Severe Multidirectional Instability of the Gleno-Humeral Joint

jAnuAry 2010 45 © 2010 Human Kinetics ATT 15(1), pp. 45-49 ULTIDIRECTIONAL instability (MDI) of the gleno-humeral (GH) joint is defined as symptomatic instability in two or more directions. This condition is primarily diagnosed on the basis of clinical findings, which requires a thorough patient history and physical examination.1-3 MDI typically presents one of three distinct patterns: (a) antero-inferior dislocation with posterior subluxation,( b) postero-inferior dislocation with anterior subluxation, and (c) antero-posteroinferior dislocation.1-4 Patients with MDI often present GH laxity, symptomatic multi-planar translation, and impingement syndrome.3,5 The chief complaint is often generalized shoulder pain that is exacerbated by overhead activities and specific arm positions. The GH joint is generally asymptomatic at rest in the anatomical position.1-3 Clinical findings may include (a) a positive sulcus sign (at least 2mm), (b) positive anterior and posterior apprehension tests, (c) a positive Neer or Hawkins-Kennedy test, and (d) joint glide hypermobility.3,6,7 MDI lacks a consistent definition in the literature, which complicates interpretation of epidemiologic studies.1-4,8,9 Owens et al.9 reported that females had a greater incidence of MDI events than males had. This difference is likely due to differences in joint laxity between men and women.10 Initial management of MDI consists of activity modification and rehabilitation that is focused on strengthening the rotator cuff (RTC) and scapular stabilizers and improvement of GH joint proprioception.1,3,7,11,12 As many as 89% of patients with MDI may respond favorably to rehabilitation and thereby avoid a surgical intervention.1,13 This report reviews the clinical presentation of a patient who had prolonged neurological and functional impairments associated with undiagnosed MDI. The cause of dysfunction was confirmed to be GH laxity, rather than psychosomatic or neurological factors. The patient was diagnosed with severe MDI in all three planes. An open inferior capsular shift was performed to address capsular redundancy.1,7,11 This surgical procedure has been reported to have an 86% success rate at 38 months postsurgery.1 The patient was able to return to asymptomatic activities of daily living (ADLs).