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Multidirectional Instability, Shoulder
Michael J. Tuite, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Multidirectional instability (MDI)
            • AMBRII (mnemonic for MDI features)
              • Atraumatic
              • Multidirectional
              • Bilateral
              • Rehabilitation is usual treatment
              • Inferior capsule: If surgery, capsule is tightened
              • Interval (rotator) is also tightened/reconstructed if surgery
          • Synonyms

            • Recurrent atraumatic instability
          • Definitions

            • Pain from excessive anterior, posterior, and inferior humeral head translation without labral tear

          IMAGING

          • General Features

            • MR Findings

              • Imaging Recommendations

                DIFFERENTIAL DIAGNOSIS

                  PATHOLOGY

                  • General Features

                    • Gross Pathologic & Surgical Features

                      CLINICAL ISSUES

                      • Presentation

                        • Demographics

                          • Natural History & Prognosis

                            • Treatment

                              DIAGNOSTIC CHECKLIST

                              • Consider

                                • Reporting Tips

                                  Selected References

                                  1. Longo UG et al: Multidirectional instability of the shoulder: a systematic review. Arthroscopy. 31(12):2431-43, 2015
                                  2. Burt DM: Arthroscopic repair of inferior labrum from anterior to posterior lesions associated with multidirectional instability of the shoulder. Arthrosc Tech. 3(6):e727-30, 2014
                                  3. Schaeffeler C et al: MR arthrography including abduction and external rotation images in the assessment of atraumatic multidirectional instability of the shoulder. Eur Radiol. 24(6):1376-85, 2014
                                  4. Lee HJ et al: Multidirectional instability of the shoulder: rotator interval dimension and capsular laxity evaluation using MR arthrography. Skeletal Radiol. 42(2):231-8, 2013
                                  5. von Eisenhart-Rothe R et al: Simultaneous 3D assessment of glenohumeral shape, humeral head centering, and scapular positioning in atraumatic shoulder instability: a magnetic resonance-based in vivo analysis. Am J Sports Med. 38(2):375-82, 2010
                                  6. Provencher MT et al: An analysis of the rotator interval in patients with anterior, posterior, and multidirectional shoulder instability. Arthroscopy. 24(8):921-9, 2008
                                  7. Kim SH et al: Loss of chondrolabral containment of the glenohumeral joint in atraumatic posteroinferior multidirectional instability. J Bone Joint Surg Am. 87(1):92-8, 2005
                                  8. Inui H et al: Three-dimensional relationship of the glenohumeral joint in the elevated position in shoulders with multidirectional instability. J Shoulder Elbow Surg. 11(5):510-5, 2002
                                  9. Levine WN et al: Treatment of the athlete with multidirectional shoulder instability. Orthop Clin North Am. 32(3):475-84, 2001
                                  10. An YH et al: Multidirectional instability of the glenohumeral joint. Orthop Clin North Am. 31(2):275-85, 2000
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Top Differential Diagnoses

                                        • Clinical Issues

                                          TERMINOLOGY

                                          • Abbreviations

                                            • Multidirectional instability (MDI)
                                            • AMBRII (mnemonic for MDI features)
                                              • Atraumatic
                                              • Multidirectional
                                              • Bilateral
                                              • Rehabilitation is usual treatment
                                              • Inferior capsule: If surgery, capsule is tightened
                                              • Interval (rotator) is also tightened/reconstructed if surgery
                                          • Synonyms

                                            • Recurrent atraumatic instability
                                          • Definitions

                                            • Pain from excessive anterior, posterior, and inferior humeral head translation without labral tear

                                          IMAGING

                                          • General Features

                                            • MR Findings

                                              • Imaging Recommendations

                                                DIFFERENTIAL DIAGNOSIS

                                                  PATHOLOGY

                                                  • General Features

                                                    • Gross Pathologic & Surgical Features

                                                      CLINICAL ISSUES

                                                      • Presentation

                                                        • Demographics

                                                          • Natural History & Prognosis

                                                            • Treatment

                                                              DIAGNOSTIC CHECKLIST

                                                              • Consider

                                                                • Reporting Tips

                                                                  Selected References

                                                                  1. Longo UG et al: Multidirectional instability of the shoulder: a systematic review. Arthroscopy. 31(12):2431-43, 2015
                                                                  2. Burt DM: Arthroscopic repair of inferior labrum from anterior to posterior lesions associated with multidirectional instability of the shoulder. Arthrosc Tech. 3(6):e727-30, 2014
                                                                  3. Schaeffeler C et al: MR arthrography including abduction and external rotation images in the assessment of atraumatic multidirectional instability of the shoulder. Eur Radiol. 24(6):1376-85, 2014
                                                                  4. Lee HJ et al: Multidirectional instability of the shoulder: rotator interval dimension and capsular laxity evaluation using MR arthrography. Skeletal Radiol. 42(2):231-8, 2013
                                                                  5. von Eisenhart-Rothe R et al: Simultaneous 3D assessment of glenohumeral shape, humeral head centering, and scapular positioning in atraumatic shoulder instability: a magnetic resonance-based in vivo analysis. Am J Sports Med. 38(2):375-82, 2010
                                                                  6. Provencher MT et al: An analysis of the rotator interval in patients with anterior, posterior, and multidirectional shoulder instability. Arthroscopy. 24(8):921-9, 2008
                                                                  7. Kim SH et al: Loss of chondrolabral containment of the glenohumeral joint in atraumatic posteroinferior multidirectional instability. J Bone Joint Surg Am. 87(1):92-8, 2005
                                                                  8. Inui H et al: Three-dimensional relationship of the glenohumeral joint in the elevated position in shoulders with multidirectional instability. J Shoulder Elbow Surg. 11(5):510-5, 2002
                                                                  9. Levine WN et al: Treatment of the athlete with multidirectional shoulder instability. Orthop Clin North Am. 32(3):475-84, 2001
                                                                  10. An YH et al: Multidirectional instability of the glenohumeral joint. Orthop Clin North Am. 31(2):275-85, 2000