Narrative review of multidirectional shoulder instability from the Cleveland Clinic group. It covers the pathophysiology, diagnostic criteria, and the distinction between laxity and instability. It lays out nonoperative rehabilitation and the open inferior capsular shift for patients who fail conservative care.
The board-critical rule: laxity is not instability. A shoulder that translates in three directions but produces no symptoms has laxity only. MDI requires symptom reproduction on top of that translation.
When you see a young patient in their third decade with atraumatic, midrange, pain-dominant shoulder complaints and bilateral laxity, think AMBRII, not TUBS. The chief complaint is usually pain, not a sense of dislocation.
Manage the vast majority nonoperatively. A structured rotator cuff and scapular program run for at least 6 months restores concavity compression and neuromotor control, the dynamic stabilizers that lax shoulders depend on in midrange.
Reserve surgery for compliant patients who still fail rehab. The open inferior capsular shift addresses both the global capsular pouch and the rotator interval defect. Two pitfalls: never operate on a voluntary dislocator with emotional problems, and recognize Ehlers-Danlos or Marfan, since soft-tissue repairs fail in these connective tissue disorders.
Narrative review of multidirectional shoulder instability from the Cleveland Clinic group. It covers the pathophysiology, diagnostic criteria, and the distinction between laxity and instability. It lays out nonoperative rehabilitation and the open inferior capsular shift for patients who fail conservative care.
The board-critical rule: laxity is not instability. A shoulder that translates in three directions but produces no symptoms has laxity only. MDI requires symptom reproduction on top of that translation.
When you see a young patient in their third decade with atraumatic, midrange, pain-dominant shoulder complaints and bilateral laxity, think AMBRII, not TUBS. The chief complaint is usually pain, not a sense of dislocation.
Manage the vast majority nonoperatively. A structured rotator cuff and scapular program run for at least 6 months restores concavity compression and neuromotor control, the dynamic stabilizers that lax shoulders depend on in midrange.
Reserve surgery for compliant patients who still fail rehab. The open inferior capsular shift addresses both the global capsular pouch and the rotator interval defect. Two pitfalls: never operate on a voluntary dislocator with emotional problems, and recognize Ehlers-Danlos or Marfan, since soft-tissue repairs fail in these connective tissue disorders.