Search Our Scientific Publications & Authors

Am J Sports Med 2019 Mar 30;47(3):682-687. Epub 2019 Jan 30.

The Steadman Clinic, Vail, Colorado, USA.

Background:: Anterior and posterior shoulder instabilities are entirely different entities. The presenting complaints and symptoms vastly differ between patients with these 2 conditions, and a clear understanding of these differences can help guide effective treatment.

Purpose:: To compare a matched cohort of patients with anterior and posterior instability to clearly outline the differences in the initial presenting history and overall outcomes after arthroscopic stabilization. Read More

J Shoulder Elbow Surg 2019 Jan 19;28(1):95-101. Epub 2018 Oct 19.

Vanderbilt Sports Medicine, Nashville, TN, USA.

Hypothesis: The purpose of this multicenter epidemiologic study was to determine the distribution of patients within the Frequency, Etiology, Direction, and Severity (FEDS) classification system to determine which categories are of clinical importance.

Methods: Shoulder instability patients were identified using International Classification of Diseases, Ninth Revision coding data from 3 separate institutions from 2005-2010. Data were collected retrospectively. Read More

Biomed Res Int 2018 18;2018:8961805. Epub 2018 Jul 18.

Shoulder and Elbow Unit, "D. Cervesi" Hospital, Cattolica-AUSL della Romagna, Ambito Rimini, Italy.

Background: Recurrent shoulder dislocations occur much more frequently in adolescents than in the older population but a clear explanation of this incidence does not exist. The aim of the present study was to define the age-related distribution of the elastic fibers (EFs) in the shoulder capsule's extracellular matrix as a factor influencing shoulder instability.

Materials And Methods: Biopsy specimens were obtained from the shoulder capsule of patients divided preoperatively into three groups: Group 1 consisted of 10 male patients undergoing surgery for unidirectional traumatic anterior instability (TUBS); Group 2 consisted of 10 male patients undergoing surgery for multidirectional instability (MDI); Group 3 represents the control, including 10 patients with no history of instability. Read More

J Orthop Trauma 2018 Aug;32 Suppl 1:S4-S5

Cooper University Hospital, Camden, NJ.

Purpose: The purpose of this video is to demonstrate the surgical technique of a shoulder arthrodesis for a patient with multidirectional instability and multiple failed previous surgeries.

Methods: A 25-year-old woman with a long history of left shoulder multidirectional instability in the setting of Ehlers-Danlos syndrome is shown undergoing a shoulder arthrodesis. The video demonstrates intraoperative patient positioning, approach, shoulder osseous and articular preparation, implant placement (narrow 4. Read More

Am J Sports Med 2018 Aug 9;46(10):2449-2456. Epub 2018 Jul 9.

Investigation performed at the Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.

Background: Intra-articular glenohumeral joint changes frequently occur after shoulder instability events.

Purpose: (1) To compare demographic characteristics, baseline patient-reported outcomes, and intraoperative findings for patients undergoing primary or revision shoulder stabilization surgery and (2) to determine the incidence of glenohumeral bone and cartilage lesions in this population while identifying factors independently associated with these lesions.

Study Design: Cross-sectional study; Level of evidence, 3. Read More

J Am Acad Orthop Surg 2018 Mar;26(6):204-213

From Elite Sports Medicine, Connecticut Children's Medical Center, Farmington, CT (Dr. Gelber), the Cleveland Indians Professional Baseball Organization, Cleveland, OH (Dr. Soloff), the Cleveland Clinic Sports Health Center, and the Orthopedic and Rheumatologic Institute, Cleveland (Dr. Schickendantz).

Overhead athletes subject their shoulders to extreme repetitive torque, compression, distraction, and translation stresses, resulting in adaptive changes of the soft tissues and osseous structures within and around the glenohumeral joint. These anatomic adaptations result in biomechanical enhancements, which improve performance. Understanding the difference between necessary and adaptive changes and pathologic findings is critical when making treatment decisions. Read More

J Shoulder Elbow Surg 2018 Apr 18;27(4):624-634. Epub 2017 Dec 18.

Sports Medicine & Shoulder Service, Hospital for Special Surgery, New York, NY, USA.

Background: Shoulder capsular plication aims to restore the passive stabilization of the glenohumeral capsule; however, high reported recurrence rates warrant concern. Improving our understanding of the clinical laxity assessment across 2 dimensions, capsular integrity and shoulder position, can help toward the standardization of clinical tools. Our objectives were to test and describe glenohumeral laxity across 5 capsular tension levels and 4 humeral position levels and describe tension-position interplay. Read More

Am J Sports Med 2018 01 19;46(1):87-97. Epub 2017 Oct 19.

Department of Rehabilitation, Nutrition and Sport, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.

Background: The recommended initial treatment for multidirectional instability (MDI) of the shoulder is a rehabilitation program, yet there is very low-quality evidence to support this approach. Purpose/Hypothesis: The purpose was to compare the Watson MDI program and Rockwood Instability program among patients with nontraumatic, nonstructural MDI. The hypothesis was that the Watson MDI program would produce clinically and statistically superior outcomes over the Rockwood Instability program. Read More

Ann Phys Rehabil Med 2018 Jan 5;61(1):46-53. Epub 2017 Oct 5.

Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.

Background: The global range of motion of the arm is the result of a coordinated motion of the shoulder complex including glenohumeral (GH), scapulothoracic, sternoclavicular and acromioclavicular joints.

Methods: This study is a non-systematic review of kinematic patterns in degenerated shoulders. It is a based on our own research on the kinematics of the shoulder complex and clinical experience. Read More

Open Orthop J 2017 31;11:826-847. Epub 2017 Aug 31.

Department of Trauma and Orthopaedic Surgery, Hospital Universitario y Politécnico La Fe, Valencia, Spain.

Background: It is estimated that approximately 5% of glenohumeral instabilities are posterior. There are a number of controversies regarding therapeutic approaches for these patients.

Methods: We analyse the main surgery alternatives for the treatment of the posterior shoulder instability. Read More

J Shoulder Elbow Surg 2018 Jan 22;27(1):104-111. Epub 2017 Sep 22.

La Trobe Sport and Exercise Medicine Centre, La Trobe University, VIC, Australia. Electronic address:

Background: Conservative management is commonly recommended as the first-line treatment for multidirectional instability (MDI) of the shoulder. Despite this, the evidence for efficacy of treatment is limited, and until recently, guidance for clinicians on conservative rehabilitation programs has been inadequate. This study evaluated the effectiveness of a physiotherapy-led exercise program for participants with MDI. Read More

Sports Med Arthrosc Rev 2017 Sep;25(3):123-130

*Department of Orthopaedic Surgery, Walter Reed National Military Medical Center †Uniformed Services University of Health Sciences, Bethesda, MD.

The glenohumeral joint is one of the most frequently dislocated joints and occurs with increasing frequency in collision and contact athletes, especially those in sports that repeatedly place the glenohumeral joint in a position of vulnerability. Nonoperative management of shoulder instability especially in young contact athletes results in unacceptably high recurrence rates; thus, early surgical stabilization has become commonplace. Surgical stabilization typically yields acceptable outcomes. Read More

Sports Med Arthrosc Rev 2017 Sep;25(3):e12-e17

Department of Orthopaedic Surgery at West Point; Keller Army Community Hospital, West Point, NY.

Glenohumeral instability is one of the more common conditions seen by sports medicine physicians, especially in young, active athletes. The associated anatomy of the glenohumeral joint (the shallow nature of the glenoid and the increased motion it allows) make the shoulder more prone to instability events as compared with other joints. Although traumatic dislocations or instability events associated with acute labral tears (ie, Bankart lesions) are well described in the literature, there exists other special shoulder conditions that are also associated with shoulder instability: superior labrum anterior/posterior (SLAP) tears, pan-labral tears, and multidirectional instability. Read More

J Hand Ther 2017 Apr - Jun;30(2):175-181. Epub 2017 May 30.

Department of Rehabilitation, Nutrition and Sport, La Trobe University, College of Science, Health and Engineering, Bundoora, Victoria, Australia.

Multidirectional instability of the shoulder is a type of glenohumeral joint shoulder instability. There are discrepancies in the definition and classification of this condition, which can make diagnosis and treatment selection challenging. Knowledge of contributing factors, the typical clinical presentation, and current best evidence for treatment options can assist in the diagnosis and appropriate treatment selection for this pathology. Read More

Arthrosc Tech 2016 Aug 4;5(4):e685-e690. Epub 2016 Jul 4.

Department of Orthopaedic Surgery, Guthrie Army Health Clinic, Fort Drum, New York, U.S.A.

Inferior labrum anterior to posterior lesions as an isolated injury or as part of an extensive traumatic labral tear are uncommon and may present as multidirectional instability of the shoulder. These lesions are hard to visualize radiographically and many times are diagnosed only during surgery. Arthroscopic repair of these lesions requires advanced arthroscopic skills and is required for restoration of glenohumeral stability. Read More

BMJ Open 2016 09 12;6(9):e013083. Epub 2016 Sep 12.

Department of Rehabilitation, Nutrition and Sport, La Trobe University, Bundoora, Victoria, Australia.

Introduction: The most commonly recommended treatment for multidirectional instability (MDI) of the shoulder is exercise. Despite this recommendation, there is limited evidence to support the effectiveness of exercise. The aim of this paper is to describe a pilot randomised controlled trial comparing the effectiveness of 2 exercise programmes on outcomes of participants with MDI. Read More

Am J Sports Med 2016 Dec 19;44(12):3188-3197. Epub 2016 Aug 19.

Steadman Philippon Research Institute, Vail, Colorado, USA

Background: Outcomes after arthroscopic pancapsular capsulorrhaphy (APC) with suture anchors for multidirectional instability (MDI) of the shoulder are not widely reported.

Purpose: To compare intraoperative findings and midterm outcomes of APC with suture anchors for MDI between female and male athletes and between a classic, atraumatic onset versus clinical onset of MDI after a traumatic event.

Study Design: Cohort study; Level of evidence, 3. Read More

Open Access Maced J Med Sci 2015 Jun 9;3(2):310-4. Epub 2015 Jun 9.

Orthopaedics, Trauma Hospital Centre, Tirana, Albania.

Aim: To evaluate the functional outcomes of the Bristow-Latarjet procedure in patients with recurrent anterior glenohumeral instability.

Patients And Methods: Personal clinical records of 42 patients with 45 operated shoulders were reviewed retrospectively. Patient age at time of first dislocation, injury mechanism, and number of recurring dislocations before surgery were recorded. Read More

Br J Sports Med 2016 Sep 20;50(18):1105-6. Epub 2016 May 20.

Instr Course Lect 2016 ;65:411-35

Physician, Department of Orthopaedics, Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi.

Arthroscopic shoulder stabilization offers several potential advantages compared with open surgery, including the opportunity to more accurately evaluate the glenohumeral joint at the time of diagnostic assessment; comprehensively address multiple pathologic lesions that may be identified; and avoid potential complications unique to open stabilization, such as postoperative subscapularis failure. A thorough understanding of normal shoulder anatomy and biomechanics, along with the pathoanatomy responsible for anterior, posterior, and multidirectional shoulder instability patterns, is very important in the management of patients who have shoulder instability. The treating physician also must be familiar with diagnostic imaging and physical examination maneuvers that are required to accurately diagnose shoulder instability. Read More

Br J Sports Med 2016 Sep 23;50(18):1115-23. Epub 2015 Dec 23.

Department of Rehabilitation, Nutrition and Sport, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia.

Background: The most commonly recommended treatment for multidirectional instability (MDI) is exercise-based management, followed by surgery if exercise management fails. We aimed to evaluate the effectiveness of exercise-based management compared with surgery in patients with MDI. Secondary aims were to identify effective protocols and any adverse effects associated with exercise or surgery. Read More

Orthop J Sports Med 2015 May 11;3(5):2325967115584318. Epub 2015 May 11.

New England Baptist Hospital, Boston, Massachusetts, USA.

Background: Shoulder instability in the older patient traditionally has received less attention in the literature than in the younger patient population. However, when traumatic dislocation does occur, these patients often still have frequent pain, disability, and even continued instability.

Purpose: To characterize the pathoanatomy of traumatic anterior shoulder instability in the older patient population and to discuss the correlating symptoms that ultimately led to operative treatment. Read More

Orthop J Sports Med 2015 Jan 23;3(1):2325967115571084. Epub 2015 Jan 23.

John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, US Military Academy, West Point, New York, USA.

Background: Most of the literature on shoulder instability focuses on patients experiencing anterior glenohumeral dislocation, with little known about the treatment of anterior subluxation events.

Purpose: To determine the outcomes of surgical stabilization of patients with anterior glenohumeral subluxations and to compare open and arthroscopic approaches.

Study Design: Randomized controlled trial; Level of evidence, 2. Read More

Int J Shoulder Surg 2015 Jul-Sep;9(3):81-9

Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA.

Purpose: The 2-year outcomes of patients undergoing repair of triple labrum tears using an all-suture anchor device were assessed.

Materials And Methods: Eighteen patients (17 male, one female; mean age 36.4 years, range: 14. Read More

Knee Surg Sports Traumatol Arthrosc 2016 Feb 1;24(2):390-7. Epub 2015 Aug 1.

Shoulder Center of Kentucky, 1221 South Broadway, Lexington, KY, 40504, USA.

The shoulder is a closed-chain mechanism that balances the mobility required by the ranges of motion in normal activities with the stability required to act as a stable ball and socket base for those activities. The scapula plays key roles in the closed-chain mechanism by being mobile enough to place the glenoid in optimal relation to the humerus to facilitate concavity/compression and by being a stable base for coordinated muscle activation to compress the humerus into the glenoid. Scapular dyskinesis alters these roles and is frequently present in many types of glenohumeral instability. Read More

Arthroscopy 2015 Dec 21;31(12):2431-43. Epub 2015 Jul 21.

Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy.

Purpose: To analyze outcomes of surgical and conservative treatment options for multidirectional instability (MDI).

Methods: A systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. A comprehensive search of the PubMed, MEDLINE, CINAHL, Cochrane, EMBASE, and Google Scholar databases using various combinations of the keywords "shoulder," "multidirectional instability," "dislocation," "inferior instability," "capsulorrhaphy," "capsular plication," "capsular shift," "glenoid," "humeral head," "surgery," and "glenohumeral," over the years 1966 to 2014 was performed. Read More

J Shoulder Elbow Surg 2015 Nov 25;24(11):1723-7. Epub 2015 Jun 25.

The Shoulder and Elbow Service, The Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK.

Background: The purpose of this study was to review our experience with recurrent shoulder instability in epileptic patients and to discuss factors influencing its management.

Methods: A retrospective review was conducted at a single facility. All patients with epilepsy and recurrent shoulder instability were included for study. Read More

Semin Musculoskelet Radiol 2015 Jul 28;19(3):254-68. Epub 2015 May 28.

Department Radiology and Orthopedic Surgery, University of California, San Francisco, San Francisco, California.

The glenohumeral joint is an inherently unstable articulation and consequently the most frequently subluxed and frankly dislocated joint in the body. Shoulder instability can be uni- or multidirectional related to acute or repetitive stress and is occasionally secondary to congenital or developmental abnormalities such as a lax joint capsule or glenoid dysplasia. The clinical diagnosis of instability can be difficult, and knowledge of the imaging findings of anterior, posterior, multidirectional, and microinstability is essential to guide the correct treatment of these patients. Read More

Radiologe 2015 Mar;55(3):195-202

Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Johannes-Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland,

Shoulder instability is defined as a symptomatic abnormal motion of the humeral head relative to the glenoid during active shoulder motion. Glenohumeral instabilities are classified according to the causative factors as the pathogenesis of instability plays an important role with respect to treatment options. Instabilities are classified into traumatic and atraumatic instabilities as part of a multidirectional instability syndrome and into microtraumatic instabilities. Read More

Eur J Orthop Surg Traumatol 2015 Aug 1;25(6):975-85. Epub 2015 Feb 1.

Unit of Shoulder and Elbow Surgery, "D. Cervesi" Hospital, Cattolica, AUSL della Romagna Ambito Territoriale di Rimini, Cattolica, Italy,

Multidirectional instability (MDI) of the shoulder is a condition where the dislocation occurs in more than one direction with minimal or no causative trauma. Its pathoanatomy is complex and characterized by a redundant capsule, resulting in increased glenohumeral joint volume. The fact that several further factors may contribute to symptom onset complicates the diagnosis and hampers the identification of a therapeutic approach suitable for all cases. Read More

Eur Radiol 2014 Jun 13;24(6):1376-85. Epub 2014 Mar 13.

Department of Radiology, Technische Universität München, Ismaninger Str.22, 81675, Munich, Germany,

Objective: To evaluate diagnostic signs and measurements in the assessment of capsular redundancy in atraumatic multidirectional instability (MDI) of the shoulder on MR arthrography (MR-A) including abduction/external rotation (ABER) images.

Methods: Twenty-one MR-A including ABER position of 20 patients with clinically diagnosed MDI and 17 patients without instability were assessed by three radiologists. On ABER images, presence of a layer of contrast between the humeral head (HH) and the anteroinferior glenohumeral ligament (AIGHL) (crescent sign) and a triangular-shaped space between the HH, AIGHL and glenoid (triangle sign) were evaluated; centring of the HH was measured. Read More

J Shoulder Elbow Surg 2014 Jan;23(1):128-42

Musculoskeletal Research Centre, Department of Physiotherapy, Faculty of Health Sciences, La Trobe University, Bundoora, VIC, Australia; LifeCare Prahran Sports Medicine Centre, Prahran, VIC, Australia.

Background: The most commonly recommended treatment for multidirectional instability (MDI) of the glenohumeral joint is exercise-based management. The primary objective of this review was to evaluate the effectiveness of exercise-based management in patients with MDI. The secondary aim was to observe the types of exercise protocols and outcomes used, as well as any adverse results associated with exercise. Read More

Clin Sports Med 2013 Oct;32(4):607-24

Department of Trauma and Orthopaedic Surgery, The University of Edinburgh, EH16 4SA, UK. Electronic address:

Glenohumeral joint motion results from a complex interplay between static and dynamic stabilizers that require intricate balance and synchronicity. Instability of the shoulder is a commonly encountered problem in active populations, especially young athletes. The underlying pathoanatomy predisposing to further episodes and the needs of individual athletes must be considered in determining the most appropriate treatment. Read More

J Shoulder Elbow Surg 2013 Sep 15;22(9):1209-20. Epub 2013 Feb 15.

Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison, Chicago, IL 60612, USA.

Background: Revision arthroscopic posterior glenohumeral stabilization requires a thorough understanding of the static and dynamic stabilizers of the glenohumeral joint. The evaluation of these patients is complex but critical given the variety of possible underlying lesions.

Method: We reviewed the literature surrounding recurrent and revision posterior instability biomechanics, etiology, evaluation, treatment, and outcomes. Read More

Instr Course Lect 2013 ;62:95-103

University of Texas Health Sciences Center, University of Texas, San Antonio, TX, USA.

Shoulder stability is critical for proper functioning of the upper extremity and is dependent on the interplay between static and dynamic stabilizers of the glenohumeral joint. Surgical management of patients with atraumatic and multidirectional instability is effective if the capsular redundancy is properly reconstructed to restore glenohumeral joint biomechanics. Residual capsular laxity is a common cause of recurrent glenohumeral joint dislocation in patients who had previous stabilization procedures; surgical results become less predictable in patients who had multiple revision procedures. Read More

Rehabil Res Pract 2012 7;2012:783824. Epub 2012 Aug 7.

The Shoulder Center of Kentucky, Lexington Clinic, Lexington, KY 40504, USA.

This study examines if electromyographic (EMG) amplitude differences exist between patients with shoulder instability and healthy controls performing scaption, prone horizontal abduction, prone external rotation, and push-up plus shoulder rehabilitation exercises. Thirty nine subjects were categorized by a single orthopedic surgeon as having multidirectional instability (n = 10), anterior instability (n = 9), generalized laxity (n = 10), or a healthy shoulder (n = 10). Indwelling and surface electrodes were utilized to measure EMG activity (reported as a % of maximum voluntary isometric contraction (MVIC)) in various shoulder muscles during 4 common shoulder exercises. Read More

Eur J Orthop Surg Traumatol 2012 Aug 21;22(6):437-441. Epub 2011 Sep 21.

Department of Orthopaedics, Traumatology and Hand Surgery, University of Medical Sciences in Poznan, Ul. 28 Czerwca 1956r 135/147, 62-545 Poznan, Poland.

Multidirectional instability is very complex pathology. Excessively redundant capsule is one of the important reasons causing symptomatic laxity in multiple planes. Arthroscopic techniques are not able to reproduce the potential of open methods to reduce the joint volume. Read More

Magn Reson Imaging Clin N Am 2012 May 16;20(2):295-312, xi. Epub 2012 Feb 16.

Department of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, YAW 6030, Boston, MA 02114, USA.

The glenohumeral joint enables tremendous range of motion at the expense of stability. Functional stability is maintained by the synchronous coordination of complex static and dynamic structures. Symptomatic glenohumeral instability most often results from injury to the inferior labral-ligamentous complex, the primary passive stabilizer of the shoulder. Read More

J Am Acad Orthop Surg 2011 Dec;19(12):758-67

The Steadman Clinic, Vail, CO, USA.

Multidirectional shoulder instability is defined as symptomatic instability in two or more directions. Instability occurs when static and dynamic shoulder stabilizers become incompetent due to congenital or acquired means. Nonspecific activity-related pain and decreased athletic performance are common presenting complaints. Read More

World J Radiol 2011 Sep;3(9):224-32

Manisha Jana, Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, 110029 New Delhi, India.

The glenohumeral joint is the most commonly dislocated joint of the body and anterior instability is the most common type of shoulder instability. Magnetic resonance (MR) imaging, and more recently, MR arthrography, have become the essential investigation modalities of glenohumeral instability, especially for pre-procedure evaluation before arthroscopic surgery. Injuries associated with glenohumeral instability are variable, and can involve the bones, the labor-ligamentous components, or the rotator cuff. Read More

Indian J Radiol Imaging 2011 Apr;21(2):98-106

Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.

The glenohumeral joint is the most commonly dislocated joint in the body, and anterior instability is the most common type of shoulder instability. Depending on the etiology and the age of the patient, there may be associated injuries, for example, to the anterior-inferior labro-ligamentous structures (in young individuals with traumatic instability) or to the bony components (commoner in the elderly), which are best visualized using MRI and MR arthrography. Anterior instability is associated with a Bankart lesion and its variants and abnormalities of the anterior band of the inferior glenohumeral ligament (IGHL), whereas posterior instability is associated with reverse Bankart and reverse Hill-Sachs lesions. Read More

Orthopedics 2011 Apr 11;34(4). Epub 2011 Apr 11.

Department of Orthopedics, Chosun University Hospital, Gwangju, South Korea.

Multidirectional instability of the shoulder is a complex condition that can be difficult to diagnose and treat. Clinically, it is characterized by symptomatic global laxity of the glenohumeral joint and may present either traumatically or atraumatically, unilaterally or bilaterally, and with or without generalized joint laxity. Capsular plication is a primary treatment option in these patients and is used to tension the redundant or lax capsule. Read More

Am J Sports Med 2011 Mar 2;39(3):526-31. Epub 2011 Feb 2.

Division of Orthopaedics, The University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL 35205, USA.

Purpose: To quantify the relationship between the amount of shoulder capsule imbricated with a simple stitch and the degree of glenohumeral volume reduction in a multidirectional instability model. Secondary purposes were to identify the number of arthroscopic plication stitches required to reduce the shoulder volume equal to that of an open lateral-based inferior capsular shift and to compare volume reductions between suture anchor and suture-only capsular plication stitches.

Study Design: Controlled laboratory study. Read More

J Shoulder Elbow Surg 2010 Sep;19(6):802-13

Department of Orthopedics and Traumatology, Saint John's Hospital, Budapest, Hungary.

Hypothesis: This study compared the kinematic parameters and activity pattern of muscles around the glenohumeral joint in multidirectional instability (MDI) treated by only physiotherapy and by capsular shift and physiotherapy, before and after treatment, to test the hypothesis that the surgery group would demonstrate better kinematic and muscle activity than the physiotherapy group.

Materials And Methods: The study comprised 32 patients with MDI treated with only physiotherapy, 19 patients with MDI treated by capsular shift and physiotherapy, and 50 healthy shoulders as the control group. The investigated kinematic parameters were the range of humeral elevation in the scapular plane, the scapulothoracic and glenohumeral angle, the scapulothoracic and glenohumeral rhythms, and relative displacement between the rotational centers of the humerus and the scapula. Read More

Am J Sports Med 2010 Jul 3;38(7):1413-9. Epub 2010 Jun 3.

Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois 60612, USA.

Background: The use of posterior capsular plication to decrease capsular volume and address capsular laxity for treatment of posterior instability, multidirectional instability, or as an additional technique in the treatment of anterior instability is common. Multiple different suturing techniques have been described.

Hypothesis: The simple stitch will have inferior biomechanical properties compared with either the horizontal mattress or figure-of-8 stitches for suture plication of the posteroinferior quadrant of the glenoid. Read More

Open Orthop J 2009 Dec 24;3:107-14. Epub 2009 Dec 24.

Department of Trauma and Reconstructive Surgery, Friederikenstift Hospital Hannover, Humboldtstrasse 5, D-30169 Hannover, Germany.

Purpose: This prospective case series evaluates the outcome, and the return to sports of young overhead athletes with a persistent, symptomatic multidirectional instability (MDI) with hyperlaxity type Gerber B5 treated with an arthroscopic anteroposteroinferior capsular plication and rotator interval closure.

Methods: 9 young overhead athletes (10 shoulders) with the rare diagnosis of MDI (Gerber B5) and an indication for operative treatment, after a failed physiotherapy program were physically examined 3, 6 and 12 months postoperatively by a physical examination, and got a final phone interview after median 39 months.

Results: At the final follow-up all patients were satisfied; Rowe Score showed 7 "excellent" and "good" results; Constant Score was "excellent" and "good" in 6, and "fair" in 1 patient. Read More

Radiol Med 2010 Feb 28;115(1):133-40. Epub 2009 Dec 28.

Department of Radiology, Ziekenhuizen Oost-Limburg, Genk, Belgium.

Purpose: Unrestricted physiologic joint motion results in multidirectional displacement of the anatomic structures. When performing real-time magnetic resonance (MR) imaging of such a joint motion, continuous adjustment of the scan plane position may be required. The purpose of this study was to evaluate the clinical feasibility of a method to guide the scan plane position during dynamic-motion MR imaging of freely moving joints. Read More

Am J Sports Med 2010 Feb 25;38(2):375-82. Epub 2009 Nov 25.

Clinic of Orthopaedics and Traumatology, Klinikum Rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675 Munich, Germany.

Background: Success rates in the treatment of atraumatic shoulder instability differ, and in vivo identification of the individual insufficient stabilizers is difficult.

Hypothesis: Atraumatic shoulder instability is an inhomogeneous entity with varying alterations of the active and passive stabilizers. This might be a reason for inferior treatment results. Read More

J Electromyogr Kinesiol 2010 Jun 14;20(3):489-501. Epub 2009 Oct 14.

Budapest University of Technology and Economics, Department of Structures, 1111 Budapest Bertalan Lajos u. 2, Hungary.

Purpose: The aim of the study was to compare the kinematic parameters and the on-off pattern of the muscles of patients with multidirectional instability (MDI) treated by physiotherapy or by capsular shift and postoperative physiotherapy before and after treatment during elevation in the scapular plane.

Scope: The study was carried out on 32 patients with MDI of the shoulder treated with physiotherapy, 19 patients with MDI of the shoulder treated by capsular shift and postoperative physiotherapy, and 25 healthy subjects. The motion of skeletal elements was modeled by the range of humeral elevation, scapulothoracic angle and glenohumeral angle, scapulothoracic (ST) and glenohumeral (GH) rhythms, and relative displacement between the rotation centers of the humerus and scapula. Read More

Am J Sports Med 2009 Jun 12;37(6):1178-85. Epub 2009 Mar 12.

Orthopaedic Biomechanics Laboratory, VA Healthcare System, Long Beach, CA 90822, USA.

Background: Commonly performed arthroscopic rotator interval closure techniques that imbricate the rotator interval in a superior-inferior direction have been unable to reproduce the stabilizing effects of an open medial-lateral rotator interval imbrication.

Hypothesis: The medial-lateral rotator interval closure will allow less inferior and posterior glenohumeral translation than the superior-inferior rotator interval closure, and the medial-lateral rotator interval closure will result in less loss of external rotation than the superior-inferior closure.

Study Design: Controlled laboratory study. Read More