Multidirectional instability of the shoulder (MDI) – focus on non-operative management

Abstract

Background: The aetiology of multidirectional instability (MDI) is primarily laxity of the capsule and capsular thickenings. The other factors include dysfunction of dynamic stabilisers with loss of neuromuscular co-ordination, and altered neuromuscular control of activation patterns of rotator cuff muscles and scapular stabilisers.

Methods: A literature search of the following databases, MEDLINE, CINAHL, EMBASE, Cochrane, AMED and Science direct was carried out. In addition, reference lists were hand searched for relevant papers. Seven studies qualified for inclusion and their methodological quality assessed with a risk of bias tool. A systematic review was done using narrative synthesis as there was not enough homogeneity in the studies to undertake a meta-analysis.

Results: The studies were of low quality with a high risk of bias but showed consistent evidence that retraining neuromuscular control, proprioception and strengthening of dynamic stabilisers can compensate for deficit in static stabiliser function. About 60–100% success rate can be achieved with long-term compliance with the exercise programme being important for maintaining the results.

Conclusions: Exercise-based therapy involving strengthening, proprioception and plyometric training is appropriate in the initial management of patients with MDI. The programme should be continued for about 6 months and maintained for the long term.

Keywords:

• Shoulder
• multidirectional instability
• instability
• physiotherapy
• physical therapy
• non-operative treatment
• gleno-humeral
• rehabilitation

Disclosure statement

No potential conflict of interests was reported by the authors.