Neer and Foster's 1980 case series introduced the inferior capsular shift for involuntary inferior and multidirectional shoulder instability. It asks whether one capsular volume-reduction procedure can correct instability in all planes, and whether MDI deserves its own diagnostic category. The series included 40 shoulders in 36 patients who had failed prior surgery or lacked a clear diagnosis.
When you see a patient with instability in multiple directions, a positive inferior sulcus sign, and positive load-and-shift both anteriorly and posteriorly with no discrete traumatic event, think MDI and reach for volume reduction rather than a Bankart repair.
This paper's central mental model: the pathology is global capsular redundancy, so tightening one focal spot leaves inferior laxity behind and can even drive a fixed dislocation the opposite direction with arthritis.
Management follows a clear sequence. A minimum of rotator cuff and deltoid strengthening comes first. If that fails after at least a year of disability, an inferior capsular shift is done through the approach matching the dominant direction of instability.
Two Neer principles have not changed: voluntary dislocators are excluded from surgery, and a coexisting Bankart lesion must be repaired at the time of the shift or the repair fails.
Neer and Foster's 1980 case series introduced the inferior capsular shift for involuntary inferior and multidirectional shoulder instability. It asks whether one capsular volume-reduction procedure can correct instability in all planes, and whether MDI deserves its own diagnostic category. The series included 40 shoulders in 36 patients who had failed prior surgery or lacked a clear diagnosis.
When you see a patient with instability in multiple directions, a positive inferior sulcus sign, and positive load-and-shift both anteriorly and posteriorly with no discrete traumatic event, think MDI and reach for volume reduction rather than a Bankart repair.
This paper's central mental model: the pathology is global capsular redundancy, so tightening one focal spot leaves inferior laxity behind and can even drive a fixed dislocation the opposite direction with arthritis.
Management follows a clear sequence. A minimum of rotator cuff and deltoid strengthening comes first. If that fails after at least a year of disability, an inferior capsular shift is done through the approach matching the dominant direction of instability.
Two Neer principles have not changed: voluntary dislocators are excluded from surgery, and a coexisting Bankart lesion must be repaired at the time of the shift or the repair fails.