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Multidirectional shoulder instability/ dislocation

What is Multidirectional Shoulder Instability?

This is another form of instability whereby shoulder can dislocate either in the front or back or down. Often this is as a result of inherently lax ligaments. The dislocation occurs even without any injury or only with minor injury. Some of them even can dislocate habitually.

What causes it?

In this group of individuals the ligaments are lax by birth. This can be part of other disease conditions like Marfans syndrome or other collagen abnormalities, but it can also occur for no defined cause. This is common in girls as part of their development around puberty due to the hormonal influence. Some of those who can dislocate are also good in gymnastics as their body can bend so easily.

What are the symptoms/effects?

They can have multiple dislocations of the shoulder joint. They can also come with knee cap dislocations or other joint dislocations. Some of the dislocations are painful, and at times they don’t have that much pain and hence they can relocate the joint themselves without attending to see a doctor.

How is it diagnosed?

A thorough physical assessment and investigation such as X ray/MRI as needed will be done.

Treatment:

A general strengthening exercises to build up the muscles around the shoulder joint especially the posterior muscles will help to gain more control and confidence over the shoulder joint. A systematic physiotherapy will be useful for that.

If the dislocation is painful and does not get better with physiotherapy then a surgery to tighten the capsule of the shoulder joint may be beneficial. The name of the surgery is “Circumferential capsular plication/ Rotator interval closure and Radiofrequency capsulorrhaphy”. The success of this surgery is not as good as a surgery performed for the anterior shoulder instability occurring as a result of trauma. Hence it is only advised if full course of physiotherapy didn’t help.