Table of ContentsView AllTable of ContentsOverview of Shoulder InstabilityCauses of MDISymptomsDiagnosisTreatmentSurgery
Table of ContentsView All
View All
Table of Contents
Overview of Shoulder Instability
Causes of MDI
Symptoms
Diagnosis
Treatment
Surgery
Theshoulder joint is a complex jointthat allows more motion than any other joint in the body. This joint mobility is usually stable and well controlled.
But some people have shoulder joints that are too mobile. This may make the shoulder more likely to move out of joint. When the shoulder does not sit as tightly as it should within the joint, it’s calledshoulder instability.
This article will discuss the multi-directional instability of the shoulder, also known as “swimmer’s shoulder,” a condition where the shoulder joint is too loose.Keep reading to learn what causes multi-directional instability, its symptoms, and how your doctor diagnoses and treats it.
The shoulder is a ball-and-socket joint. Sometimes the ball comes partially out of the socket—a condition described as ashoulder subluxation. And if the ball comes completely out of the socket, this is ashoulder dislocation.
There aretwo general typesof shoulder instability:
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There are three factors that contribute to the stability of any joint in the body. These include:
When doctors diagnose multi-directional instability in the shoulder, they consider your medical history. They also do a thorough medical exam.Your doctor will move your arm around in various positions to determine how mobile your shoulder is.
Your doctor may order tests of your shoulder. There are several tests to properly diagnosis multidirectional instability and some of those include:
The treatment of MDI is different from treatment for traumatic instability of the shoulder. Usually, people can recover from multi-directional instabilitywith non-surgical treatments. This includes high-level, competitive athletes.
Treatment should focus on strengthening the muscles and tendons of the shoulder joint. This is done with physical therapy.
Multi-directional instability can also happen when the shoulder blade movements are not well-coordinated with the shoulder movements. Shoulder joint function can improve when you restore normal shoulder blade motion with strengthening exercises.
Many studies have shown that most people can recover from multi-directional instability with a focused shoulder rehab program.Many patients who undergo such a program will report good results. However, some people don’t improve and may need to have shoulder surgery.
RecapMost of the time, people can recover from multi-directional instability (MDI) without getting surgery. They do this through strengthening exercises. These exercises gradually improve shoulder blade motion while making the muscles and tendons stronger. When strengthening exercises don’t work, the doctor may recommend surgery.
Recap
Most of the time, people can recover from multi-directional instability (MDI) without getting surgery. They do this through strengthening exercises. These exercises gradually improve shoulder blade motion while making the muscles and tendons stronger. When strengthening exercises don’t work, the doctor may recommend surgery.
Surgical procedures for MDI are considered for patients who continue to have symptoms of shoulder instability despite non-surgical treatments. Usually, the surgery involves tightening the ligaments that surround the shoulder. This can be done with arthroscopic surgery or standard surgical incisions.
The best surgery for multi-directional instability is called a capsular shift or capsular plication. These are procedures that tighten the shoulder capsule, a group of ligaments that surround the ball-and-socket joint. The doctor may also recommend a rotator interval closure, a procedure that closes the gap between two of the rotator cuff muscles.
Thermal shrinkage, using heat probes to burn soft tissue in the shoulder to tighten the joint capsule, is a procedure that is no longer used but was popular not long ago. Thermal shrinkage procedures had very poor results and often required additional surgery. If you have had thermal shrinkage treatment, you might need surgery if your symptoms return.
People usually receive several months of rehab after surgery for multi-directional instability. Initially, after surgery, the shoulder is kept from moving to allow the tightened tissues to heal. For example, the doctor may have you wear a sling.
Summary
Multi-directional instability (MDI) happens when the shoulder joint is loose in the socket. You may experience pain or instability when reaching overhead. You may even feel a popping in your shoulder joint. Sometimes your shoulder may feel like it’s slipping out of its position. Fortunately, your doctor can diagnose MDI and create a treatment plan to help you recover from this medical condition.
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.De Martino I, Rodeo SA.The swimmer’s shoulder: multi-directional instability.Current Reviews in Musculoskeletal Medicine. 2018;11(2):167-171. doi. 10.1007/s12178-018-9485-0.De Martino I, Rodeo SA.The swimmer’s shoulder: multi-directional instability.Curr Rev Musculoskelet Med.2018;11(2):167-171. doi: 10.1007/s12178-018-9485-0Bishop ME, Patel H, Erickson BJ, Dodson CC.Multidirectional instability in female athletes.Ann Joint. 2021;0:0-0. doi:10.21037/aoj-20-33Schenk TJ, Brems JJ.Multidirectional instability of the shoulder: pathophysiology, diagnosis, and management.Journal of the American Academy of Orthopedic Surgeons. 1998;6(1):65-72. doi:10.5435/00124635-199801000-00007American Academy of Orthopedic Surgeons.Shoulder pain and common shoulder problems - OrthoInfo.Best MJ, Tanaka MJ.Multidirectional instability of the shoulder: treatment options and considerations.Sports Medicine and Arthroscopy Review. 2018;26(3):113-119. doi:10.1097/JSA.0000000000000199Friedman LGM, Lafosse L, Garrigues GE.Global perspectives on management of shoulder instability.Orthopedic Clinics of North America. 2020;51(2):241-258. doi: 10.1016/j.ocl.2019.11.008Additional ReadingGaskill TR, Taylor C (Ret) DC, Millett PJ.Management of multidirectional instability of the shoulder:American Academy of Orthopaedic Surgeon. 2011;19(12):758-767. doi:10.5435/00124635-201112000-00006
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.De Martino I, Rodeo SA.The swimmer’s shoulder: multi-directional instability.Current Reviews in Musculoskeletal Medicine. 2018;11(2):167-171. doi. 10.1007/s12178-018-9485-0.De Martino I, Rodeo SA.The swimmer’s shoulder: multi-directional instability.Curr Rev Musculoskelet Med.2018;11(2):167-171. doi: 10.1007/s12178-018-9485-0Bishop ME, Patel H, Erickson BJ, Dodson CC.Multidirectional instability in female athletes.Ann Joint. 2021;0:0-0. doi:10.21037/aoj-20-33Schenk TJ, Brems JJ.Multidirectional instability of the shoulder: pathophysiology, diagnosis, and management.Journal of the American Academy of Orthopedic Surgeons. 1998;6(1):65-72. doi:10.5435/00124635-199801000-00007American Academy of Orthopedic Surgeons.Shoulder pain and common shoulder problems - OrthoInfo.Best MJ, Tanaka MJ.Multidirectional instability of the shoulder: treatment options and considerations.Sports Medicine and Arthroscopy Review. 2018;26(3):113-119. doi:10.1097/JSA.0000000000000199Friedman LGM, Lafosse L, Garrigues GE.Global perspectives on management of shoulder instability.Orthopedic Clinics of North America. 2020;51(2):241-258. doi: 10.1016/j.ocl.2019.11.008Additional ReadingGaskill TR, Taylor C (Ret) DC, Millett PJ.Management of multidirectional instability of the shoulder:American Academy of Orthopaedic Surgeon. 2011;19(12):758-767. doi:10.5435/00124635-201112000-00006
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
De Martino I, Rodeo SA.The swimmer’s shoulder: multi-directional instability.Current Reviews in Musculoskeletal Medicine. 2018;11(2):167-171. doi. 10.1007/s12178-018-9485-0.De Martino I, Rodeo SA.The swimmer’s shoulder: multi-directional instability.Curr Rev Musculoskelet Med.2018;11(2):167-171. doi: 10.1007/s12178-018-9485-0Bishop ME, Patel H, Erickson BJ, Dodson CC.Multidirectional instability in female athletes.Ann Joint. 2021;0:0-0. doi:10.21037/aoj-20-33Schenk TJ, Brems JJ.Multidirectional instability of the shoulder: pathophysiology, diagnosis, and management.Journal of the American Academy of Orthopedic Surgeons. 1998;6(1):65-72. doi:10.5435/00124635-199801000-00007American Academy of Orthopedic Surgeons.Shoulder pain and common shoulder problems - OrthoInfo.Best MJ, Tanaka MJ.Multidirectional instability of the shoulder: treatment options and considerations.Sports Medicine and Arthroscopy Review. 2018;26(3):113-119. doi:10.1097/JSA.0000000000000199Friedman LGM, Lafosse L, Garrigues GE.Global perspectives on management of shoulder instability.Orthopedic Clinics of North America. 2020;51(2):241-258. doi: 10.1016/j.ocl.2019.11.008
De Martino I, Rodeo SA.The swimmer’s shoulder: multi-directional instability.Current Reviews in Musculoskeletal Medicine. 2018;11(2):167-171. doi. 10.1007/s12178-018-9485-0.
De Martino I, Rodeo SA.The swimmer’s shoulder: multi-directional instability.Curr Rev Musculoskelet Med.2018;11(2):167-171. doi: 10.1007/s12178-018-9485-0
Bishop ME, Patel H, Erickson BJ, Dodson CC.Multidirectional instability in female athletes.Ann Joint. 2021;0:0-0. doi:10.21037/aoj-20-33
Schenk TJ, Brems JJ.Multidirectional instability of the shoulder: pathophysiology, diagnosis, and management.Journal of the American Academy of Orthopedic Surgeons. 1998;6(1):65-72. doi:10.5435/00124635-199801000-00007
American Academy of Orthopedic Surgeons.Shoulder pain and common shoulder problems - OrthoInfo.
Best MJ, Tanaka MJ.Multidirectional instability of the shoulder: treatment options and considerations.Sports Medicine and Arthroscopy Review. 2018;26(3):113-119. doi:10.1097/JSA.0000000000000199
Friedman LGM, Lafosse L, Garrigues GE.Global perspectives on management of shoulder instability.Orthopedic Clinics of North America. 2020;51(2):241-258. doi: 10.1016/j.ocl.2019.11.008
Gaskill TR, Taylor C (Ret) DC, Millett PJ.Management of multidirectional instability of the shoulder:American Academy of Orthopaedic Surgeon. 2011;19(12):758-767. doi:10.5435/00124635-201112000-00006
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