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Đa chiều bất ổn của vai là một thực thể phức tạp. Tương đối FEW loạt các bệnh nhân có tình trạng này đã được báo cáo. Có bệnh nhân bị ảnh hưởng tổng thể (phía trước, thấp kém, và sau) quá lỏng lẻo của các viên nang doanh glenohumeral và khoảng thời gian xoay vòng luân viên khuyết tật. | Multidirectional Instability of the Shoulder Pathophysiology Diagnosis and Management Thomas J. Schenk MD and John J. Brems MD Abstract Multidirectional instability of the shoulder is a complex entity. Relatively few series of patients with this condition have been reported. Affected patients have global anterior inferior and posterior excessive laxity of the glenohumeral joint capsule and a rotator interval capsule defect. The onset of symptoms is frequently related to atraumatic events. The chief complaint is more often related to pain than to instability per se. Symptoms are mostly experienced within the midrange of glenohumeral motion. Because the contralateral shoulder is often equally lax and asymptomatic it appears that factors in addition to excessive capsular laxity play a pathophysiologic role. These factors may include subtle losses of strength and or neuromotor coordination of the rotator cuff and scapular stabilizing muscles defective proprioceptive responses and the absence of a limited joint volume. Most patients can be successfully treated nonopera-tively with a specific exercise program. If a 6-month trial of nonoperative management fails the patient is a candidate for surgical reconstruction. The most time-honored procedure is an open inferior capsular shift which corrects excessive global laxity of the capsule and the rotator interval defect. J Am Acad Orthop Surg 1998 6 65-72 The first series of patients with multidirectional instability MDI of the shoulder was reported by Neer and Foster in 1980.1 Patients suffered recurrent instability and pain. On clinical examination the shoulder could be dislocated inferiorly and subluxated or dislocated anteriorly and posteriorly. They reported specifically on patients with MDI who did not respond to a program of strengthening exercises and then were treated surgically with an inferior capsular shift. A large redundant inferior capsule was identified intraoperatively in all cases. The surgical procedure .
