Multidirectional Instability and Loose Shoulder in Athletes

Abstract

Multidirectional instability (MDI) is not a common condition in athletes. However, loose or hyperlax shoulders are frequently observed among young athletes, especially throwers. Although shoulder laxity itself is sometimes advantageous in throwing athletes for their performance, excessive laxity or instability, mostly due to repetitive microtrauma or functional deterioration such as scapular dyskinesis, causes problems and can force them out of games. When clinicians see these athletes, besides history, functional evaluation including both flexibility and strength of the trunk and shoulder girdle structure is extremely important because most of the athletes are associated with these functional problems. On the other hand, imaging study to detect anatomical disorders or redundant capsular volume is also important. In addition to functional X-rays, MR arthrography is extremely helpful for detecting ligamentous problems in the glenohumeral joint. Regardless of the presence of anatomical disorder, physical therapy correcting functional degradation of the trunk and shoulder girdle is the first choice of treatment. Many athletes can return to their game only through these physical therapy and exercise-based program. Surgery is indicated only for athletes who remain symptomatic even after successful physical therapy. Arthroscopic stabilization is indicated for these athletes; however, reported return rate after surgical intervention is not necessarily high.