450 1271 354 646 1421 1513 472 858 807 153 293 1301 648 1022 592 634 1092 54 424 54 1355 1258 1553 149 71 422 755 127 330 513 1338 89 457 1048 1366 1161 1318 809