The inferior capsular-shift procedure for multidirectional instability of the shoulder.

Abstract

Thirty-eight patients (forty-three shoulders) who had disabling multidirectional instability of the shoulder were managed with an inferior capsular-shift procedure through an anterior approach. All of the patients were followed for a minimum of two years. The postoperative range of motion of the shoulders was well maintained. The mean forward elevation was 172 degrees; external rotation, 77 degrees; and internal rotation, to the level of the eighth thoracic vertebra. Four patients (four shoulders) had recurrence of symptomatic and disabling multidirectional instability, but thirty-nine (91 per cent) of the shoulders continued to function well with no instability. Nine patients (24 per cent) continued to have episodes of apprehension, which correlated with the residual inferior and posterior translations found at the postoperative physical examination. Thirty-four patients (thirty-nine shoulders) stated that they were subjectively satisfied with the status of the shoulder, but four patients, in whom the instability had recurred, were not satisfied. Thirty-seven (86 per cent) of the shoulders were judged to have been improved by the procedure, the initial postoperative stability had been maintained, and the result had not deteriorated with time. Six shoulders, however, including the four with recurrent instability, were thought by the patient to have deteriorated with the increased duration of follow-up. It was our experience that if non-operative treatment of multidirectional instability of the shoulder failed, the inferior capsular-shift procedure provided satisfactory objective and subjective results. Failures and recurrences of symptomatic instability occurred early in the postoperative period. There appeared to be no deterioration of the results with follow-up to seventy-one months.