Skip to main content

Hyperlaxity and Multidirectional Shoulder Instability

  • Chapter
  • First Online:
360° Around Shoulder Instability

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kirk JA, Ansell BM, Bywaters EL. The hypermobility syndrome. Ann Rheum Dis. 1967;26:419.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Perry J. Anatomy and biomechanics of the shoulder in throwing, swimming, gymnastics, and tennis. Clin Sports Med. 1983;2:247–70.

    CAS  PubMed  Google Scholar 

  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.

    PubMed  PubMed Central  Google Scholar 

  4. Everman DB, Robin NH. Hypermobility syndrome. Pediatr Rev. 1998;19:111–7.

    Article  CAS  PubMed  Google Scholar 

  5. Hakim AJ, Grahame R. Joint hypermobility. Best Pract Res Clin Rheumatol. 2003;17:989–1004.

    Article  PubMed  Google Scholar 

  6. Larsson LG, Baum J, Mudholkar GS, Srivastava DK. Hypermobility: PREVALENCE and features in a Swedish population. Br J Rheumatol. 1993;32:116–9.

    Article  CAS  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  8. Beighton P, Solomon L, Soskolne CL. Articular mobility in an African population. Ann Rheum Dis. 1973;32:413–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Bulbena A, Duró JC, Porta M, et al. Clinical assessment of hypermobility of joints: assembling criteria. J Rheumatol. 1992;19(1):115–22.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  16. Gerber C, Nyffeler RW. Classification of glenohumeral joint instability. Clin Orthop Relat Res. 2002;400:65–76.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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. 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.

    Article  PubMed  Google Scholar 

  20. Beasley L, Faryniarz DA, Hannafin JA. Multidirectional instability of the shoulder in the female athlete. Clin Sports Med. 2000;19:331–49.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  22. Morris AD, Kemp GJ, Frostick SP. Shoulder electromyography in multidirectional instability. J Shoulder Elbow Surg. 2004;13:24–9.

    Article  PubMed  Google Scholar 

  23. Moroder P, Danzinger V, Maziak N, et al. Characteristics of functional shoulder instability. J Shoulder Elbow Surg. 2020;29(1):68–78, ISSN 1058-2746

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  28. Longo UG, Rizzello G, Loppini M, et al. Multidirectional instability of the shoulder: a systematic review. Arthroscopy. 2015;31(12):2431–43.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  30. Toth AP, Warren RF, Petrigliano FA, Doward DA, et al. Thermal shrinkage for shoulder instability. HSS J. 2011;7(2):108–14.

    Article  PubMed  Google Scholar 

  31. Cicak N, Klobucar H, Bicanic G, Trsek D. Arthroscopic extracapsular plication to treat multidirectional instability of the shoulder. Arthroscopy. 2005;21:1278.

    Article  PubMed  Google Scholar 

  32. Snyder SJ. Shoulder arthroscopy. New York: Lippincott Williams and Wilkins; 2003. p. 22–8.

    Google Scholar 

  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.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Wojciech Solecki .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 ESSKA

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Solecki, W., Błasiak, A., Laprus, H., Brzóska, R. (2020). Hyperlaxity and Multidirectional Shoulder Instability. In: Brzóska, R., Milano, G., Randelli, P., Kovačič, L. (eds) 360° Around Shoulder Instability. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-61074-9_39

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-61074-9_39

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-61073-2

  • Online ISBN: 978-3-662-61074-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics