Advertisement

Hyperlaxity and Multidirectional Shoulder Instability

  • Wojciech SoleckiEmail author
  • Adrian Błasiak
  • Hubert Laprus
  • Roman Brzóska
Chapter
  • 36 Downloads

Abstract

Hyperlaxity is a condition that often coexists with multidirectional shoulder instability (MDI). Special care must be taken to recognize symptoms of joint hypermobility as it may affect the treatment protocol and results. MDI is usually a combination of altered shoulder girdle muscles activation patterns and failure of static joint restraints. The first line of treatment consists of intensive kinesiotherapy, provided no structural lesions are present. The results of open and arthroscopic surgical treatment and potential risks are discussed in this chapter.

Keywords

Hyperlaxity Multidirectional shoulder instability Generalized joint laxity 

References

  1. 1.
    Kirk JA, Ansell BM, Bywaters EL. The hypermobility syndrome. Ann Rheum Dis. 1967;26:419.CrossRefGoogle Scholar
  2. 2.
    Perry J. Anatomy and biomechanics of the shoulder in throwing, swimming, gymnastics, and tennis. Clin Sports Med. 1983;2:247–70.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Saccomanno MF, Fodale M, Capasso L, Cazzato G, Milano G. Generalized joint laxity and multidirectional instability of the shoulder. Joints. 2014;1(4):171–9.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Everman DB, Robin NH. Hypermobility syndrome. Pediatr Rev. 1998;19:111–7.CrossRefGoogle Scholar
  5. 5.
    Hakim AJ, Grahame R. Joint hypermobility. Best Pract Res Clin Rheumatol. 2003;17:989–1004.CrossRefGoogle Scholar
  6. 6.
    Larsson LG, Baum J, Mudholkar GS, Srivastava DK. Hypermobility: PREVALENCE and features in a Swedish population. Br J Rheumatol. 1993;32:116–9.CrossRefGoogle Scholar
  7. 7.
    Remvig L, Jensen DV, Ward RC. Epidemiology of general joint hypermobility and basis for the proposed criteria for benign joint hypermobility syndrome: review of the literature. J Rheumatol. 2007;34:804–9.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Beighton P, Solomon L, Soskolne CL. Articular mobility in an African population. Ann Rheum Dis. 1973;32:413–8.CrossRefGoogle Scholar
  9. 9.
    Junge T, Jespersen E, Wedderkopp N, Juul-Kristensen B. Inter-tester reproducibility and inter-method agreement of two variations of the Beighton test for determining generalized joint hypermobility in primary school children. BMC Pediatr. 2013;13:214.CrossRefGoogle Scholar
  10. 10.
    Bulbena A, Duró JC, Porta M, et al. Clinical assessment of hypermobility of joints: assembling criteria. J Rheumatol. 1992;19(1):115–22.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Grahame R, Bird HA, Child A, et al. The revised (Brighton 1998) criteria for the diagnosis of benign joint hypermobility syndrome (BJHS). J Rheumatol. 2000;27:1777–9.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Cameron KL, Duffey ML, DeBerardino TM, et al. Association of generalized joint hypermobility with a history of glenohumeral joint instability. J Athl Train. 2010;45:253–8.CrossRefGoogle Scholar
  13. 13.
    Chahal J, Leiter J, McKee MD, Whelan DB. Generalized ligamentous laxity as a predisposing factor for primary traumatic anterior shoulder dislocation. J Shoulder Elbow Surg. 2010;19(8):1238–42.CrossRefGoogle Scholar
  14. 14.
    Meehan RE, Petersen SA. Results and factors affecting outcome of revision surgery for shoulder instability. J Shoulder Elbow Surg. 2005;14(1):31–7.CrossRefGoogle Scholar
  15. 15.
    Zabinski SJ, Callaway GH, Cohen S, et al. Revision shoulder stabilization: 2- to 10-year results. J Shoulder Elbow Surg. 1999;8:58–65.CrossRefGoogle Scholar
  16. 16.
    Gerber C, Nyffeler RW. Classification of glenohumeral joint instability. Clin Orthop Relat Res. 2002;400:65–76.CrossRefGoogle Scholar
  17. 17.
    Merolla G, Cerciello S, Chillemi C, Paolo P, De Santis E, Porcelli G. Multidirectional instability of the shoulder: biomechanics, clinical presentation, and treatment strategies. Eur J Orhop Surg Traumatol. 2015;25(6):975–85.CrossRefGoogle Scholar
  18. 18.
    Castagna A, Cesari E, Gigante A, Di Matteo B, Garofalo R, Porcellini G. Age-related changes of elastic fibers in shoulder capsule of patients with glenohumeral instability: a pilot study. BioMed Res Int. 2018;2018:8961805, 7 pages.Google Scholar
  19. 19.
    Lee HJ, Kim NR, Moon SG, Ko SM, Park JY. Multidirectional instability of the shoulder: rotator interval dimension and capsular laxity evaluation using MR arthrography. Skeletal Radiol. 2013;42(2):231–8.CrossRefGoogle Scholar
  20. 20.
    Beasley L, Faryniarz DA, Hannafin JA. Multidirectional instability of the shoulder in the female athlete. Clin Sports Med. 2000;19:331–49.CrossRefGoogle Scholar
  21. 21.
    Guerrero P, Busconi B, Deangelis N, Powers G. Congenital instability of the shoulder joint: assessment and treatment options. J Orthop Sports Phys Ther. 2009;39:124–34.CrossRefGoogle Scholar
  22. 22.
    Morris AD, Kemp GJ, Frostick SP. Shoulder electromyography in multidirectional instability. J Shoulder Elbow Surg. 2004;13:24–9.CrossRefGoogle Scholar
  23. 23.
    Moroder P, Danzinger V, Maziak N, et al. Characteristics of functional shoulder instability. J Shoulder Elbow Surg. 2020;29(1):68–78, ISSN 1058-2746CrossRefGoogle Scholar
  24. 24.
    Chen D, Goldberg J, Herald J, Critchley I, Barmare A. Effects of surgical management on multidirectional instability of the shoulder: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2016;24(2):630–9.CrossRefGoogle Scholar
  25. 25.
    Illyes A, Kiss J, Kiss RM. Electromyographic analysis during pull, forward punch, elevation and overhead throw after conservative treatment or capsular shift at patient with multidirectional shoulder joint instability. J Electromyogr Kinesiol. 2009;19:e438–47.CrossRefGoogle Scholar
  26. 26.
    Levine WN, Arroyo JS, Pollock RG, et al. Open revision stabilization surgery for recurrent anterior glenohumeral instability. Am J Sports Med. 2000;28:156–60.CrossRefGoogle Scholar
  27. 27.
    Neer CS II, Foster CR. Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder. A preliminary report. J Bone Joint Surg Am. 1980;62(6):897–908.CrossRefGoogle Scholar
  28. 28.
    Longo UG, Rizzello G, Loppini M, et al. Multidirectional instability of the shoulder: a systematic review. Arthroscopy. 2015;31(12):2431–43.CrossRefGoogle Scholar
  29. 29.
    Hawkins RJ, Krishnan SG, Karas SG, Noonan TJ, Horan MP. Electrothermal arthroscopic shoulder capsulorrhaphy: a minimum 2-year follow-up. Am J Sports Med. 2007;35(9):1484–8.CrossRefGoogle Scholar
  30. 30.
    Toth AP, Warren RF, Petrigliano FA, Doward DA, et al. Thermal shrinkage for shoulder instability. HSS J. 2011;7(2):108–14.CrossRefGoogle Scholar
  31. 31.
    Cicak N, Klobucar H, Bicanic G, Trsek D. Arthroscopic extracapsular plication to treat multidirectional instability of the shoulder. Arthroscopy. 2005;21:1278.CrossRefGoogle Scholar
  32. 32.
    Snyder SJ. Shoulder arthroscopy. New York: Lippincott Williams and Wilkins; 2003. p. 22–8.Google Scholar
  33. 33.
    Ponce BA, Rosenzweig SD, Thompson KJ, et al. Sequential volume reduction with capsular plications: relationship between cumulative size of plications and volumetric reduction for multidirectional instability of the shoulder. Am J Sports Med. 2011;39:526–31.CrossRefGoogle Scholar

Copyright information

© ESSKA 2020

Authors and Affiliations

  • Wojciech Solecki
    • 1
    Email author
  • Adrian Błasiak
    • 1
  • Hubert Laprus
    • 1
  • Roman Brzóska
    • 1
  1. 1.Shoulder and Upper Limb DepartmentSt. Luke’s HospitalBielsko-BialaPoland

Personalised recommendations