[Multidirectional instabilities and hyperlaxity of the shoulder]

Multidirectional instability is an unusual entity which is frequently missed in the context of unstable shoulder. The diagnosis of this condition may be difficult and is based on demonstration of basic anatomical lesions, usually acquired: capsular distension and damage to the inferior glenohumeral ligament responsible for the inferior component of the instability. Despite a suggestive clinical history, the positive diagnosis is based on a very detailed clinical and radiological examination, performed under general anaesthesia if necessary, in order to define the preferential direction of instability. Conventional and CT arthrography are of undeniable diagnostic and therapeutic value in the context of assessment. First-line treatment should be conservative. When surgery is indicated, it may consist of a combination of bone grafts and capsulorraphy, as described by C.S. Neer.