Multidirectional Instability of the Shoulder: Treatment Options and Considerations

Background: Multidirectional Instability (MDI) of the shoulder is a complex condition characterized by excessive movement of the glenohumeral joint in various directions due to laxity of the surrounding ligaments and capsule. This instability can arise from congenital factors or develop over time, often exacerbated by repetitive overhead activities common in athletes. Diagnosis is challenging due to subtle clinical manifestations, which often lack a clear traumatic history, complicating treatment decisions. Initial management typically includes conservative approaches, such as physical therapy aimed at strengthening the rotator cuff and periscapular muscles to enhance dynamic stability. Methods: This study explores various treatment options for MDI, emphasizing non-surgical and surgical methods. Non-surgical treatment focuses on structured rehabilitation programs that involve proprioceptive training and strengthening exercises designed to improve shoulder stability, while surgical interventions are considered for patients who remain symptomatic despite adequate rehabilitation efforts. Discussed techniques include open inferior capsular shift and arthroscopic capsular procedures, both aimed at reducing capsular volume and improving joint stability. Results: Findings indicate that while many patients respond well to conservative management, a subset continues to experience debilitating symptoms that require surgical intervention. Surgical options such as open capsular shift and arthroscopic techniques have shown comparable outcomes, effectively addressing the anatomical deficiencies contributing to instability. Additionally, the success of these interventions is influenced by preoperative factors, including the patient's psychological state and adherence to rehabilitation protocols. Notably, psychological conditions can significantly impact postoperative outcomes, highlighting the need for individualized treatment plans that consider both physical and mental health aspects. Conclusion: Consequently, MDI presents a multifaceted challenge in orthopedic practice that requires a careful balance between conservative management and surgical intervention. While rehabilitation remains the first line of treatment for most patients, individuals with persistent symptoms may benefit from surgical stabilization techniques. Furthermore, the decision to proceed with surgery should be based on the severity of symptoms, anatomical findings, and individual psychosocial factors. Future research should focus on optimizing rehabilitation protocols and understanding the long-term outcomes of various surgical techniques.

کلیدواژه ها:

Multidirectional instability ، shoulder instability ، rehabilitation ، surgical techniques ، capsular plication