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Multidirectional Shoulder Instability: Treatment.

Miguel Angel Ruiz Ibán1, Jorge Díaz Heredia1, Miguel García Navlet2

  • 1Hospital Universitario Ramon y Cajal, Cta Colmenar km9, 100, Madrid, 28046, Spain.

The Open Orthopaedics Journal
|October 6, 2017
PubMed
Summary

Multidirectional shoulder instability often improves with physical therapy. Surgery, such as capsular plication, is recommended if conservative treatment fails after three months.

Keywords:
Arthroscopic capsular plicationConservative treatmentMultidirectional instabilityOpen capsular shiftShoulder

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Area of Science:

  • Orthopedic Surgery
  • Sports Medicine
  • Rehabilitation Science

Background:

  • Multidirectional shoulder instability presents complex treatment challenges.
  • Understanding patient-specific factors like hyperlaxity, anatomy, and muscle balance is crucial.
  • Identifying traumatic incidents is important for managing shoulder instability.

Purpose of the Study:

  • To review the literature on managing multidirectional shoulder instability.
  • To compare conservative and surgical treatment options for shoulder instability.
  • To identify prognostic factors for conservative shoulder instability treatment.

Main Methods:

  • Comprehensive literature review of indexed English and Spanish journals.
  • Focused analysis on both surgical and conservative management strategies.
  • Evaluation of treatment outcomes for shoulder instability.

Main Results:

  • Conservative physical therapy, focusing on dynamic stabilizer strength and balance, is the primary treatment for most patients.
  • Poor prognostic factors for conservative treatment include significant trauma, anatomical issues, and psychological problems.
  • Surgical options like open capsular shift or arthroscopic capsular plication offer similar outcomes when conservative care fails after three months; thermal/laser capsulorrhaphy is not recommended.

Conclusions:

  • Multidirectional shoulder instability requires a tailored treatment approach.
  • Conservative management strengthening dynamic stabilizers is the initial approach.
  • Surgical intervention (open or arthroscopic capsular plication) is indicated for persistent cases.