Shoulder Multidirectional Instability
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By: Allan O. Fiesta, PT, DPT, OCS
What is Multidirectional Instability of the Shoulder?
When the shoulder loses it’s stability due to injury or congenital causes, this could lead to a condition known as shoulder instability. There are different classifications of shoulder instability. Depending on the direction of the instability. They are classified as anterior (front), posterior (back), inferior (downward) or multidirectional (a combination of two or more directions).
In multidirectional instability (MDI) of the shoulder, there is subluxation or dislocation of the shoulder joint in two or more directions. This is accompanied by shoulder symptoms and pain. Therefore, it is so important that if you have shoulder multidirectional instability.
Shoulder Multidirectional Instability
The pathology of shoulder MDI is primarily the result of repeated soft tissue injury. These small episodes of trauma cause the joint to become loose. Often this can laxity of the joint is present since birth. MDI of the shoulder joint is somewhat difficult to diagnose because usually, there is no known traumatic event related to this condition. It was long believed that the typical patient presentation for MDI of the shoulder is an adolescent female who is able to sublux one or both shoulders and can do it consistently. However, there is currently not enough evidence to affirm this view.
Anatomy of Shoulder MDI
The Glenohumeral joint, or the shoulder joint is the articulation between the head of the humerus (the long bone which makes your upper arm) and glenoid fossa of the scapula, or the socket of your shoulder blade. Ligaments, joint capsule and muscles strengthen and provide stability to this joint. To learn more about the shoulder joint, please go to this article on Shoulder Anatomy.
What are the Causes of MDI?
- Redundancy of the joint capsule
- Genetic Factors or heredity
- Collagen factors
- Biomechanical factors such as the sport that you play.
What are the Symptoms of MDI?
- Rotator cuff pain (this is usually the first presenting symptom)
- Rotator cuff impingement
- Apprehension with a sensation that the shoulder is going to dislocate or move out of the socket
- Scapulothoracic dyskinesia – Defined as the uncontrolled, involuntary movement of the muscles around the shoulder blade
- Deficits in shoulder proprioception – Impairment in the body’s ability to perceive or be aware of the position and movement of the shoulder and the surrounding structures around the shoulder
- Weakness of the shoulder and scapular muscles
- Neuropathic or nerve pain which could result from the excessive translation or movement of bony structure of the shoulder (humeral head) imposed on nerve tissues around the shoulder
How do You Treat MDI of the Shoulder?
Multidirectional instability of the shoulder as well as the other directional instabilities is treated through physical therapy. Goals of intervention for shoulder MDI are restoration of dynamic stability. The goal is to improve the control of the shoulder by strengthening the muscles around the shoulder joint. These muscles or dynamic stabilizers function to contain the humeral head within the glenoid.
During acute onset of shoulder pain, a brief period of immobilization using a sling may be necessary for comfort. One should avoid prolonged immobilization because the shoulder joint has the tendency to stiffen quickly with sling use.
Upright row for MDI
If you are diagnosed with multidirectional instability of the shoulder, you will benefit from a referral to physical therapy. Your physical therapist can teach you specific exercises, which will address the instability such as but not limited to:
- Scapular stability exercises
- Closed-chain exercises
- Early exercises to rehabilitate scapular dyskinesis
These exercises aim to strengthen the muscles around your shoulder and shoulder blades to improve shoulder stability. Your physical therapist is the qualified professional to prescribe you with the most appropriate exercises and progress these exercises to reach your rehabilitation goals.
Also if you have recently had a shoulder surgery watch our video on How to Properly Put on an UltraSling 4 or Dressing the Upper Body After an Injury or Surgery
Related articles: Swimmer’s Shoulder and Thumbs Up Shoulder Exercises.
Book an Appointment with The Jacksonville Orthopaedic Institute Today!
JOI Physicians continue to offer online new patient appointments.This is another option to make it more convenient to make new patient appointments with less phone hold times. Follow the link below to select your JOI MD and schedule online.
You can still call 904-JOI-2000 to make new patient JOI Physician Appointments if that is your preference.
To make appointments with JOI Rehab, please call 904-858-7045.
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